Sir, we read with interest the research paper by Dorman et al. (BDJ 2007; 202: E30) regarding the management of children undergoing surgical orthodontics with the aid of intravenous conscious sedation (IVCS). The authors should be congratulated on their drive to explore alternatives to general anaesthesia in children. Unfortunately the use of IVCS in children, as alluded to in the paper, is somewhat in conflict with GDC guidance1 and we therefore feel its use should only be exercised with caution in a specialist unit with paediatric anaesthetic cover. We were disappointed that the paper largely dismissed the use of local anaesthetic alone.

In a recent retrospective audit in one of our satellite district general hospital units we performed surgical orthodontic procedures on 44 paediatric patients (age 12-16) over a three-year period. Twenty-five of these patients were willing to undergo the procedure under local analgesia (LA). Twenty of the LA procedures involved the exposure of palatal canines. All the patients had been initially assessed and then treated by the same specialist oral surgeon. Adequate time was given to discuss the procedure and answer any questions the child or parent had. LA was administered in a slow controlled manner with the adjunct of topical analgesia. The incisive block (where required) was initially introduced from the labial aspect via the interdental papilla and then completed via the orthodox palatal route significantly reducing patient discomfort. All the patients remained cooperative and tearless throughout. In most cases a parent remained in the room during the procedure. Only one procedure was abandoned due to incomplete analgesia. The successful outcome rate is in line with that stated in the paper by Dorman et al.

In conclusion we feel that a significant number of surgical orthodontic procedures can be safely and successfully performed under LA provided adequate explanation, time and atraumatic techniques are utilised.