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To contact Chartwell Dental Clinic please click on the following e-mail link
History
Chartwell Dental Clinic began by providing a General Anaesthetic service, serving dentists in South West Hertfordshire. From 1976 to 2002 we administered over 35,000 General Anaesthetics without a single mishap. This is because our overriding concern has always been the patient's safety. After 2002 all general anaesthetics in the dental chair ceased.
In 1998 in accordance with the General Dental Council's guidelines, we replaced our general anaesthetic with sedation. We have developed new sedation techniques revolving around Low Dose Sevoflurane Inhalation Sedation. This, together with a variety of Intravenous Sedation techniques, enables us to deal with the most anxious of patients who have a fear of dental treatment. Our techniques are particularly suitable for patients with a needle phobia, patients who are physically or mentally challenged, and also for very young children.
One of the great strengths of Chartwell Dental Clinic is that all our staff have been working together as a team, in some cases, for as long as 27 years. This stability has created an experienced and highly trained team of a doctors and a dentists, together with their assistants, to look after and treat you or your child. The efficiency of our unit, where every member is familiar with all aspects of the range of treatments at Chartwell, is rarely found elsewhere. Even most Hospitals have to rely heavily on agency staff, and doctors who are in a training post for short periods. We regularly train together in advanced resuscitation and life support, Advanced Paediatric Life Support under the supervision of our resident Consultant Anaesthetist, Dr. Mark Patten.
We have very sophisticated monitoring equipment that constantly monitors the heart, breathing, blood pressure and well being of you or your child throughout their treatment
Monitoring of every patient during Intravenous Sedation includes not only pulse oximetry (the oxygen content of the blood with every heart beat), but also where appropriate, continuous ECG, Inspired Oxygen, Carbon Dioxide, Nitrous Oxide and volatile anaesthetic agents.
There are three recovery beds supervised by highly trained recovery staff, including two SRN's. The recovery room is fully equipped with pulse oximetry, plus a central oxygen/suction supply All patients in recovery are also continuously monitored by pulse oximetry and are under continuous audio visual surveillance by the anaesthetist
Referral to Chartwell Dental Clinic
Treatment under Local Anaesthetic
In 2006 a new dental contract was implemented for all NHS dentists. Chartwell has a NHS contract from West Herts Primary Care Trust for treatment of patients under sedation only. Our new contract does not cover treatments under local anaesthetic.
Chartwell still accepts many patients who prefer to have their treatment under local anaesthetic but as we do not have an NHS contract for this treatment, local anaesthetic can only be undertaken on a private basis.
Chartwell was founded around the service we offered to dentists for the treatment of patients who find dental treatment too frightening. Most patients now prefer to come to Chartwell and be seen and treated with just one appointment. This is particularly suitable for patients travelling longer distances or for small children.
More complicated patients referred to Chartwell Dental Clinic have a pre operative assessment appointment. We have a variety of sedation techniques, which can be tailored to your specific needs. This will depend on factors such as age, medical history, the nature and length of your dental treatment, and special problems such as needle phobias or gagging.
Principals of sedation in the dental chair.
Chartwell accepts the General Dental Council’s definition of Conscious Sedation and their guidance to use the Minimum Sedation necessary.
Your dentist has referred you for treatment under sedation.
If you do not want or do not wish for yourself or your child to have treatment under sedation then please return to your dentist for treatment/further discussion as to the possibility of treatment without sedation.
There are different types of sedation.
1. Oral sedation.
1 Oral sedation
This is when the patient/child takes a drug like Valium orally.
a) This will relax the child and make him sleepy.
b) Valium does not relieve pain and is very long lasting.
c) In our experience this is not sufficient for most patients referred to Chartwell.
d) Intravenous administration of a smaller dose of a similar agent can achieve the same effect, and the patient will leave Chartwell more alert because they have had a smaller intravenous dose.
e) We do not routinely give children oral sedation because the failure rate is too high and it makes the administration of the alternative treatments more complicated.
When considering inhalation sedation the understanding is that this means ‘nitrous oxide’ or ‘Laughing Gas’.
a) Nitrous oxide is very good for pain relief.
b) However nitrous oxide alone has a failure rate of about 50%.
c) Prolonged administration of nitrous oxide is frequently associated with nausea and vomiting which is very hazardous during dental work when the mouth is obstructed by the dentist.
For these reasons we very rarely use Nitrous Oxide alone except for the simplest of cases.
At Chartwell we use an advanced type of ‘Inhalation Sedation’ involving the administration of nitrous oxide with a low dose of Sevoflurane. This is particularly suitable for needle phobic patients, the very elderly, children and patients having simple dental extraction. Once the local anaesthetic injections have been given the nitrous oxide is discontinued (for prolonged cases intravenous sedation may be added in addition to Sevoflurane inhalation). Sedation is maintained with 100% oxygen and a low concentration of Sevoflurane. It is our belief that Sevoflurane Inhalation Sedation is the safest and the best form of sedation for very young children. It is used when simple Nitrous Oxide sedation is not adequate. (Sevoflurane Inhalation Sedation is not available on the NHS because West Herts Primary Care Trust will not fund this).
Except for the simplest of cases most patients/children will have an Intravenous Cannula (needle) inserted into their arm. This is an important safety practice. It is usually inserted while the patient/child is breathing nitrous oxide. With the technique used at Chartwell most children will feel very little of the injection. Nitrous oxide is administered for a very short period and is usually not long enough to cause nausea.
a) At Chartwell we believe that treatment should be carried out using the smallest dose of sedative possible.
b) In spite of adhering to the principal of minimum sedation we find that most patients/children referred to Chartwell for treatment require some intravenous sedation.
The reason for this can be:-
i Very young children.
ii Very painful work.
iii Anxiety and needle/dental phobia.
iv Extraction in the presence of infection when local anaesthetic is often ineffective.
v Multiple fillings and extraction where treatment is prolonged.
Chartwell Dental Clinic specialises in the treatment of children under sedation. Children as young as 2 have been treated for emergencies. However as a general rule we prefer that the child is at least 5 years old. For young children, this will involve breathing nitrous oxide (laughing gas) plus a very low dose of Sevoflurane (another inhalation anaesthetic agent), which will be administered via a face or nasal mask. Because this is not a general anaesthetic, the child will have to co-operate with the administration of this gas.
Different drugs will be used depending on age, the length of you treatment, whether you are having oral surgery, orthodontics, fillings and conservation treatment and dental implants.
Conservation dental treatment is done by Dr. Arlene Theron. She has been treating patients under sedation at Chartwell since 1997. She is a very experienced dentist, who is particularly good with children and very anxious patients.
Conservation treatments include:-
Chartwell Dental Clinic has an experienced team of implantologists which is led by Mr de la Rey our senior Maxillo Facial and Oral surgeon.
Our sedation facilities enable us to perform the most difficult of oral surgery procedures. In our experience it is NEVER necessary for patients to be treated under GENERAL ANAESTHESIA (which can only be done in hospital).
Treatments available under sedation include:-
Periodontal Service
Gum disease is a significant cause of loss of teeth. It is imperative that patients having dental implants have impeccable oral hygiene. Chartwell has a visiting periodontist is Dr Hennie van Jaarsveld and a dental hygienist.
The clinic has a multidisciplinary approach to Implantology. We have a wide range of skills including the expertise of a resident Oral surgeon, Prosthodontist, (Specialist in restorative dentistry), Periodontist (specialist in gum disease) Medical Doctors, Consultant Anaesthetist and an experienced Implant Hygienist.
Our resident Oral Surgeon is Dr Johan (Buks) de la Rey sedation facilities routinely perform bone augmentation/grafting when there is insufficient bone to place implants - this includes ridge expansion, guided bone regeneration, block/onlay grafts, sinus lift/grafts and nerve lateralisation
Chartwell has always had a very high profile in Dental Anaesthesia and we have two anaesthetists in our team, led by Dr Mark Patten , Consultant Anaesthetist at Luton and Dunstable Hospital.
We are Association of Dental Implantology members and all patients are informed as advocated by the Association of Dental Implantology.
Click here to leave the Chartwell website and visit the Association of Dental Implantology web site.
Financial Planning for Implants
In association with Chrysalis, we can offer up to 12 months interest free credit (conditions applying)
We offer a pre operative appointment to patients with special medical or dental problems, for all implant patients and for private patients. The exceptions to this pre-operative assessment are either patients in severe pain who need immediate emergency treatment, or patients who live further a field and prefer to be seen and treated at one appointment.
At this appointment, you will see a very experienced dentist, oral surgeon or anaesthetist. Your dental treatment will be planned and fully discussed with you. Patients having treatment under sedation sometimes express a preference as to how the sedation will be administered e.g. needle phobic patients do not want injections. Other patients prefer to be sedated without having to inhale gases through a facemask. The final choice of sedation rests with the anaesthetist, but it is very rare for patients choice to be ignored.
1. You will be given full written instructions and information about your treatment and sedation.
2. You will also receive a quote for the cost of your treatment.
3. Some patients prefer to be given some form of pre-medication, which helps to reduce anxiety and can also reduce the amount of sedation the anaesthetist will need to give you for your operation. It will also help with any post operative pain.
Every patients referred to Chartwell Dental Clinic will need to fill forms 1-3(see below). If it is easier you can download these forms and bring them with you when attending Chartwell Dental Clinic. Alternatively you will be sent these forms in your instruction pack. Alternatively you may be interested to see the procedures for patients having treatment under sedation.
1. Instructions on the day of operation (word .doc)
2. Medical Questionnaire (Excel .xls)
3. Consent for operation (Excel .xls)
4. Instructions for Children (word .doc)
6. Information on Dental Implants
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Dentist Dr Arlene Theron B.Ch.D(Pret) Dr Julian Muller B.Ch.D(Pret) |
Anaesthetists Dr Mark Patten FFARCS Dr Jeffrey Zane MB. BS. LRCP. MRCS. DA. |
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Oral Surgeon Dr. Jonus Osher BDS MD BS
Periodontist
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Anaesthetic assistants Mora Finan SRN Dental Hygienists |
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Practice Manager Tracy Dare |
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Dr Julian Muller
Dr Jeffrey Zane MB. BS. LRCP. MRCS. DA.
Jeff Zane leads the anaesthetic team at Chartwell. Jeff gave up his appointment as locum consultant anaesthetist at Watford General Hospital to specialise in the field of Dental Anaesthesia. He has been working together with Julian Muller since 1976, providing dental treatment for patients requiring general anaesthesia in the dental practice that grew into Chartwell Dental Clinic. During this period over 35,000 patients were treated under general anaesthesia, without a single mishap. The quality of our service attracted Hertfordshire Health Authority who placed a contract with Chartwell for the treatment of patients requiring surgical extractions under general anaesthesia.
From 1998 Jeff has been involved in the treatment of patients under sedation. He has refined the new technique of Low Dose Inhalation Sedation for dental sedation. In addition to this he has pioneered a number of new Intravenous Sedation techniques. Jeff Zane works in close cooperation with a team that now specialises in the treatment of children and needle phobic patients, for whom these sedation techniques are particularly suitable.
Dr Arlene Theron BChD (Pret).
Arlene has been a full time GDP with Chartwell since 1997 and is well known as our restorative dentist. Arlene’s work ethics, empathy and clinical skills are second to none and she has been singly responsible for the high standard of conservation treatment which has become synonymous with Chartwell. Quietly, and in her un-assuming way she has increased her post graduate portfolio to include implants. She becomes our Implant Co-ordinator to oversee the smooth running of the clinic.
Consultant Anaesthetist Luton & Dunstable
Dr Johan de la Rey BChD MChD (Pret) (Maxillo Facial & Oral Surgery)
Dr Johan (Buks) de la Rey obtained his Masters Degree as a Maxillo Facial and Oral Surgeon in 1982. During his many years in private practice in Cape Town, he also placed a multitude of implants and brings all his experience in traumatology, oncology and minor oral surgery to Chartwell. ‘Buks’ is a Fellow of The International Society of Maxillo Facial and Oral Surgeons and a Registered Specialist in Surgical Dentistry with the British Dental Council
Dr Hennie van Jaarsveld (BchD MchD Pret Masters in Periodontology & Oral Medicine)
Hennie has over 20 years experience in periodontal surgery and Implantology. He was appointed as Senior Lecturer and External Examiner for pre- and post-graduate students at the Universities of Pretoria and Witwatersrand in South Africa. He has also given lectures at National Congresses. He is a registered Specialist in Periodontology with the British Dental Council, and a Member of the American Academy of Periodontology
Karen Marshall is qualified to instruct and treat patients in the specialist field of dental implants.. Hygienists play an important role in post implant monitoring
Sevoflurane has had a Product License for use as a General Anaesthetic agent, where it has been used for over 23 years. It is now well established as a safe drug with unique properties of rapid uptake and rapid elimination. It has a wide safety margin. However, General Anaesthesia carries a risk of mortality and in the field of dentistry in the U.K. General Anaesthesia has been totally replaced by a much safer technique of Sedation.
At Chartwell we are proud of the fact that we offer a sedation technique using Sevoflurane. This uses tiny concentrations of Sevoflurane in doses of about 90% less than those used for General Anaesthesia. Chartwell had a lot of experience using Sevoflurane when General Anaesthesia was permitted and we now do over 1000 cases per year of Sevoflurane Sedation. It is our experience that the use of Sevoflurane Sedation is the best and safest technique for sedation in the dental chair.
Sevoflurane Inhalation Sedation is not available on the NHS because West Herts Primary Care Trust will not fund this.
