Sir, rapid adaption of dental care due to the pandemic includes the delivery of intravenous sedation (IVS) through Midazolam. While the IVS procedure itself, which includes venous cannulation, is not considered an aerosol generating procedure, the turnover rate of sessions has been reduced due to the lack of clinical staff, surgery availability and optimising patient safety.

An audit within our tier two community dental trust in North West England showed a 62.5% drop in the number of IVS sessions in 2020 compared to 2019. While the most notable reason is likely due to the decrease in clinical activity during the initial national lockdown, another possibility is clinicians undertaking more dental treatment during a single IVS session to reduce multiple visits.

The height of the pandemic reduced the capacity for elective activity including dental treatment under general anaesthetic (GA). This increased pressure for patients who may not have been 'ideal' candidates for IVS to review this option. As the pandemic continues and with capacity for elective GA remaining low, community dental services are likely to experience sustained pressure from long waiting lists for this treatment. This may lead to an increased number of referrals to tertiary care for anaesthetist-led sedation or scope to increase the access and provision of IVS in community. In general, IVS may be considered to pose fewer overall complications and mortality rates in comparison to a GA procedure.1

Understandably, there remains a cohort of patients where IVS will remain poorly tolerated, with GA being the only alternative. This includes patients with profound autism with heightened sensory function, who would be able to tolerate disinhibition for dental treatment. However, a push and tolerance for IVS playing a more prominent role in dentistry could be more favourable. IVS sessions have allowed a conservative, pragmatic and holistic approach to clinical treatment. As the long-term effects of COVID-19 are unknown, particularly in relation to the respiratory system, it would be interesting to consider the impacts of this on the delivery of conscious sedation in the years to come.