Is it possible to treat teeth under general anesthesia?

Nowadays, with many safe anesthetic drugs available, the use of general anesthesia for dental treatment or extraction may seem excessive. However, it allows you to carry out any procedure - treatment, tooth extraction, restoration of fillings or sanitation of the oral cavity - completely painlessly. Many people still choose to have teeth removed under general anesthesia. Be that as it may, the choice of anesthesia method remains with the patient; the doctor’s duty in this case is to give the patient information about the advantages and consequences of each method.

Types of combined anesthesia

Neuroleptanelgesia. The method involves a combination of antipsychotic and narcotic drugs. In this case, antipsychotics have an inhibitory effect on the nervous system, and narcotic substances enhance the analgesic effect. The drugs most often used are: etapyrazine, aminazine, droperidol and haloperidol;

Ataralgesia. The combination of analgesics and tranquilizers gives a calming, relaxing and analgesic effect. The most commonly used tranquilizer components are: Relanium, Elenium, Phenazepam and Grandaxin.

Intubation anesthesia. The substance enters the respiratory system using a laryngeal mask. Due to its complexity, this method is also not used often.

Contraindications

General anesthesia cannot always be used, even if there are indications for it. So, it cannot be used if the patient:

existing chronic diseases have worsened;
acute heart failure;
recently had a myocardial infarction (at least six months must have passed);
acute infectious disease;
epilepsy;
dysfunction of the respiratory system;
anemia;
diabetes in the stage of decompensation.

Pregnant women are also not recommended to have teeth pulled out under general anesthesia, since medications introduced into the body during the procedure have a toxic effect on the fetus and can cause disturbances in its development.

Introduction of anesthesia: step-by-step description

Introduction to a state of anesthesia.
Analgesia. The duration of the stage is approximately 4-5 minutes. At this time, the patient's pain sensitivity decreases, but all reflexes and stable body temperature are preserved.
Excitation. The duration of the stage is 7 minutes. During this period, the following are observed: instability of pulse and temperature, increased salivation and muscle tone.
Maintaining anesthesia. This stage is conditionally divided into several stages-levels:
Easy. Characterized by rhythmic breathing and muscle relaxation. At this point, the doctor can already begin initial, superficial manipulations;
Full anesthesia. There is complete relaxation of the muscles, rhythmicity of the pulse and breathing, and a slight decrease in blood pressure;
Ultra-deep anesthesia. Characterized by shallow breathing, weak pulse and low blood pressure.

After completing the manipulations, the supply of the anesthetic substance is stopped and it is replaced with pure oxygen for 2-3 minutes. It is during this interval that the patient awakens, and after 30 minutes his complete recovery is observed.

Preventive measures

In order for the rehabilitation period to pass faster and to avoid negative consequences, the following recommendations must be followed:

No later than 10 minutes after a sterile swab has been applied to the wound, it must be removed from the oral cavity. This will avoid infection and inflammation.
You cannot eat for three hours after surgery and anesthesia. If thirst occurs, you can drink clean water.
Physical activity and hot water procedures (including shower, bath, sauna, steam bath) are contraindicated for a couple of days after surgery. You should also not heat your cheek.
You should not smoke or drink alcohol for several days, this will help prevent the seams from coming apart.
If the patient is experiencing severe pain, an ice compress will help reduce the pain. You can apply cold for no more than five minutes. The doctor may also prescribe pain relievers.
The patient must take all prescribed medications.

A few days after the operation, you need to see your doctor, and if you experience unpleasant or severe pain, then sooner.

In our clinics, general anesthesia is not used.

The main nuances and disadvantages of treatment under general anesthesia

There are a number of disadvantages in the question “ is it possible to treat teeth under general anesthesia ”:

There is an increased load on the pulmonary and cardiovascular systems;
Post-anesthesia symptoms are common: nausea, vomiting and weakness;
Due to limited time, it is possible that the selection of filling material is insufficiently high-quality and the treatment process is disrupted, which consists in the impossibility of preserving the anatomical forms of the tooth being restored.

All manipulations when working with general anesthesia are carried out by: a dentist, a nurse and an anesthesiologist. Throughout the procedure, the operation of all vital systems is constantly monitored.

Sedation in dentistry for children and adults –

As we said above, sedation is the general strong calming of the patient, in which he is on the verge of sleep. During sedation, the patient is able to perform simple actions at the request of the doctor (for example, opening his mouth) - although patients do not remember any of this afterwards. The big advantage is that sedation has no contraindications and is much easier to tolerate.

Dental extraction and treatment under sedation is much safer than under general anesthesia. For example, sedation can be performed on a patient every day (without harm to health), and there is no mortality from it. The patient wakes up just a few minutes after the end of the drug administration, and all patients immediately orient themselves well in space and move normally. Sedation is carried out by inhalation or intravenous route, or a combination of both.

The inhalation route of administration is not very convenient for interventions in the oral cavity. The most inexpensive option for inhalational sedation is the use of nitrous oxide; the drug Sevoran (sevoflurane) is much more effective. But if the latter already immediately has both a sedative and analgesic effect, then in any case, either local anesthesia or a narcotic analgesic will have to be added to nitrous oxide. The most modern version of sedation is intravenous sedation with the drugs Midazolam and Propofol (diprivan).

Drugs for intravenous sedation –

Of all the possible drugs for intravenous sedation, Midazolam and Propofol are the most modern and safe. Their administration causes depression of consciousness within 20-40 seconds. If a patient is planning to have teeth filled under sedation, then very often they are premedicated with a diphenhydramine solution (this is especially important in children). The latter contributes to a sharp decrease in salivation, which is very important for high-quality dental fillings.

Midazolam belongs to the class of benzodiazepines and is preferable for short-term interventions.
This drug has several benefits. Firstly, it is the shortest-acting benzodiazepine, which allows the anesthesiologist to make sedation as manageable as possible. The anesthesiologist will continually add small amounts of the drug during the treatment or tooth extraction process. The second advantage is that patients during shallow sedation with midazolam are even able to communicate with the doctor during treatment and follow his commands, but after the end of treatment they do not remember at all that the treatment was carried out. Those. the patient does not remember anything from the moment of the intravenous injection until he comes out of sedation. Disadvantage – it belongs to drugs from “list B”, and therefore requires additional permits.

Propofol (Diprivan) is a hypnotic that is intended for intravenous administration. It is a fairly expensive drug, so it is not used very often in Russia (although it is one of the most popular drugs in the world). Awakening from propofol sedation occurs more quickly and with fewer residual reactions than most other drugs.

Important: It should be noted that sedation and analgesia are not the same thing. Sedation involves turning off fear and anxiety, and at the same time the patient will be conscious (on the verge of sleep). Moreover, if a painful intervention is planned, then the patient under classical sedation with nitrous oxide, propofol or midazolam will feel pain. Therefore, in their pure form, these drugs are used only for those interventions that are not capable of causing pain. In other cases, analgesics are added to them.

Therefore, it is worth distinguishing between “conventional sedation” and “sedation with analgesia.” The first allows you to cope only with stress and fear of dental intervention, the second is also aimed at pain relief. To achieve pain relief, intravenous sedation drugs are combined, for example, with ketamine. Or you can immediately use an inhalation drug such as Sevoran (Sevoflurane), which has both a sedative and analgesic effect (24stoma.ru).

General anesthesia and sedation in dentistry for children - reviews

Dental treatment under sedation in children is possible at any age.
The anesthesiologist selects a drug for sedation based on the child’s age, physical activity, and level of aggressiveness. When only sedation (without pain relief) is required, it is better to use Propofol in children of any age. If sedation with anesthesia is required, use a combination of propofol with ketamine, or the inhalation anesthesia drug Sevoran. Separately, we note that inhalation anesthesia with Sevoran is not used for infants, and therefore either pure Propofol or a combination of propofol with ketamine will be indicated. Sedation in dentistry for children has the most positive reviews from parents, allowing them to neutralize the child’s fear of intervention, as well as sanitize the entire oral cavity - most often in just 1 visit to the dentist. However, if long-term interventions are necessary, preference will be given to general anesthesia, or sometimes a combination of both.

Sedation in dentistry in children: video (video 1 – child’s behavior during shallow sedation and recovery from it; video 2 – intravenous sedation).

Premedications

Sedatives of plant origin (Corvalol, tinctures of motherwort and valerian). Necessary to reduce excitability.
Neuroleptics (droperidine).
Anticholinergic drugs.
Opioid drugs (promedol and morphine).

The selection of the listed drugs is made by the attending physician, based on the specific situation and individual characteristics of the small patient. There must be a compelling reason to use general anesthesia in children.

Situations in which it is unlikely to be possible without anesthesia

Having studied the condition of the patient’s oral cavity and the results of x-ray diagnostics, a qualified dentist can immediately tell how the tooth will be removed. Most often, anesthesia is used when it comes to:

Chewing teeth with irregular and strongly “curled” roots. It takes a long time to extract them all. Anesthesia makes it possible to carry out the procedure carefully and in one visit, without unnecessary haste.
A wisdom tooth that has not fully erupted. Such operations are always difficult. The roots of eights are often intertwined. They have to be removed piece by piece through incisions made in the gums.
The need to pull out several molars at once during one visit to the doctor. This happens during the period of preparation for implantation and prosthetics. Additionally, the doctor can perform gum grafting and bone grafting.

Is it possible to remove teeth under general anesthesia?

Tooth extraction under general anesthesia requires compliance with all the previously listed measures and is carried out taking into account all individual nuances. Contraindications are given the greatest attention. If there is an excess of possible risks over the expected benefits, the use of general anesthesia is replaced by other measures.

Indications for use

Only a qualified dentist can decide whether anesthesia is necessary. Sometimes, out of fear, a person refuses to undergo removal under local anesthesia. But, if the procedure promises to be simple, it is not advisable to use systemic agents. It is wiser to use some kind of sedative and local anesthesia.

If the treatment is serious and takes a lot of time, the doctor himself will suggest general anesthesia. Indications for its use are:

inability to use topical products due to an allergy to their composition;
a sharp increase in blood pressure due to nervous experiences;
severe fear of treatment, which does not allow the patient to sit in the dental chair;
a very large volume of planned manipulations;
the presence of a pronounced gag reflex, which does not allow removal to be carried out calmly;
the presence of diseases due to which the patient cannot sit quietly.

Features of tooth extraction in the upper jaw

The structure of the upper and lower jaws is significantly different. They also vary in density and location. Therefore, the method of tooth extraction will differ:

on the upper jaw the operation is faster;
the recovery period is shorter;
pain relief is simpler and more effective.

Complications during tooth extraction in the upper jaw occur less frequently than in the lower jaw.

Anesthesia

The secret of high-quality pain relief is the correct delivery of the drug to the nerve. The choice of anesthesia method takes into account the patient’s age, his general condition, and the complexity of the tooth being removed.

Anesthesia of the upper jaw

The upper jaw is less dense than the lower jaw. It is covered with a cortical plate with many holes. Nerves and blood vessels pass through them. Pain relief is easier and faster than in the lower jaw

Sinus damage

Above the upper jaw is the nasal sinus, also known as the maxillary sinus. Its bottom may be close to the root of the tooth being removed. Then, during removal, sinus perforation may occur. This complication is typical for surgery on molars. This pattern is explained by the fact that the jaw in the area of the incisors is longer, and the nasal cavity is further away relative to them.

The main sign of sinus perforation is the escape of air, food and fluid through the nose. There is foam in the hole. Hospitalization in a hospital may be indicated for treatment.

Entry of part of the root into the sinus

Due to perforation of the sinus, part of the root can get inside it. This is caused by thinning of the bone plate or errors during the removal operation.

The symptoms when part of the root gets into the sinus are the same as when perforation occurs: air and contents of the oral cavity escape through the nose. But at the same time there is pain and increased body temperature. Treatment requires hospitalization.

Operation stages

Before removing a unit that cannot be restored, the dentist talks with the client and clarifies whether he is allergic to medications. The patient must first undergo a blood test and an electrocardiogram. The doctor also carefully studies the results of the completed studies to understand whether it is possible to proceed with surgical intervention.

On the day of surgery, the patient should not eat anything. The anesthetic is administered on an empty stomach. Almost immediately after this, the person falls asleep and relaxes. Then the doctor proceeds to treatment. An anesthesiologist is always nearby. He makes sure that all vital signs meet normal criteria.

The dose of anesthetic is calculated in such a way that about 10-20 minutes pass from the moment the last surgical procedures are performed until the client returns to consciousness. When the client wakes up, the surgeon inquires about his well-being. After an hour (sometimes later) he can go home.

Features and difficulties during removal

Extraction of the upper wisdom tooth is complicated by its specific anatomical features.
“Eights” erupt late, when the dentition is already formed. Therefore, very often they are incorrectly located, grow together with the roots of neighboring teeth, grow towards the cheek or even horizontally. Each of these factors complicates the extraction process placed on top of the 8th tooth. But if we compare wisdom tooth removal from above and below, then in the first case the surgical procedure is much simpler. In the upper dentition, the bone is less dense and massive, there are much fewer blood vessels in the soft tissues and the risks of damage to the trigeminal nerve are lower. Therefore, the operation to remove the G8 is easier and safer.