sedation options in UK

[KTP]

I'm from the US and don't understand my options for sedation in the UK. I think I may need a filling or root canal. So many questions: is it possible to private pay for sedation but get the treatment covered under NHS? Can my NHS dentist prescribe me an oral sedative? How long is the wait likely to be if I am referred to the NHS sedation clinic? Is there a big difference in the quality of care between NHS and private dental care? Also, is inhalation sedation available in the UK? I've always had that in the US and I prefer it so that I can drive myself home.

 

[Gordon]

1) Yes I think so in England, no in Scotland
2) Yes
3) How long is a piece of string? Massive differences across different areas as far as I know.
4) Depends on who's doing it, good NHS is better than poor private of course.
5) Yes

 

[KTP]

To follow up, I saw my NHS dentist yesterday and he says I need a filling. I asked him whether he could prescribe an oral seditive. He said no, that he has worked for the NHS for 10 years and never done this. Waiting for the NHS sedation clinic would be 4-6 months, so I'd rather not go down that road, and I really can't afford to go private at this clinic as it would be £600 vs. £60 for NHS. How could I find an NHS dentist who is willing to prescribe an oral seditive?

 

[drhirst]

Hi KTP,
It might be worth spending some time on the phone ringing NHS practices to see if they will give you an oral sedative. Inhalation sedation is only available to NHS practices with a sedation contract, so has virtually died out in NHS practices that are not designated sedation clinics. It's all to do with the farcically low fees the NHS pays. Apprehensive patients take more time to treat and the NHS will not pay for it so many busy NHS dentists are not interested in encouraging apprehensive patients by offering oral sedation. How much dentistry will £60 buy you in the US?
If the tooth that needs filling is not causing you any pain, the chances are it could wait 4 months or so without it being a problem, so you could go down the NHS sedation clinic route, but I would just check this with your dentist first!

Hope this helps

Lincoln

 

[brit]

To follow up, I saw my NHS dentist yesterday and he says I need a filling. I asked him whether he could prescribe an oral seditive. He said no, that he has worked for the NHS for 10 years and never done this. Waiting for the NHS sedation clinic would be 4-6 months, so I'd rather not go down that road, and I really can't afford to go private at this clinic as it would be £600 vs. £60 for NHS. How could I find an NHS dentist who is willing to prescribe an oral seditive?

A quick google threw Summertown Dental. Looks like they have inhalation sedation and i/v sedation. Also do some NHS.

 

[letsconnect]

Waiting for the NHS sedation clinic would be 4-6 months, so I'd rather not go down that road, and I really can't afford to go private at this clinic as it would be £600 vs. £60 for NHS.

£600 sounds extremely steep for a filling and an oral sedative... is the quote for IV sedation?

 

[KTP]

The quote is for iv sedation and filling. The practice linked above is actually the one I've been going to--I was lured in by the website. It turns out that they don't offer inhalation sedation, only iv sedation for private patients.

 

[KTP]

To answer the question about us costs, I had good dental insurance in the US that fully covered my dental most years (it had an annual cap but was enough for a few root canals and crowns in one year). The only thing I paid for was a $40 fee for inhalation sedation /nitrous oxide. I was fortunate to have good dental insurance, of course. Many in the US do not...

 

[KTP]

I have now made an appointment with my GP hoping that they will prescribe a sedative. Otherwise I might wait for the sedation clinic but the tooth does hurt, though not excruciating. The NHS dentist I saw was very patient and willing to take his time, BTW. Just not willing to prescribe a sedative. I guess that's a credit to him under the pressures Lincoln describes!

 

[drhirst]

Sounds like you've really tried everything to get it done KTP, but been thwarted at every turn!
I charge much less for oral sedation than iv or even inhalation sedation, but now we are expected to consent, monitor and provide paperwork in exactly the same way as if it were IV, so I can understand why charges are rising or it is not being offered. Also, if you wish to give more than a minimal dose you have to be fully iv trained which caused hundreds of dentists to give it up. Having said that the say rules do not appear to apply to GPs so many sympathetic doctors will be happy to write you a prescription for a mild dose.

 

[Gordon]

Didn't realise what a mess NHS dentistry has become in England, thank goodness for Devolution

 

[brit]

To follow up, I saw my NHS dentist yesterday and he says I need a filling. I asked him whether he could prescribe an oral seditive. He said no, that he has worked for the NHS for 10 years and never done this. Waiting for the NHS sedation clinic would be 4-6 months, so I'd rather not go down that road, and I really can't afford to go private at this clinic as it would be £600 vs. £60 for NHS. How could I find an NHS dentist who is willing to prescribe an oral seditive?

If you liked the dentist, you said he was patient, for just a filling why don't you try without? Or without, but with a valium from your Medical GP. It solves your problem long-term then, if you have a good experience.

 

[KTP]

I'm willing to try with a valium from my GP, but I don't think I'm up for trying without any sedation. I have a diagnosed anxiety disorder that I don't think I can just shrug off. I left the dentists office in tears/panic attack last week after hearing that he couldn't offer any relief. I have only been to the dentist once in the two years since I moved here because I knew that finding options for sedation was going to be a problem, which is a shame because I'd been taking very good care of my teeth in the US with the help of a sympathetic dentist and lots of nitrous oxide.

 

[Gordon]

NOT Valium (Diazepam) it's a pretty useless drug as an oral premed. It also has a long clinical action which isn't required.

Now, I've not examined you, this is not an absolute recommendation but more guidelines as to what, in general, would be the correct regime for a patient who needed a little bit of help getting through a dental appointment.

It's my experience that nervous dental patients do much better with Temazepam.
If your weight is more than 50kg, you'd need 30mg about 1hr before your dental appointment. Most people would benefit from a good night's sleep first too, so I would recommend that a patient takes 10mg before bed to help with that. If you're less than 50kg then 20mg is a more appropriate dose.

It's absolutely essential that you bring an escort to the appointment with you, they must do the driving and you must go straight home afterwards and have your escort keep an eye on you for at least the next 6 hrs. Do not go back to work, do not sign any important documents etc etc. You must not drink alcohol for the next 24 hrs.

This drug regimen is perfectly within the scope of a dentist to prescribe and deal with, however if your dentist refuses then your friendly local GP will probably help out.

 

[drhirst]

I agree with Gordan, this sort of dose of Temazepam is very effective. Unfortunately, in England this would be considered a sedation dose rather than premedication dose. The current guidelines state that unless your dentist is IV trained they could not prescribe this. If you manage to get your gp to prescribe it then follow Gordan's safety tips as you will need close supervision as you will be too relaxed to cross a road safety your own.