Who needs General Anesthesia Dentistry?
Who needs Dental General Anesthesia?
General Anesthesia in dentistry is required for only a small number of cases.
Performing dental treatments in completely unconscious patients under general anesthesia poses an increased level of risk for the patient, which is not always necessary.
However in some cases the use of dental general anesthesia is unavoidable, especially in case of physically or mentally handicapped, or some extremely phobic patients.
Indications for the use of General Anesthesia Dentistry
Many patients may prefer to have their dental treatments performed under some form of dental sedation or even general anesthesia.
These patient groups generally include:
- Patients with dental anxiety or dental phobia.
- Patients that are about to undergo extensive and invasive oral surgery (e.g. removal of impacted wisdom teeth).
- Patients with time constraints, who want their dental treatments to be completed in as less appointments as possible.
- Patients with sensitive gagging reflex, or very low pain threshold.
However, most of these patients can be treated without the need for general anesthesia. Local anesthesia in combination with any form of conscious dental sedation
(using nitrous oxide, oral sedation, or iv sedation)
are enough to provide an adequate level of relaxation and comfort during dental procedures for the majority of patients.
In recent years, the progress in the technology of sedative drugs and conscious sedation protocols have reduced significantly the number of patients who can not be treated using other more conservative sedation methods
and still require the use of dental general anesthesia to tolerate dental treatment.
Before proceeding to use general anesthesia. the dentist must explain to the patient the potential risks of general anesthesia versus other sedation methods and discuss alternative solutions
using conscious sedation which is very effective and much safer.
General anesthesia should be viewed as a last reserve for most patients seeking general dental treatment, and be used only when other sedation methods can not provide the desired results.
When Dental General Anesthesia is recommended?
Conscious dental sedation should be used in preference to general anaesthesia whenever possible. But some complex cases, highly phobic and special needs patients,
and children may require the more controlled and deeper sedation level of general anesthesia.
For certain patients, dentists may be unable to provide dental treatment unless the patient is totally unconscious. General anesthesia may be recommended in case of:
- Severely dental phobic patients. Few people with severe dental anxiety may find it impossible to cooperate, remain calm and stay still even under conscious dental sedation. For them GA may be the only solution.
- Difficulty of getting numbed. Some patients have a very high tolerance even to the drugs used for IV conscious sedation. In this case general anesthesia is needed to provide satisfactory pain management.
- Invasive or complex dental procedures (e.g. maxillofacial surgery). Some complex and lengthy treatments may be extremely tiring and exhaustive for the patient, so that GA can help eliminate patient’s fatigue.
- Need for muscle relaxation. Procedures that require the use of medicines for muscle relaxation may affect the patient’s breathing ability. In such cases, breathing can best be supported if general anesthesia is used.
- Anxious children who cannot stay still during surgery and need general anesthesia.
- Special needs patients such as:
- Mentally or emotionally handicapped patients (e.g. Down syndrome, Autism, Alzheimer) who can not remain relaxed and cooperative during treatment.
- Physically handicapped patients (e.g. Parkinson’s disease, Cerebral Palsy, or other muscle disorders) who have muscle spasms and can not control their movements.
Restrictions for the use of Dental General Anesthesia
Even if a patient is included in the groups where general anesthesia may be recommended, there are several disadvantages and contraindications that both the dentist
and the patient must take into considerations before GA is selected as the most suitable options. These may include:
- General Anesthesia risks. Although the safety of GA has improved dramatically over the past, it may pose an increased health risk for some patients compared to conscious sedation.
- Medical conditions – Allergies. Patients with certain medical conditions have higher risk of complications during or after GA.
- Pre-operative tests. Laboratory blood tests, chest x-rays and electrocardiograph (ECG) are often required before having GA, because of the greater risks involved.
- Pre-operative and post-operative restrictions. You can’t drink or eat for 6 hours before the procedure, and you must take at least a day off after the procedure until you have fully recovered.
- Hospitalization. Although in US dental general anesthesia can be administered in properly equipped, staffed and licensed private practices, procedures under GA are usually performed in hospital environment. In most other countries, GA can only be provided as a hospital-based service where there is access to intensive care facilities.
- Cost. General anesthesia is much more expensive than other sedation methods because it requires the presence of a dental anesthesiologist, expensive equipment for patient monitoring, and it is usually performed in a hospital.
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General anesthesia can be appropriate for highly phobic patients, patients receiving complex oral surgical procedures and those with certain physical and mental handicaps,
but due to the increased health risks, GA should be reserved only for cases that it is really necessary.