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SAAD Digest Vol 27 11.10

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SAAD Digest Vol 27 11.10 CONTENTS 2 Editorial 3 Refereed Papers SAAD Trustees: - Nigel Robb, TD PhD BDS FDSRCSEd FDSRCPS SAAD Research Grant FDS(Rest Dent) FHEA, President 30 - Derek Debuse, BDS MFGDP(UK), Hon. Secretary - Stephen Jones, BDS MSc DDPHRCS Dip Sed, Hon. Treasurer - Andrew Wickenden, BDS DGDP Dip Sed, 31 MSc Project Abstract Membership Secretary - David Craig, MA BDS MMedSci MFGDP (UK) MBCS, CITP, Course Director - Francis Collier, MSc BDS DipDSed (Lond), 33 Visiting Professor Hon. Assistant Secretary - Christopher Mercer, PhD BDS FDSRCS FHEA - Paul Averley, BDS DGDP(UK) RCS Dip SED MPhil PhD 40 2010 Conference MSc implant dentistry - Carole Boyle, BDS MFGDP FDSRCS MMedSci MSNDRSEd, President Elect - Christopher Holden, BDS LDSRCS(Eng) DGDP(UK), 54 National Course DSTG Representative - Darrin Robinson, BDS MBA - Peter Walker, BDS MFDS RCS(Ed) - Michael Wood, B.ChD(Stel) MSc(Sed&SpCD) MFGDP 56 Forum MRD RCS(I) M SND RCS(Ed) The SAAD Digest is published each January and the 57 IACSD Press Release SAAD Newsletter each June annually by the Society for the Advancement of Anaesthesia in Dentistry. Editorial Board: 58 History Paul Averley Bill Hamlin Christopher Mercer 66 ADA Report Nigel Robb Michael Wood Fiona Wraith 68 DSTG Report Original articles and correspondence should be addressed to: Fiona Wraith Executive Secretary 77 Journal Scan 21 Portland Place, London W1B 1PY Tel: 01302 846149 Email: [email protected] 86 SAAD Courses Membership: £40 (UK) and £43 (international) per annum and includes the SAAD Digest and SAAD Newsletter, which are published on behalf of SAAD, 21 Portland Place, London 87 SAAD Supplies W1B 1PY. The opinions expressed in this and previous SAAD Digests and Newsletters are those of the authors and are not necessarily those 88 SAAD Subscriptions of the Editorial Board nor of the SAAD Board of Trustees. ISSN 0049-1160 92 Guidelines for Authors The cover photograph is scanning electro-micrograph of adrenalin. It is reproduced with the kind permission of the National High Magnetic Field Laboratory, Florida State University. 96 Diary Scan SAAD DIGEST | VOL.27 | JANUARY 2011 1 EDITORIAL e are now over a professions as the Board of Trustees were very concerned Wdecade into the new regarding the wording of the sections related to pain and millennium whether you anxiety control. believe it started on the 1st of January 2000 or the 1st Another area of activity for SAAD is the Intercollegiate of January 2001!! We are Advisory Committee for Sedation in Dentistry. There is now producing the 6th an abstract of the report of this committee included in the volume of the relaunched conference report. Currently four SAAD members are SAAD Digest. It hardly serving on this committee – two representing the Faculty seems any time since the of General Dental Practice and two representing the Editorial Board was Faculty of Dental Surgery of the Royal College of formed and we set out on Surgeons of England. The committee is currently working our first meetings. on developing a syllabus and piloting a course in alternative (or advanced) sedation techniques. The group I am delighted with the progress that has been made and has the potential to advance this area which has been an the number and quality of submissions that we receive. I area of significant need for a number of years. As you will hope that you will enjoy reading the varied contributions see from the abstract of the presentation, the committee that are enclosed. has members from both the Dental Faculties of all the Royal Colleges and from the Royal College of During 2010 we have seen the Consultation and Anaesthetists. It represents a golden opportunity for both (hopefully) publication of the NICE guidelines on professions to work together for the common good – paediatric sedation. SAAD was a stakeholder and as such namely improving the service available to patients. responded to the consultation. The process was delayed by the general election in May, but the consultation period In November 2010 the SAAD faculty ran a pilot course ended in July 2010. I presented a summary of some of our for Dental Hygienists and Therapists to train them in the main concerns at the annual symposium in September. At administration of Inhalation Sedation. The General that symposium we were fortunate to have the chairman Dental Council’s latest Scope of Practice document allows of the committee, Mike Sury, and Kathleen De Mott, a appropriately trained Hygienists and Therapists to research fellow of the NICE Guideline Programme who administer Inhalation Sedation as an operator/sedationist. works at the National Clinical Guideline Centre, present The results of this pilot course will be reported at the the draft document to us. Indeed we were the first external Annual Symposium. Unfortunately the deadlines for organisation that they had presented to. As I write this submission of the material for this edition of Digest do editorial in October, the final version of the NICE not allow us to evaluate and report the course. document is still not available, but I am hopeful that our response will have produced some positive changes in the SAAD remains an active and vibrant Society working to final document. advance pain and anxiety control in dentistry. The Board of Trustees, via a small working group, I hope you enjoy this edition of Digest and if you feel published an editorial in the British Dental Journal in moved to write for us, we will be happy to receive your August last year.1 The subject of the editorial was the contributions! (mis)use of temazepam in dentistry. We had become aware of a number of practitioners who were using sedative doses Happy New Year. of temazepam, but referring to the technique as “anxiolysis”. This seemed designed to muddy the waters Nigel Robb and was of concern as those practicing this technique had neither the training nor the facilities required for the practice of intravenous conscious sedation – something in 1. Oral Temazepam Causing Anxiety direct conflict with current dental guidance. SAAD President's Advisory Group & Nigel D. Robb* *Senior Lecturer in Sedation in Relation to Dentistry/Honorary Consultant in Restorative Dentistry, Glasgow Dental Hospital and The working group has also produced a response to the School draft of the intended learning outcomes for dental Br Dent J 2010; 209(2):55-55 (24 July 2010) 2 SAAD DIGEST | VOL.27 | JANUARY 2011 REFEREED PAPER WHAT’S NEW WITH PHENTOLAMINE MESYLATE: A REVERSAL AGENT FOR LOCAL ANAESTHESIA? John A. Yagiela DDS, PhD Distinguished Professor and Chair, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA Author information: John A. Yagiela, DDS, PhD, UCLA School of Dentistry, 10833 Le Conte Ave., Los Angeles, CA 90095-1668, USA Email: [email protected], Phone: 310-825-9300, FAX: 310-825-7232 function or appearance — were consistently resolved by Abstract the time sensation to touch had returned to normal. Phentolamine mesylate (OraVerse), a nonselective Adverse effects of phentolamine injected in approved Ȋ-adrenergic blocking drug, is the first therapeutic agent doses for reversal of local anaesthesia in patients ranging marketed for the reversal of soft-tissue anaesthesia and in age from 4 to 92 years were similar in incidence to the associated functional deficits resulting from an those of sham injections, and no serious adverse events intraoral submucosal injection of a local anaesthetic caused by such use were reported. The clinical use of containing a vasoconstrictor. In clinical trials, phentolamine is viewed favorably by dentists who have phentolamine injected in doses of 0.2 to 0.8 mg (0.5 to administered the drug and by patients who have received 2 cartridges), as determined by patient age and volume of it. Optimal use may require some modifications of the local anaesthetic administered, significantly hastened the technique described in the package insert; cost of the return of normal soft-tissue sensation in adults and agent may be influencing its widespread adoption into children 6 years of age and older. Median lip recovery clinical practice. times were reduced by 75 to 85 minutes. Functional deficits, such as drooling and difficulty in drinking, smiling, or talking — and subjects’ perception of altered Figure 1. Phentolamine mesylate (Oraverse, Courtesy Novalar Pharmaceuticals, Inc.) Figure 2. Structural formulas of epinephrine and phentolamine. SAAD DIGEST | VOL.27 | JANUARY 2011 3 REFEREED PAPER Phentolamine mesylate, in the form of OraVerse As is the case with most competitive antagonists, (Novalar Pharmaceuticals, San Diego, USA) represents a phentolamine shares a structural similarity with the new therapeutic class of drugs in dentistry intended to agonist epinephrine but includes bulky side chains that reverse soft-tissue anaesthesia after nonsurgical dental are presumed to permit receptor binding yet prevent procedures (e.g., restorative or deep scaling/root planing receptor activation. procedures). As shown in Figure 1, OraVerse is manufactured in 1.7 mL dental cartridges, each of which The pathway leading to the use of phentolamine as a contains 0.4 mg active drug. This review describes the local anaesthesia “reversal” agent began with a trip to development of phentolamine as a dental drug, its the dentist. Dr. Eckard Weber, an inventor, specialist in pharmacologic characteristics, and how it may be used in creating companies pursuing innovative drug therapies, clinical practice to improve patient care. and former professor of pharmacology at the University of California, Irvine, wondered why patients were constrained to remain numb for hours after each dental appointment. Although the notion of using phentolamine after local anaesthesia to hasten the Background return of normal sensation had been contemplated at Phentolamine is an old drug. It was first approved by least twice previously, Weber was the first to take the United States Food and Drug Administration action.
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