Preprocedural Assessment for Patients Anticipating Sedation

Estimating the Need for Sedation in Patients with Dental Anxiety and Medical Complexities Reporting to Tertiary Care Dental Hospital Using the IOSN Tool

Objectives

To provide consistent method for assessment of sedation need among patients undergoing dental treatment based on specific risk factors that is dental anxiety, medical status, and treatment complexity of needed dental treatment using IOSN (indication of sedation need) tool for assisting the clinician in decision making process.

Methods

A total of 237 patients aged ≥12, ASA I and II were enrolled in the study. A structured questionnaire comprising of three sections was distributed among the participants. Section 1 comprises details about age, gender, literacy level, occupation, monthly income, and previous dental treatment history. Section 2 is based on Modified Dental Anxiety Scale which is a questionnaire comprising of five questions ranging from “not anxious” to “extremely anxious.” The third section was based on using the IOSN tool comprising three components: MDAS (Modified Dental Anxiety Scale) rank score, Systemic Health (ASA status) rank score, and treatment complexity rank scores. The total of three scores was then computed to determine the total rank score which suggested the sedation need. History of past traumatic dental experiences was also inquired from each patient.

Results

A total of 237 patients aged ≥12, ASA I and II were enrolled in the study, out of which 56.1% were female. Statistical analysis was conducted by using the IBM SPSS Statistics 23 software. Based on the MDAS score, 47/237 (19.8%) participants were found to be highly anxious related to dental procedures. 34.6% of the participants showed to have a high sedation need while performing a dental procedure. The sedation need was found to be significantly associated with the female gender with a significant p value of (p=0.016), higher education status (p=0.016), and history of previous traumatic dental experience (p < 0.001).

Conclusion

A simple assessment tool can enable clinicians in their decision making to identify patients in need for dental treatment under sedation based on patient-specific risk factors such as past traumatic dental experiences. Need for sedation can be assessed by information on patient anxiety level towards dental treatment, medical history, and complexity of planned dental treatment. The IOSN tool is a simple and quick assessment tool that can be applied for preprocedural assessment of sedation need for dental treatment.

Development and validation of the nursing confidence in managing sedation complications scale

Aim

To develop the Nursing Confidence in Managing Sedation Complications Scale.

Design

A multi‐phased approach was used.

Methods

An initial bank of items was created based on the authors' experience and clinical practice guidelines. An expert panel assessed content validity. Exploratory factor analysis was used for item reduction and regression was used to explore construct validity. Responsiveness was evaluated using a pre‐test post‐test design.

Results

Criteria for content validity was met for 34 items. An 18‐item, three‐factor solution was identified from exploratory factor analysis performed using Nursing Confidence in Managing Sedation Complications Scale scores from 228 nurses. Subscales accounted for 66% of the variance. Cronbach's alpha for the scale (0.95) and subscales was high (>0.85). There were differences (p < .001) in Nursing Confidence in Managing Sedation Complications Scale scores relative to years of experience and work environment. NC‐MSCS scores increased significantly from before to after sedation training (mean difference = 31.8; 95% CI = 24.4–39; N = 31).