Dental Anaesthesia : An Overview.

Dentists have been the founder of anaesthesia because of their day to day experience of pain while doing their job. Due to high morbidity and mortality, general anaesthesia never won the heart and trust of the dentist. Although several local anaesthetic agents were used in dental practice but they could not last long due to toxic side effects. A new chapter was written in dental anaesthesia with the invention of wonder drug “Lidocaine” and till date it remains the most popular drug amongst the dental fraternity for the majority of the dental procedures. Recently due to safe new drugs, techniques and advanced monitoring the concept of general anaesthesia for dental surgeries has reemerged and is being used with minimal morbidity and mortality at several centers. In the present review article after obtaining the literature from PUB MED/MEDLINE, books and print journals we have discussed in detail the drugs, techniques, complications along with their management, and new development in dental anaesthesia.

Dental anaesthesia in Siriraj Hospital.

We reported the use of anaesthesia for dental treatment and surgery in 60 patients during September 1989 – December 1990. Most of the pathological indications comprised dental caries, impacted teeth, bone exostosis and infection in the oral cavity. Twenty percent of the patients came to our unit in order to avoid dental treatment under local infiltration with local anaesthetics. Forty-seven percent of patients had associated diseases and 21 percent had taken regular medication. The laboratory investigation is helpful only when was indicated by history and physical examination. A routine complete blood count should be replaced with hematocrit and a routine urine examination should be abandoned. The method of payment for treatment was cash out of pocket 64.9 percent, reimbursement 28.1 percent and financial assistances 7.1 percent, but the fee for anaesthesia had to be reduced because costs of anaesthesia were much more than local infiltration. General anaesthesia was used in 58 patients and intravenous sedation in 2 patients. Monitoring included pulse oximetry, automated blood pressure, EKG, stethoscopy, because the anaesthesiologist and the dentist had to share the airway and the patients had to be ambulatory within a few hours. Anaesthetic time was less than 90 minutes in 81.7 percent of the patients and recovery time was less than three hours in 73.3 percent of them. Only minor complications were noted in recovery time was 13.1 percent and nausea 11.7 percent. Ninety-six percent of the patients were satisfied with the result of treatment under anaesthesia. Therefore, while dental anaesthesia needs the presence of competent anaesthesiologists and close monitoring, it can help dentists in performing their work and overcoming the inconvenience of the patients.