Dental General anesthesia offers the deepest form of sedation that can be used to provide relaxation and analgesia during dental procedures. General anesthesia use in dentistry is necessary only in special circumstances and it is reserved for a very limited number of cases such as very anxious children, extremely phobic or patients with special needs, or extensive dental surgery procedures.
General anesthesia is defined as a state of drug-induced unconsciousness, during which there is a loss of feeling or sensation and patients can not respond to verbal commands or physical stimulation (even to painful stimulation). There is also a complete loss of protective reflexes including those required for independently maintaining the airway.
The term “anesthesia” comes from the Greek “an” + “aisthisia” which means "loss of sensation", describing a reversible condition where the patient has no sensation (including pain) from his body or parts of it. While local and regional anesthesia are procedures used to control pain during surgery for specific parts of the body without affecting the brain function, general anesthesia is a procedure that puts the patient into a state of controlled sleep and unconsciousness.
General anesthesia is mainly used for medical surgical procedures, however the use of general anesthesia in dentistry also is required in certain cases. Dental general anesthesia is considered less invasive because it usually does not require intubation to maintain breathing.
Dental general anesthesia is used to eliminate dental anxiety, relieve pain, and immobilize the patient allowing the dentist to focus on performing the dental procedures. The dentist can work much faster on the anesthetized patient and for longer time, reducing the need of multiple dental visits.
Patients having dental treatment under general anesthesia are completely unconscious, unaware of what is happening during the surgery, do not feel pain or other sensation, and after the procedure they have no memory of it.
For adult healthy patients, dental general anesthesia can be utilized for complex oral surgery procedures (e.g., removal of impacted wisdom teeth) but it is not recommended for routine dental work like fillings. The relative risk involved is too high to warrant the use of general anesthesia for simple procedures.
In US, general anesthesia can be delivered either in a hospital setting (normally in an outpatient basis) or in a dental office that is properly equipped, staffed, and licensed. However in other countries, such as UK, dental procedures under general anesthesia or deep sedation can be performed only in a hospital or specialist clinic.
Deep sedation is a state of sedation when patients have a “deeply depressed level of consciousness” but they still respond to pain with reflex withdrawal, while in general anesthesia there is a complete loss of consciousness. The boundaries between deep sedation and general anesthesia can not be clearly identified clinically, and a patient’s state may move between both conditions during a sedation procedure. Therefore in some countries deep sedation is considered equivalent to general anesthesia.
Sleep dentistry is a term that is commonly found in the advertisements of many dentists. However, the use of the term “sleep dentistry” is inaccurate because most of the dentists claiming it offer only conscious sedation. Although lighter methods of dental sedation do put the patient in a “near sleep” condition, the term “sleep dentistry” can properly be used only by dentists who are qualified to administer general anesthesia.