In the UK tooth decay is a leading cause of hospital admissions for children aged five to nine.1,2 A 2023 Community Dental Services survey reported that 27,000 children were on NHS waiting lists for specialist dental care.3 Alarmingly, over 12,000 children were waiting for dental procedures under general anaesthetic, with average waits of up to 80 weeks.3 The Intercollegiate Advisory Committee for Sedation in Dentistry is currently updating the ‘Standards for Conscious Sedation in the Provision of Dental Care for Adults and Children'. Any policy change that might restrict the use of intravenous (IV) conscious sedation in a specialist primary care setting arguably threatens to exacerbate the dental crisis that is experienced by (too) many children.

Against this backdrop, Toothbeary Dental Practice, a specialist paediatric clinic in Southwest London, conducted a survey of parents whose children had received IV conscious sedation at their facility. The practice, which has safely treated over 5,000 children with a combination of ketamine and propofol, aimed to assess parental perceptions of this service, their experiences with NHS care, and the perceived consequences of a potential policy change.

The survey received 592 responses including 493 testimonials which revealed several significant findings.

The presence of an NHS service gap is apparent: most respondents (65.2%) had initially sought care through the NHS, but over 62.9% found waiting times unacceptable, and 71% felt the treatment options were inadequate (Fig. 1A).

Fig. 1
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Survey capturing the responses of 592 parents whose children had received specialist paediatric dental treatment under intravenous (IV) conscious sedation at Toothbeary assessing the reason for sedation (A), the overall satisfaction of the service (if they had to choose again) (B), the location preference (C), and the perceived impact should sedation be removed (D)

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There is a clear demand for IV conscious sedation: many parents were referred to Toothbeary by NHS providers or actively sought private care due to medical urgency, with 45.9% travelling between 10 and 50 miles, and 20.1% over 50 miles.

Parental satisfaction was very high: parents expressed overwhelming satisfaction with IV conscious sedation, with 99.5.% reporting they were very satisfied or satisfied (Fig. 1B). Likewise, 99.1% stated they preferred a primary care setting over a hospital environment (Fig. 1C).

IV conscious sedation supports restorative care: qualitative analysis of the testimonials revealed a strong desire for tooth preservation. Parents noted that IV sedation enabled complex treatments (e.g., crowns and pulp therapy), which were often unavailable through NHS pathways. Parents frequently noted the NHS's over-reliance on tooth extraction as the only option, rather than restorative treatments. IV sedation was identified to be of particular value concerning children with complex needs, dental anxiety, or neurodevelopmental conditions.

Policy change would exert a negative impact: 97.7% of parents agreed or strongly agreed that removing IV sedation from primary care would negatively impact their child's dental health (Fig. 1D). They feared delayed treatment, increased anxiety, and unnecessary use of general anaesthesia in hospitals.

The survey revealed that IV conscious sedation in a specialist primary care setting provides timely, compassionate, and effective dental care, filling a critical gap left by the NHS. It serves as a vital alternative to general anaesthesia, offering restorative options that improve children's long-term oral health, and reduces pressure on hospitals and addresses health inequalities. These findings strongly support the preservation of this service.