Dental general anaesthesia — is there a need for it?

Key Points

• Parents and children are receptive to being steered away from DGA by clinicians willing to do so.

• Parents and patients appreciate information, explanation and being part of the decisions around the use of GA for dentistry.

• DGA may be unnecessary for up to three in four of patients referred for uncomplicated extractions, and may not be necessary at all for uncomplicated orthodontic extractions.

• Careful application of current professional guidance, coupled with a desire to avoid GA can significantly reduce numbers of children going on to have GA.

• Considerable reduction in future planned provision of DGA may be rather more realistic than has previously been thought to be possible.

• It is legitimate to start from a premise that DGA will not be used unless there are good reasons to do so.

Abstract

Aim

To find out how many patients for whom dental general anaesthesia was requested actually needed it in order to complete treatment.

Design

Analysis of clinical outcomes supported by telephone canvassing of parents.

Method

In summer 1998, eighty two child patients were seen in the Community Dental Service in Rochdale with a request for the provision of dental general anaesthesia (DGA) for the extraction of teeth. Their ages ranged from 3 to 14 years and all were required to attend for a pre-anaesthetic visit. Unless objective indicators of a need for DGA applied, the parents and children were actively discouraged from having DGA, and the alternative of local anaesthetic (LA) was offered. Clinical outcomes and parent satisfaction were recorded after treatment was finished.

Results

In 75% of cases it proved possible to complete the extractions without need for DGA; in the 10% of cases where DGA was necessary, it was to deal with the sequelae of dental caries. Fifteen percent of subjects failed to complete treatment. Subjects found to have a need for DGA tended to be younger and with treatment required in more than one sextant. Pain as a presenting symptom, young age and multiple treatment needs were found to be poor predictors of need for DGA and did not automatically preclude successful treatment without DGA. The satisfaction ascertained from users of the service was high and explanation of proposed treatments, especially the comparative risks and benefits of DGA versus LA, was well received.

Conclusion

There is scope for significant reduction in provision of dental general anaesthesia if current professional guidelines are followed.

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