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Dutch investigate mentally ill

patients that is required to manage lists for dental exodontia. It has been obvious for many years that the time when each dental surgery could provide general anaesthetic services has been coming to an end. The provision of general anaesthesia is at last being recognised by all but those ignorant of danger as "not something for amateurs" (to quote Minerva2). The general medical practitioners and general dental practitioners who, after a brief undergraduate spell with a rag and bottle or Makesson 100% nitrous oxide machine, provided anaesthesia from the first day of qualification are now all approaching, or past, retirement. When consultants can collect, without quibble, more for a private anaesthetic for a dilatation and curettage than an evening spent stressing the coronaries in a poorly equipped dental surgery,3 why should they give dental anaesthetics? Recent pronouncements by the sheriff in Scottish inquests regarding the need for electrocardiographic monitoring during dental anaesthesia and the condemnation by the coroner of a dentist who failed to resuscitate the first patient who died in his 25 years of giving "anaesthetics" (because he had not had the continuing training that anaesthetists are expected to undergo) also sped up the change. The Poswillo report firmly classifies the polypharmacy employed by some in the name of sedation as general anaesthesia. There will be many patients for whom conservation work in the dental surgery will be impossible without the full set up for general anaesthesia being provided. We provide this service in our community clinic among the original mentally handicapped patients and note greatly increasing demands. We are therefore rather concerned that the provisions for dental anaesthesia in the community service seem to be shrinking in many parts of the country. This is no doubt because short sighted financial restraints have been placed on these services and accordingly consultants are reluctant to venture out from the main hospital to work. We believe that the clinics should be on the site of or in the community hospital so that expensive equipment can serve both. We also believe that if the standard of staffing and equipment of the clinics matches that of the main hospital the safety of the patients will be the same.