Dental treatment under general anesthesia (GA) is an excellent solution for kids with special physical and psychological health requirements. A pediatric dentist may consider administering treatment under general anesthesia if the child is too anxious, is undergoing complex dental treatment, has a strong gag reflex, or has special needs.

Dental treatment under GA is also necessary for children uncontrollable with sedation or local anesthesia since no patient cooperation is necessary.

General anesthesia (GA) means that your little one is fully asleep. The treatment approach allows the dentist to complete all treatment and x-rays in one appointment instead of local anesthesia, requiring four to five dental appointments. Additionally, the average time taken to complete comprehensive treatment under general anesthesia is around one and a half hours.

GA will minimize your child having a negative experience at the dental clinic and developing dental phobias. A study showed that negative dental experiences in childhood could influence dental fear in adulthood. This article discusses dental treatment under GA for children, how your dentist decides, the preparation process, and how to manage stress for both the parent and their child.

General anesthesia refers to a way of giving medicine to make a person fall “asleep.” It’s used during surgery and administered by breathing in a gas through a mask or an intravenous (IV) route. Below are some facts to note:

• Brisbane Kids dentist Dr Soha Sharif will only recommend GA to perform dental treatments when necessary
• Your child will sleep throughout the procedure and will wake up with no memory of it
• When your dentist opts to use GA, there are special rules for fasting, eating, and drinking at home in the hours leading up to the procedure
• Your child will face some restrictions after the procedure
• Take a day off to take care of your child after the procedure and monitor their progress
• Many young children benefit from the delivery of extensive dental treatment and care in one GA session

Why Use General Anesthesia for Dental Treatment?

A dentist will only opt to use general anesthesia for a dental procedure if they find it’s appropriate and if it keeps your child safe and comfortable. It’s also suitable when the dentist needs to perform extensive and complicated surgeries that could take a long time to complete or require several procedures done simultaneously.

In such cases, a pediatric anesthesiologist who specializes in anesthesia for children will administer the medications to your child to put them to sleep soundly during the procedure. GA will completely relax your child’s reflexes so they won’t feel any pain during the surgery or have any memory of it.

Your family dentist can do the following dental procedures while your child is under GA:

• Dental Examinations
• Radiographs
• Fissure sealants
• Fillings
• Scale and clean
• Nerve and pulp treatment
• Fluoride therapy
• Stainless steel crown for kids
• Tooth extractions

Dentistry using GA is the preferred management technique for the following pediatric patients:

• Children with special needs or disability: GA provides a safe method for the dental care of kids unable to cooperate because they have a limiting physical or mental condition
• Children with medically compromising disability: Some kids have a co-existing medical diagnosis that could either be medical or psychological, for example, brain injuries, Autism, or ADHD
• Children for whom local anesthesia or sedation is not effective
• Extremely uncooperative kids: For various reasons, your child may become extremely uncooperative, fearful, anxious, and physically resistant during dental treatment. In such cases, dentistry under GA is appropriate, especially when the dentist has no reason to believe or expect that the child’s behavior may improve
• Children with extensive dental trauma: Patients may require dental restoration work or extensive surgical procedures, and the dentist may consider local anesthesia ineffective
• Children who need several significant surgical procedures
• Children allergic to local anesthesia

GA is not the preferred or recommended treatment for healthy and cooperative children or kids with minimal dental needs. Additionally, dental treatment under GA is not permissible when a medical contraindication to GA is present.

Usually, the younger your child is, the higher their likelihood of needing general anesthesia for dental treatment. The decision rests with the judgment of the dentist but depends on a combination of the following factors:

• The child’s age
• The level of perceived anxiety
• The degree of the surgical trauma or procedures involved
• The complexity of the procedure
• The child’s history responding to similar surgeries
• The child’s medical requirement associated with anesthesia

The dentist must assess your child and consider all relevant factors before deciding to put them under GA since there are no fast rules.

Other factors that could influence the decision-making process include:

• Allergies
• Medications (current and previous)
• Physical and developmental status
• Weight of the child
• Specific surgical requirements
• Airway patency
• The child’s psychological status

Dentists only use general anesthesia when other management techniques fail or prove inappropriate and impractical. It means that your dentist will only employ dental treatment under GA after assessing all relevant factors and finds that it’s the most appropriate strategy.

Before general anesthesia, the anesthetist will need to review your child’s medical history and exam them. A separate preoperative anesthetic assessment may be necessary on the day preceding the surgery date. Below are some things that they need to be aware of:

• Behavioural issues including developmental delay and Autism
• Cardiac disease or heart murmur
• Extreme anxiety or needle phobia
• Previous surgeries
• Syndromes like Down Syndrome or velocardiofacial
• Respiratory disease or airway problems such as micrognathia, asthma, or history of croup
• Congenital disabilities
• Sleep apnoea, previous tracheostomy, or known history of intubation difficulties
• Neurological disease including cerebral palsy, epilepsy, or previous brain injuries
• Endocrine and metabolic disorders such as diabetes or genetic metabolic disorders
• Hematological such as hemophilia, thrombocytopenia, or hemoglobinopathies
• Neuromuscular disorders like muscular dystrophy
• Allergies such as an allergy to latex

In the week before the dental procedure, a nurse working with either the dentist or anesthesia doctor will call you to confirm the time to come in for the appointment. At this point, it’s critical to tell the nurse about any medicines that your child is taking or if they have fallen sick recently. Also, free up your schedule on the day of the dental procedure because you will need to take care of your child for the rest of the day.

On the day of the procedure, follow the following specific instructions for eating and drinking:

• Six hours of fasting from milk and solids
• Four hours of fasting from breast milk
• Two hours of fasting from clear fluids (these include water, Kool-Aid, Pedialyte, and see-through juices)

Generally, after midnight on the night before the procedure, don’t give your child solid food or non-clear fluids, including milk, formula, coffee, juices with pulp, candy, and chewing gum. Additionally, if your child takes daily medication, you can give it only if you disclosed it to the scheduling nurse or anesthesiologist and they cleared it.

It’s normal to be stressed and anxious before the dental procedure. Children become upset in unfamiliar environments or may be fearful of the dentist’s office if they are old enough to know what is happening.

Therefore, being with your child during induction can significantly reduce their anxiety as well as yours. Additionally, children can tell what their parents are feeling, so it’s a good idea to remain relaxed.

The dentist can also help reduce your child’s anxiety by:

• Giving them a tour of the facility
• Allowing their favorite toy at the clinic
• Providing a child-friendly environment
• Giving pre-induction sedation and post-procedure sedation
• Re-joining children and parents as early as possible after the procedure

Your child needs to rest for the remainder of the day. You also need to stay with them at home or have a responsible adult monitor them to see how they are doing. Your dentist will tell you when to return for a follow-up visit.

Sometimes the effects of GA – usually tiredness – lasts into the next day. Additionally, your dentist may give you medicine for your child’s sensitive gums. However, call your dentist if your child experiences the following symptoms for over 24 hours following the procedure:

• Fever
• Severe pain
• Severe bleeding of the gums
• dizziness
• Severe vomiting

Treatment under general anesthesia is the most costly form of dental treatment because of the added cost of hiring an anesthetist. Despite this, its demand is relatively high due to its practicality and effectiveness in specific instances, such as extensive dental treatment or kids with disabilities and psychological conditions that make it almost impossible to use any other type of anesthesia or sedation safely.

What’s more, many pediatric patients benefit from delivering extensive dental care within one GA session.

Dr Soha Sharif is a dentist for children in Brisbane, Queensland, and is fully registered and accredited to perform dental treatment under general anesthetic. A qualified specialist anesthetist administers the general anesthetic during her procedures. Contact puredentistry.com.au today or call (07) 3343 4869 to make a booking with our paediatric dentists.