Overview
Conscious sedation plays a vital role in supporting patients who experience anxiety during dental treatment. While clinical delivery remains the responsibility of appropriately trained professionals and as such is not covered in this guidance, dental practices must also ensure that sedation is provided in a safe, compliant, and well-managed environment. Practices must ensure team members involved are appropriately trained, understand their roles, and work together effectively within established practice protocols.
Conscious sedation is defined as “the use of drugs to depress the central nervous system while maintaining verbal contact with the patient throughout, with a safety margin that makes loss of consciousness unlikely”.
The level of sedation must be such that the patient remains conscious and is able to both understand and respond to verbal commands either alone or accompanied by a light tactile stimulus.
National standards
Patients have a right to adequate anxiety control as part of their dental care, and for some, this may involve conscious sedation. The Intercollegiate Advisory Committee on Sedation in Dentistry produced the Intercollegiate Advisory Committee for Sedation in Dentistry (IACSD) 2015 report, updated in 2020, to set national standards for its safe delivery, outlining appropriate clinical techniques, environments, and expectations around patient communication, team training, audit, incident reporting, and inspection. While the guidance reflects best practice, differences in laws and governance across the UK must be observed..
UK-wide context
In response to the IACSD 2015 report, the Chief Dental Officers (CDOs) of the four UK nations commissioned the Scottish Dental Clinical Effectiveness Programme (SDCEP) to explore how its recommendations could be implemented in primary care. SDCEP’s guidance, Conscious Sedation in Dentistry (2017), reviewed and unchanged in December 2022, supports safe, effective, and person-centred care, focusing on good clinical practice without specifying drug doses or delivery methods. While the guidance is broadly applicable, each UK nation has taken a different approach to implementation, and practices must be aware of the relevant standards in their country.
England and Wales
In England and Wales, national service standards closely align with the SDCEP guidance. NHS England published Commissioning Dental Services: Service Standards for Conscious Sedation in a Primary Care Setting in July 2017, and NHS Wales followed with Service Standards for Conscious Sedation in a Dental Care Setting in June 2018. These documents reinforce the importance of appropriate environments, trained teams, patient communication, and ongoing audit and quality improvement.