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22/Jan/2021

Multiple dental extraction is defined as removal of more than one tooth in a single dental visit. This procedue usually will be done under general anaesthesia (GA) in the hospital setup. Dental extraction under GA also can be performed on children who is anxious, uncooperative or having medical condition such as cerebral palsy or hyperactive child. In some cases, dental extraction under GA is done on children with badly decay teeth which needed multiple dental visit for extraction. It is therefore, better to have it done under general anaesthesia.

The indications of dental extractions under general anesthesia are:

    • Young child with rampant decayed teeth
    • Children who is unsuitable for local anesthetic or conscious sedation due to lack of cooperation
    • Patient with medical condition such as cerebral palsy or severe seizure
    • Patient who required lot of tooth extraction

     

Dental extraction under GA di performed in the hospital setup as day-care (no hospitalization). The patient (or the child) is usually health (ASA I) and fasting since midnight. The anesthesiologist will assess the child and written consent is taken before the procedure started.

In the operating room, the anesthesiologist will put a tube in patient’s throat to administer ‘sleeping’ gas allowing patient to ‘sleep’ during the whole procedure. The oral surgeon will come in to perform the dental extraction. After the procedure, the tube with be removed from the patient’s throat, and he will placed in the recovery room. He will be allowed to discharge from the hospital when fully conscious and ambulated.

Upon the procedure, a minor bleeding in extraction site, swollen tongue/lip/chin/cheek, temporary mouth opening limitation are the sequelae or conditions to be expected.

Advantage of extraction under GA

  • Very useful to traet uncooperative patient
  • Patient has no experience of the awlful dental extraction
  • No need many dental visit for extraction
  • Other dental procedures such as fillings and dental cleaning can sometimes be done in the same visit

Disadvantage of extraction under GA

  • Patient has to be healthy for GA
  • The procedure has to be done in the hospital setup with OT facility
  • Treatment will cost more as the patient has to be admitted in the hospital as well as GA fees

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02/Dec/2020

In general anesthesia (GA), drugs are administered by intravenous or inhalation routes which makes the person to be unconscious and do not feel or remember anything during the surgery. This patient is not wakened even by painful stimulation. General anaesthesia currently can only be performed in the operating room under the hospital setup where the sleep doctor (anaesthesiologist) will be the one to make the patient sleep.

GA is recommended for:

  • Complicated, extensive, and prolonged treatment to be performed
  • Working in difficult or multiple areas in the mouth
  • Patient with special needs
  • Uncooperative patient
  • Patient with extremely dental anxiety – only if other form of sedation are ineffective

Advantages

  • The patient is unconscious – allows the dentist to perform surgery without concern of constantly moving, uncooperating or anxiety patient.
  • Patient do not feel pain
  • Patient cannot remember events occurred during the surgery
  • Longer operating time

Disadvantages

  • The patient is unconscious – can be life threatening
  • Higher risk of complications – higher risk of airway obstruction because patient unable to cough
  • Patient cannot control the situation – do not respond to sound and touch
  • Require assistant to maintain a patent airway – patient cannot breathe on his own
  • Very expensive – require special equipment
  • Patient must fast at least 8 hours before surgery
  • Requires adequately and specially trained doctor (anesthesiologist) to perform
  • Time consuming procedure – long recovery period

Procedures

  • Before administering GA, the patient should be assessed thoroughly by the anesthesiologist by taking detailed medical history, drug history, physical test, and extensive laboratory test. The patient should be explained about the procedure and informed consent form should be signed by the patient. Patient must fast at least 8 hours before the procedure.
  • Then, GA drug administered intravenously or by inhalation to induce general anaesthesia.
  • After GA is induced, the doctor will secure your airway by placing a tube into your lung via the nose, mouth or a opening in the neck to ensure sufficient oxygen to reach your lung before dental treatment begins.
  • When dentist has finished the dental treatment, the doctor will stop the administration of GA drugs and begins to bring the patient back to consciousness. The patient should be monitored for 1-2days before discharging.

The uses for general anesthesia in dentistry have decreased over the years as other less invasive sedation techniques have evolved. Nevertheless, there are still many situations that require the use of GA.

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