How dentists' experience affects pre-treatment reviews in special needs dentistry

Increasingly over the last three years, junior staff from other departments have rotated through the Special Care Unit of the Westmead Centre for Oral Health for periods of between one and three months. As a result there were concerns about the appropriateness of dental care plans for patients referred for a dental procedure under general anaesthesia(GA) or intravenous sedation(IVS). Objective: The aim of this prospective study was to compare changes at the pre-treatment review meetings (PRM) to the treatment plans of junior and senior staff referring Special Needs patients to general anaesthesia or intravenous sedation. The hypothesis was that significantly more treatment plans of dentists with a limited knowledge in special care would need modification in the PRM. Methods: Using pre-agreed criteria the care plans of all 151 patients who had been referred for a dental procedure under general anaesthesia(GA) or intravenous sedation(IVS) between March 2004 and December 2004 in the Special Care Unit (SCU) were reviewed. All PRM involved at least one senior staff member, and 94% involved 2 or more senior staff members. Results: The results showed that half of all care plans were modified at the PRM: significantly more cases referred by junior staff (61%) compared with staff with two or more years experience (37%) in the SCU had treatment plans modified. In 19% percent of cases the mode of sedation was changed: significantly more cases from juinior staff (26%) were changed compared with cases from more senior staff (8%). Fifteen percent of sessions planned for IVS were changed to GA and 5% of treatment plans were considered not to need IVS or GA. Conclusion: The results supported the hypothesis and showed that a pre-treatment review meeting prior to IVS or GA is an important step in optimising dental care for Special Needs patients.