Volume 24 - The Society for the Advancement of Anaesthesia in ...

2007 CONFERENCE
The types of hypersensitivities were reviewed, and the
definition, diagnosis, aetiopathogenesis and management
of anaphylaxis examined.
Examples of oral mucosal hypersensitivity reactions were
given, including examples of reactions to materials used in
dentistry, particularly local anaesthetics, latex and amalgam.
Recommendations for investigations and management of
these reactions were suggested.
Pepe Shirlaw
Pepe is a Consultant in Oral Medicine and Head of Service
Delivery for Dental Services at KCL Dental Institute at
Guy’s, King’s College and St Thomas’ Hospitals. Her clinical
interests include Sjögren’s syndrome and allergies related to
dentistry.
DwSI in Conscious Sedation
Dr Sharon Drake
Background
national framework for Dentists with Special
A Interests (DwSIs), Implementing a Scheme for Dentists
with Special Interests (DwSIs) was published jointly by
the Department of Health and the Faculty of General
Dental Practice in May 2004. The document described
the potential for DwSIs and highlighted the first four
clinical areas to take forward as a pilot: orthodontics,
periodontics, minor oral surgery and endodontics.
The principle of establishing Practitioners with Special
Interests developed within the NHS as a means of
managing workload between primary and secondary care
and thereby relieving pressure on secondary care services.
By providing Primary Care Trusts (PCTs) with an
opportunity to contract with dentists who have developed
a special interest in addition to their generalist role, the
choice available to patients in terms of the nature and
locality of NHS dental care is widened.
In April of this year, the Department of Health
published a policy document, Implementing care closer to
home: convenient quality care for patients, confirming the
establishment and accreditation of Practitioners with
Special Interests (PwSIs) as a commissioning option for
PCTs, and DwSIs were identified as an integral part of
this.
In 2007, two further draft guidelines and competency
frameworks have been developed for DwSIs in Conscious
Sedation and Prison Dentistry.
What are Dentists with Special Interests (DwSIs)?
A DwSI is any dentist contracting with a PCT to provide
services in a primary care setting in addition to their usual
and important generalist role. They may deliver a clinical
service beyond that usually provided by a primary dental
care practitioner, or they may deliver a particular type of
treatment, in agreement with their local PCT.
The DwSI provides a service that is complementary to
secondary care but does not replace services provided by
those who have undergone specialist training and are on
the specialist lists. DwSI status should only be given to
a practitioner following a local assessment by the PCT
that there is a need to commission such a service, and an
assessment of the practitioner against the competencies as
published.
Guidelines for the appointment of Dentists with
Special Interests (DwSIs) in Conscious Sedation
The DwSI in Conscious Sedation has been developed
jointly with the Department of Health and the Faculty
of General Dental Practice (UK), and will assist PCTs in
reviewing existing conscious sedation services and help
assure the quality of future services offering both standard
and alternative techniques. The document acknowledges
that standard conscious sedation techniques can be
carried out by all primary care dentists who are competent
to do so, and is not designed to restrict patients’ access to
sedation services.
Following the principles as set out for DwSIs, a DwSI in
Conscious Sedation is able to demonstrate a continuing
level of competence in their general dental activities as
well as a continuing level of competence in standard
conscious sedation techniques. In addition, the DwSI will
be able to demonstrate competence in some or all of the
alternative techniques.
The document draws on existing guidance, in particular
Standards for Conscious Sedation in Dentistry: Alternative
Techniques, from which the definition of standard and
alternative techniques is taken.
Sharon Drake
SAAD DIGEST | VOL.24 | JANUARY 2008 33