A dental risk management protocol for electroconvulsive therapy.

This article describes the results of an evaluation of a system to use trained junior psychiatric doctors to perform the pre-ECT oral assessment. All junior doctors were given a 1-hour training session in making oral assessments, and their ability to diagnose was tested by dental follow-up visits to patients they had assessed. Seventy-one patients were seen by both doctor and dentist, and the sensitivity for doctors ranged between 92% for the presence of dentures or removable bridges to 8% for the presence of teeth vulnerable to fracture. Where the doctors made a positive diagnosis, these were not always correct; the positive predictive value ranging from 92% for dentures or removable bridges to 25% for teeth vulnerable to fracture. It is concluded that the use of trained doctors is better than no assessment but falls short of that provided by a dentist with experience of psychiatric patients undergoing ECT.