General anaesthesia for dentistry

Dental anaesthesia developed down a different pathway from the rest of anaesthesia. Techniques such as nasal mask anaesthesia in the sitting position were specific to dental surgery, which took place largely outside hospital in dental clinics. Now dental anaesthesia is confined to locations within the aegis of a hospital and anaesthetic techniques are similar to those in other surgical specialties. Dental surgery consists of extractions and conservation. Short procedures for the extraction of teeth may still be carried out using a nasal mask, but more difficult extractions and conservation procedures are best done with a laryngeal mask or endotracheal tube. Close liaison with the dental surgeon is imperative in the planning of the anaesthetic technique. The anaesthetist must support the jaw and head in order to provide counter-pressure to help the dentist and to prevent excessive movement of the neck. Patients needing general anaesthesia include children, those with allergy to local anaesthetics, and adults with special needs who may need premedication to enable induction to take place. During the recovery phase, the airway has to be watched carefully as the potential for obstruction is great and deaths have occurred. Paracetamol is a useful analgesic for extraction of deciduous teeth, and non-steroidal analgesics are used for pain control after extraction of permanent teeth, which is more painful. In addition, local anaesthetic injections are helpful in older children.