Dental nurse training opportunities were expanded in 1999 with the addition of a second course which helped nurses to prepare for the National Examining Board for Dental Nurses' (NEBDN) Certificate in Dental Sedation Nursing. This came to be known within SAAD as the "Part 2" course. This element was developed at Guy's Hospital by Dr David Craig and Dr Carole Boyle both of whom were examiners for the NEBDN qualification. Moving to Queen Mary, University of London in 2005 the SAAD National Course had a core programme reflecting the close associations SAAD had developed with the Dental Sedation Teachers Group (DSTG), the Association of Dental Anaesthetists (ADA), the Royal College of Surgeons of England, and the Royal College of Anaesthetists.

Driven by David Craig SAAD’s longest serving course director the National Courses were simplified logistically whilst still providing the hands-on training for which SAAD was always known. David expanded the faculty to utilise capable professionals from dental nurses and administrators encouraging younger but experienced professionals. With a firm hand on the tiller the courses developed to provide a separate course for dental hygienists and therapists.

2016 marked the launch of the SAAD Assessed Sedationist, and SAAD Assessed Sedation Nurse, Schemes. These were created in part as a response to the publication of the 2015 IACSD Standards for Conscious Sedation in the Provision of Dental Care, and with the aim of providing the required hands-on clinical experience. Both schemes, along with the SAAD Inhalation Sedation Course for Dental Hygienists and Therapists, are IACSD-accredited and meet the requirements for independent practice in dental sedation. Administered by Emma Lee, SAAD committed to training pathways as well as initial training. 

The high-quality didactic teaching, experienced course tutors and relevant hands-on stations which have always been the unique selling points of SAAD courses remain an integral part of the new schemes, but this is combined with a robust and effective clinical supervision element, which delegates can undertake with a clinical supervisor of their choosing, even in their own practice or setting.

This combination of excellent theoretical training and a well-designed clinical experience module, including workplace-based assessments, reflection and a practice evaluation really sets the SAAD schemes apart from the competition in giving the new sedationist or sedation nurse the best possible start on their journey in dental sedation.

From the mid 1970’s Cestradent McKesson, an anaesthetic supplies company run by the Swann and Martinez families supported SAAD’s activities with dental trade support. Unassuming and unfailingly polite to SAAD this company helped with inhalation sedation machine provision and servicing. They willingly provided monitoring equipment and sedation sundries to SAAD’s needs as well as medical gases for many years.

SAAD Conferences have been held annually since 1993, coordinated and administered by SAAD’s executive secretary Fiona Trimingham. From the start, these have been valuable forums for discussion among colleagues and an opportunity for the formation and maintenance of contacts. Early venues varied – several conferences were held at the Royal Society of Medicine, but other locations included the King’s Fund, Cavendish Square (2001), The Eastman Dental Hospital (2002), and the General Dental Council (2003). From 2004, however, conferences have taken place at the Royal Society of Medicine - something of a homecoming for SAAD since the RSM was, after all, the location of many early SAAD meetings.

Topics for the symposia expanded to include a wider audience. For example SAAD’s 40th Anniversary Conference took place on 11th October 1997 at the Royal College of Medicine, with topics addressed including ‘IV Sedation – is midazolam obsolete?’, ‘Sedation and the GDC’, ‘Training auxiliary staff’, and ‘Sedation teaching for dentists by dentists.” In subsequent years, the themes of conferences ranged widely in subsequent years. The coming new millennium was the focus in 1999, with presentations on subjects including ‘The Inhalational Approach - A Sound Technique’ (Dr Isabelle Holroyd), ‘Intravenous Sedation – The Way Forward’ (Dr Nigel Robb) and a case report on hypnosis in general anaesthesia and sedation delivered by Dr Hugh Lyons. The guest speaker, Professor James Roelofse (South Africa) addressed paediatric outpatient anaesthesia/sedation. This expansion of patient care themes continued. The theme of the 2000 Conference was ‘The Anxious Child’ with speakers including Professor Leo Strunin (‘Can GA Ever Be Justified?’), Dr Catherine Potter (‘Does Hypnosis Have a Place?’), and Dr Tom Thayer (‘Is Acupuncture Realistic?’), while the 2002 Conference was given over to exploring the interface between sedation and anaesthesia.

The RSM has been a meeting place for SAAD throughout its history.

Annual scientific meetings continued to compliment the national courses and invariably these were held at The Royal society of Medicine London. These reflected the origins of SAAD and continued to be supported by a full audience. SAAD encouraged teamwork and dental students and dental nurses were welcomed to meetings. This was supported by SAAD offering a monetary prize for essays from both dental nurses and dental students on an annual basis. The DJ memorial essay prize which is open to all medically or dentally qualified graduates continued to be offered every year with a prize of £500. This custom continues to date.

Since D-J’s death, SAAD has offered the Drummond-Jackson Essay Prize for essays on subjects relating to dental anaesthesia or sedation.  Since its inception, the aim of this award has been to “attract entries of the highest possible quality in fitting memory of a man whose own standards had been so high”. The Prize, currently worth £500, is open to graduates and undergraduates of both medicine and dentistry anywhere in the world; separate prizes are also currently awarded to dental students (the Dental Student Essay Prize) and dental nurses (the DCP Essay Prize), each with a monetary value of £300 and the prestige of possible publication in the SAAD Digest

Trade stands made their first appearance at the 2004 SAAD Conference, although with an emphasis on allowing a small number of manufacturers to showcase new equipment and to contact existing and prospective customers, rather than on anything resembling a ‘hard sell’.  

A key aim of SAAD Conferences has always been to facilitate the sharing of knowledge and expertise among colleagues, and the 2005 SAAD Conference, which took the theme of ‘Sedation – A European Perspective’, was particularly significant in this respect. Speakers came from France, Germany, Italy, the Netherlands, Portugal, and Israel, and all were asked to answer in advance a series of key questions about sedation provision, teaching, and regulation in their home country. The results offered a fascinating snapshot of approaches to conscious sedation across Europe, leading SAAD’s  Secretary Derek Debuse to conclude that ‘at the end of the conference it was evident that UK dental sedation is in very good shape indeed.’

The 2006 SAAD Conference was dedicated to ‘Pain and Anxiety Control in Medicine and Dentistry’. Professor Peter Milgrom, the SAAD Visiting Professor in Pain and Anxiety Control for Dentistry at King’s College London Dental Institute, delivered two lectures during the day, one describing trends in current anaesthesia practice in the US, and the other addressing new sedation techniques.

In 2007, the focus was ‘Sedation in Primary Care’; however, the day began with the observation of a minute’s silence to mark the death, earlier in the year, of former President Peter Sykes. Speakers subsequently included Sharon Drake, who addressed the relatively new field of ‘Dentists with Special Interests’, and Pepe Shirlaw. A member of the allergy testing department at Guy’s Hospital, she informed delegates that rates of latex and amalgam allergies were declining, and that much of her work now focused on the testing of local anaesthetics.

In 2008, Barry Devonald was succeeded in his role as Conference Organiser by SAAD’s Executive Secretary Fiona Trimingham, who had previously provided support and backup. 

Conferences themselves became known as ‘symposia’ from 2013 to reflect their focus more accurately on the dissemination and sharing of knowledge and information.

Themes were widely ranged from ‘Fundamentals of Safety Culture in Sedation Practice’ (2008) and ‘Practical Sedation: Trances, Needles and Consent’ (2009), to ‘Drugs: The Good, the Bad and the Ugly’ (2014). Among the many notable speakers during these years were Gerry Tyrer, who in 2008 gave delegates an insight into the work of a tented dental unit in Camp Bastion, Afghanistan; Mike Gow, President of the British Society of Medical and Dental Hypnosis, who addressed the symposium in 2009; and Professor Enrico Facco of the University of Padua, Italy, who in 2014 highlighted the benefits of using hypnosis in the treatment of phobic patients.

The 2017 SAAD Symposium was held on Saturday 23rd September and served, naturally, as a focus for the Society’s Diamond Jubilee celebrations. Entitled ‘A Strong Foundation for a Bright Future’, it opened in memorable style with the entrance of SAAD President Francis Collier preceded by Pipe Major ‘Dixie’ Ingram of the First and Second Scots Guards. A total of 193 delegates were present to hear papers on subjects that included the use of virtual reality and neurolinguistic programming in the treatment of nervous patients and those with dental phobia.  Ian Brett and Christopher Holden also jointly recapped SAAD’s 60-year history. It was an occasion for looking back but also to the future, a glimpse of which came at the end of the day with Michael Allen’s reflections on the development of conscious sedation:

 “Technological advances may improve patient monitoring, and the possibility of intra-oral scanning and 3D printing may also provide useful gains.

Nanotechnology is in development and may revolutionise targeted drug delivery via nanobots. These can be applied topically, inhaled or delivered intravenously. A patient could be sedated by nanobots guided by central nervous system analysis to relieve anxiety. Dentifrobots could be applied to tooth surfaces to place resin, treat sensitivity, or remove caries.

We were all then reminded that humans are inherently social animals, and we are not quite ready for the robotic dental revolution, but we have come a long [way] since 1957!"

2018 included “Sedating the Diabetic Patient” by Dr Lucy Wray, “Conscious Sedation and Implant Dentistry” by Dr Vikram Kavi and “Dental Sedation in the RAF” presented by Marguerite Reith

SAAD contributed to British Dental Association conferences over many years. Initially it was in the form of keynote speakers such as Dr David Philips and Dr Christopher Holden in the 1990’s. From 2000-2004 SAAD had a notable presence at the British Dental Association Conference offering members and delegates the opportunity to refresh their knowledge of resuscitation techniques. These ‘Safe and Sound’ courses, which were established by SAAD members Douglas Pike and Barry Devonald at the invitation of the BDA, were run in conjunction with local ambulance trust resuscitation officers. A dental surgery was created on site (with help from  Adec Dental) allowing for the accurate simulation of equipment and conditions, and over 100 delegates would regularly be trained and certified at each conference. As Barry Devonald recalls, ‘[We [once] had a general medical practitioner pitch up on the day after his dentist wife had been ‘certified’ with three of his medical colleagues for training!’

Predicated on the contemporary standards of the time the SAAD evaluation scheme evolved int the Safe Sedation Practice Scheme. As national guidance changed so did the evaluation process. The concept remained throughout. SAAD defined the principles for the evaluation of safe sedation practice at a national level insisting that a fundamental standard for evaluation and should not be amended for local use. The evaluation must be undertaken by a professional who meets the person specification as defined in this document.

By combining national guidance documents practitioners are required to take appropriate steps to provide a minimum standard for safe and effective patient care whatever the clinical setting.

Based on consensus the SSPS still represents a fair and transparent evaluation of a facility providing conscious sedation. The same standard is applied to any setting whether hospital, community provision or general dental practice. The emphasis is peer review enabling the applicant to reach the required standard culminating in assessment of four live patient cases throughout the patient journey.

From 2011 the scheme expanded rapidly. By 2021 SAAD president Sadie Hughes, recognising the practical safety benefits of the SSPS and its importance to the future of SAAD as a membership service decided to formalise the ad hoc working group. Dr Christopher Holden led the group constantly morphing scheme adapting to a changing training pathway and a changing regulatory environment.

Often referred to as “The SAAD Evaluation Scheme” the protocol included a “steps to take” checklist reflecting a practical approach to meeting contemporary guidance. This was plagiarised and adapted by several organisations such as various NHS trusts and the Care Quality Commission. Whilst imitation is the sincerest form of flattery dilution of this robust guidance from SAAD resulted in a number of medicolegal cases that were extended unnecessarily by the confusion caused by third party adaptations. Christopher Holden commented, “SSPS is a powerful tool for robust patient safety. It is a valuable and practical service for our members and commissioners of dental sedation services.”

The first SAAD Digest was not the first SAAD publication. Since the formation of the Society, meetings and lectures had been recorded, transcribed, and published in verbatim form as ‘Digest Reports’. From February 1960 D-J also produced a ‘Librarian’s News Sheet’, which published items of news from the UK and overseas, promoted standards, provided notification of new products, and offered an opportunity for members to voice their opinions.

By 1969, and with SAAD’s membership having grown to over 2000, the difficulties in producing both publications could no longer be ignored. The current technology – a rotary duplicator – was not only unreliable, but it also made the printing process a time-consuming and messy business. D-J decided that the Society should have its own professionally produced journal, and the first issue of Digest - which replaced the Librarian’s News Sheet - subsequently appeared in January 1970. It had 20 pages, a plain, two-tone cover, and was notable for being the first SAAD publication to feature advertisements.

D-J remained editor of Digest until his death at the end of 1975 (the first issue of Volume 3, which was published in January 1976, carried a reprint of his Times obituary). After D-J’s death Peter Sykes was appointed as editor; he was succeeded in 1991 by Douglas Stewart, who in turn was succeeded in 1994 by Andrea Wraith.  

11 issues of Digest were published per year until 1988, when issues 11 and 12 were combined. Thereafter, the number of issues was reduced to four then two per year, until in 2006 it was decided that a single issue of Digest would be published annually. 

The introduction of the SAAD Newsletter came in 2003, when Digest was still being published four times a year.  This schedule was proving too demanding and so Digest became a Spring and Autumn publication, with the Newsletter appearing in Winter and Summer. The Summer Newsletter was subsequently replaced by an Autumn issue in 2014, meaning that news of the annual symposium could be brought to members in a timelier fashion. However, abstracts of presentations given on the day continued to appear in Digest.

The history of the publication to date was detailed by Nigel Robb in Digest Volume 30 (January 2014). This provided an opportunity to highlight several seminal papers that have appeared between its covers, including John Dundee about sexual fantasies in patients who had received intravenous benzodiazepines (1985 and 1989), and Whitwam and Hooper’s 1988 paper on the efficacy and safety of flumazenil.

As Nigel Robb observed, one of Digest’s more enduring features has been the ‘Journal Scan’ (or equivalent). 

In March 1988 the equivalent section was entitled Sedation Abstracts. The first abstract in Volume 7, issue no. 2, is entitled “Sedation with Propofol.” The modest conclusion is “This paper seems to indicate that a study using propofol for dental sedation might prove to be valuable.” Throughout its history SAAD Digest has sought to bring innovation to the attention of SAAD’s membership and this modest review is a good example of this philosophy.

Traditionally SAAD's activities have been recorded in the society's journal, the SAAD Digest. Over the years the journal struggled to have impact as it was edited by an enthusiast or a coerced council member with courage but lacking journalistic or scientific skills. and it had to compete with a host of glossy dental journals. It became clear this was too much to expect of an individual alone. SAAD Digest was re-launched in 2006 as a well-produced and relevant journal created by an editorial team.

SAAD Digest in its current form was conceived of in 2005 following Andrea Wraith’s resignation in 2004. It was decided that, beginning in 2006, a single issue of Digest would be published annually (consequently, no SAAD Digests appeared in 2005). In 2005 an Editorial Board was also appointed for the first time in SAAD Digest’s history, meaning that articles submitted for publication would now be subject to peer review.

The first edition of the revised SAAD Digest appeared in May 2006. In his editorial, the new Editor, Nigel Robb, reflected on these changes.

“The SAAD Digest has been held in high regard for many years by those practising sedation.  It has contained many seminal papers that are often quoted as the basis for different aspects of practice.  However, the articles have never previously been subject to peer review.  Adopting this process will enhance the reputation of the publication.”

The Editor also reiterated the mission of SAAD Digest ‘to inform and update on issues of interest to the SAAD membership, and to the wider community of those providing high-quality pain and anxiety control in dentistry.’

Included in this first edition of the new SAAD Digest were abstracts of presentations given at the 2005 Symposium, a report on the day, and an original article on mentoring by Derek Debuse. This latter was particularly welcomed by the Editor: ‘[mentoring] is fundamental to the teaching of sedation, as it provides a way of bridging the gap between the training provided by the SAAD sedation course and independent practice.’  This 22nd Volume of SAAD Digest also featured the Journal Scan along with reviews of articles in both medical and dental journals. One striking new development was the form of its cover, which was given over to a photomicrograph of a drug. This form of cover design would continue unbroken until 2017, when, to mark SAAD’s anniversary year, its cover featured a display of SAAD Digest in its previous incarnations.

SAAD Digest moved to its January publication slot in 2007 and, in the words of Nigel Robb, has since followed a path of ‘evolution rather than revolution’. However, there have been several noteworthy developments in its recent history including, from 2009, the inclusion of a ‘What’s New In…’ section that has provided members with information on the latest developments in areas from local anaesthesia to anxiety management without drugs. In 2014 this section was authored by Professor Enrico Facco, President of the European Federation for the Advancement of Anaesthesia in Dentistry and addressed hypnotherapy. This followed a series of three articles on acupuncture by Tom Thayer that appeared in Digest in 2001, illustrating the range of its coverage.

In 2013, the Journal Scan expanded to take in articles of interest from the psychology literature, a development which coincided with the appointment of health psychologist Jennifer Hare (Guy’s Hospital) to the editorial board. Another new development came in 2012 when the publication became available to members in electronic form.

In line with other journals, SAAD Digest began to offer a free, online verifiable Continuing Professional Development (CPD) scheme to members in 2013.  Up to 4 CPD hours are currently available, awarded based on correct responses to multiple choice questions on referred papers appearing in Digest. As the Editor recently pointed out, the value of this scheme is considerable: ‘Since the IACSD endorsed the recommendations of the Independent Expert Group on Training and Standards for Sedation in Dentistry, all involved in the practice of sedation are required to complete 12 hours of verifiable CPD in each five-year cycle. The CPD available in Digest can make a significant contribution to achieving this target.’

The editorial of the 2016 SAAD Digest (Vol.32) was authored by SAAD’s new President Francis Collier, who highlighted the themes of his term of office: an ongoing commitment to improving the representational balance of SAAD’s Board; continuing recognition of the importance of, and support for, sedation services in primary care environments; and the promotion of conscious sedation within special care dentistry provision.

SAAD Digest in 2017 carried a total of five refereed papers, including an article on the use of capnography in sedation. Its significance was highlighted by the Editor, who reflected that: ‘The Academy of Medical Royal Colleges’ overarching document on Safe Sedation referred to capnography as a “Developmental Standard”. It is my view that within a few years these monitors are likely to replace pulse oximeters as the way of monitoring respiratory depression in sedated patients.’ Also included in this volume of Digest were a paper by the SAAD-funded PhD candidate Joe Hulin on ‘The Decisional Needs of Young Patients Faced with the Decision to Undergo Dental Treatment with Sedation or GA’, and essays by four winners and runners-up of SAAD essay prizes. 

Nigel Robb says:

‘SAAD Digest remains as one of the main tangible benefits that members receive from SAAD. It continues to evolve with the society.

The editorial board has members from dental, medical and psychological backgrounds, covering primary secondary and tertiary care environments. As we move forward to the next 60 years of SAAD, Digest will continue to be proactive in seeking publications of interest to the membership and being a force for the advancement of the care of patients who have difficulty accessing dental care under local anaesthesia and advancing pain and anxiety control in dentistry.’

There have been many contributors to SAAD since 1957. Most are not mentioned here, not out of lack of respect or effort to record properly but all historical accounts carry some slant. Much of this history is gleaned from archived documents verbal accounts and the memories of current members and personal recollection. There have been many contributing council members, trustees, administrators, and helpers as well as long suffering partners and spouses. SAAD has occasionally been blessed with "lynch pins" who quietly but attention to detail cemented together the varied interests and needs of SAAD Council and SAAD Board. Two such people are SAAD's Secretary for many years, Margaret Hughes and in today's guise, the society's Executive Secretary Fiona Trimingham. Without all these individuals the society would not be the success it is today. 

SAAD’s membership peaked in 2004/2005, at 4225 members.  Membership currently stands at around 1,500 with members both in Europe (Ireland, France, Germany, Spain, Portugal, Italy, Poland) and beyond (Singapore, Indonesia, Japan, UAE, Hong Kong, NZ, Australia, Canada, USA). In addition, women now comprise just over 50% of the Board of Trustees. While there is always work to do to ensure that SAAD remains a dynamic, energetic, representative, and relevant body, its past and present should be a source of pride.