Yuan S, Carson S J, Rooksby M, McKerrow J, Lush C, Freeman R
Dental Health Services Research Unit, University of Dundee, DD1 4HN.
Public Dental Service, NHS Highland, IV2 7GE.
Br Dent J. 2015 Dec 18;219(12):571-6. doi: 10.1038/sj.bdj.2015.955.
To conduct an exploratory investigation of public dental service (PDS) practitioners' planned sedation modality using a structural equation modelling approach, in order to identify the explanatory value of using the Index of Sedation Need (IOSN), or its component parts, to predict sedation modality in patients referred with dental anxiety.
A convenience sample of patients referred to the PDS for dental anxiety management was invited to take part. The IOSN was completed for each patient (patient dental anxiety, medical and behavioural indicators and dental treatment complexity) as well as the American Society of Anesthesiologists Physical Status Classification System and the Case Mix Tool. The practitioners completed details of their planned sedation modality and identified normative dental treatment need. The data were entered onto an SPSS v21 database and subjected to frequency distributions, t-tests, correlation analysis and exploratory partial structural equation modelling (SEM).
Ninety-five percent of patients were ranked as MDAS 3 or 4, indicating high dental anxiety; 69% had a medical condition, which might impact on dental treatment and 82% had a dental treatment need, which was classified as intermediate/complex according to the IOSN. Eighty-eight percent of the patients in accordance with the IOSN required sedation: 62% of patients were assessed as requiring intravenous sedation. The IOSN discriminated between patients who were assessed as requiring more complex sedation modalities and had a greater normative treatment need. The SEM showed that the patient dental anxiety (P <0.02) and dental treatment complexity (P <0.02) predicted planned sedation modality. Functional morbidity was less strong, as a predictor, and was significant at the ten percent level.
The IOSN is a useful and valid assessment of sedation need and predicted sedation modality for patients referred with high dental anxiety states and secondly, that component parts of the IOSN add explanatory value in practitioners' choice of planned sedation modality.
采用结构方程模型方法对公共牙科服务（PDS）从业者计划使用的镇静方式进行探索性调查，以确定使用镇静需求指数（IOSN）或其组成部分来预测因牙科焦虑而转诊患者的镇静方式的解释价值。
邀请了一个方便样本中因牙科焦虑管理而转诊至PDS的患者参与。为每位患者完成了IOSN（患者牙科焦虑、医学和行为指标以及牙科治疗复杂性）以及美国麻醉医师协会身体状况分类系统和病例组合工具。从业者填写了他们计划的镇静方式细节，并确定了标准牙科治疗需求。数据录入SPSS v21数据库，并进行频率分布、t检验、相关分析和探索性偏结构方程建模（SEM）。
95%的患者被评为MDAS 3或4级，表明牙科焦虑程度高；69%的患者有可能影响牙科治疗的医疗状况，82%的患者有牙科治疗需求，根据IOSN分类为中级/复杂。根据IOSN，88%的患者需要镇静：62%的患者被评估为需要静脉镇静。IOSN区分了被评估为需要更复杂镇静方式且有更大标准治疗需求的患者。SEM显示，患者牙科焦虑（P<0.02）和牙科治疗复杂性（P<0.02）可预测计划的镇静方式。作为预测指标，功能发病率的作用较小，在10%的水平上具有显著性。
IOSN是一种有用且有效的镇静需求评估方法，可预测因高度牙科焦虑状态而转诊患者的镇静方式；其次，IOSN的组成部分在从业者选择计划的镇静方式方面增加了解释价值。
