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 specialities. Dental surgery consists of extractions and conservation. Short procedures for the extraction of teeth may still be carried out in children using a nasal mask, but more difficult extractions in adults and children, or 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 downward pressure applied to the mandible during the extraction of teeth may cause reduction in airway patency unless intubated, and the anaesthetist may need to support the jaw and head in order to provide counter-pressure, also preventing excessive movement of the neck.Patients needing general anaesthesia include children, those with allergy to local anaesthetics, and adults with special needs, as well as those adults who are likely to need surgical extractions with removal of alveolar bone. During the recovery phase, the airway has to be watched carefully as the potential for obstruction is increased due to stimulation and soiling of the larynx with bleeding. Paracetamol and non-steroidal analgesics are the mainstay of analgesia in combination with local anaesthetic infiltration and specific dental blocks. In addition, stronger analgesics such as tramadol may be required in adults who are having multiple extractions.It should be an aim to provide all dental surgery in a day case setting, and careful choice of the technique should make this possible for all but those with unstable cardiorespiratory disease.