The Use of General Anesthesia in Dental Treatment

Anästhesist bei Narkose im OP© Stephan Morrosch - Fotolia.com

Narkose

Anesthesia is a medication-induced controlled condition of unconsciousness.

Through paralysis of the central nervous system, anesthesia shuts down body functions such as consciousness, pain sensibility, defensive reflexes and muscle tension. The anesthesia also temporarily closes down important protective reflexes such as breathing, choking and coughing reflexes. The coughing reflex is usually intended to keep the trachea free of foreign objects and contamination. Therefore, in order to keep the stomach content from entering the respiratory tract, it is important that the stomach is empty. The patient must also be completely sober.

Intubation should be performed after the patient loses consciousness. A special camera allows you to see how the breathing tube is guided through the voice box. Behind the voice box is the trachea. The breathing tube can be inserted through the mouth or through the nose. Using the nose simplifies working conditions for the dentist. Intubation, or the penetration of the trachea with breathing tubes, also prevents breathing in of foreign objects.

Furthermore, there should always be machines that supervise the patient’s breathing, heart beat and circulation. These can provide assisted breathing in case of complications. With the use of these machines, the anesthetist can control the anesthesia while the first surgical steps are carried out in the mouth. Without such equipment, dental surgeries should not be performed using anesthesia.

In dentistry, it is common to talk about “twilight sleep” and “short-term anesthesia.” These terms are misleading for the patient because anesthesia is anesthesia. The same medication is used in all cases. The medication – mostly Propofol – is injected using a perfusor in order to keep the anesthesia going. Additionally, other medications are used that can help decrease pain sensibility and muscle tension.

A complete, high quality restoration of the teeth is not possible when using anesthesia because many dental materials need to harden for a certain period of time before additional work can be performed. Furthermore, many intermediate steps are required when working with dental materials. Therefore, theoretically, a complete tooth restoration would require anesthesia lasting a couple of days; only then would the dentist have enough time to perform all required steps and leave enough time for all the materials to harden properly. However, the likelihood of complications increases with the duration of anesthesia.

A responsible dentist informs patients about all aspects of using anesthesia and only uses anesthesia as an additional treatment option when dealing with a nervous or anxious patient in order to initiate surgical steps. Also, the issue of fear should be addressed before surgery, possibly with the help of a psychotherapist.

Unless the patient makes significant changes when it comes to cleaning and maintenance habits, the dentist’s work can be considered useless and the use of anesthesia is not worth the risk.  The patient’s dental problems may be put off by a few years, but they may never be permanently resolved.

On the topic of anesthesia, it is worth highlighting the contributions of two pioneering dentists in the field. An American dentist, Horace Wells (1815-1848), witnessed an experimental, public display of the consequences of a young man inhaling laughing gas. The public display was conducted by chemist G.Q. Colton . Wells observed how the young man got injured badly on the shin while under the influence of the gas but did not appear to feel any pain. With Colton’s help, Wells successfully tested the method during a tooth extraction.

However, a demonstration at Massachusetts General Hospital at Harvard University in Boston ended in a fiasco as the patient suffered from pain even after inhaling laughing gas. This failed display in Boston caused laughing gas to be temporarily forgotten within the medical world. On October 16th, 1846, another American dentist, William Thomas Green Morton(1819-1868), discovered the importance of ether for anesthetic purposes and performed a successful anesthesia  in the same location of Wells’ failed experiment. This date is known as the birth date of modern anesthesia.

Click here to see the video: Dental Anesthesia

This post is also available in: German

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