Frequently asked questions and answers regarding general anesthesia for dentistry
Is general anesthesia the same as “sleep dentistry” or “sedation dentistry” terms that are currently popular?
Sleep dentistry implies a patient is asleep. However, what really happens is a pill is given, perhaps in conjunction with “laughing gas” or nitrous oxide, and the patient is not asleep but doesn’t remember the dental work being done. The results of this form of sedation are unpredictable at best. With general anesthesia there is no “half awake /half asleep” result as there is with a pill and in adults general anesthesia is achieved by administering drugs through an intravenous (in the vein) route.
What are the risks of being put to sleep in the dental office?
All operations and types of anesthesia have some risks and the likelihood of their occurrence depends upon the patients’ medical condition and the degree of difficulty of the surgery planned. Fortunately, serious adverse events are very rare. The (your) anesthesia care provider takes precautions to prevent an accident from occurring just as someone driving a car or crossing a street. The chances of death under anesthesia in healthy patients undergoing a relatively uncomplicated general anesthesia in an office for dental/oral surgery are less than one per 350,000.
Who will be doing the general anesthesia for my (relative’s) surgery?
A certified anesthesia care provider, dentist, physician, or nurse, will be performing the anesthesia service for the planned surgery. All anesthesia care providers in the office have completed an anesthesia postgraduate training program in a hospital. They are all board certified and licensed to administer general anesthesia. Presently there are three dentists who are Fellows in the American Dental Society of Anesthesiology and are Diplomates of the National Dental Board of Anesthesiology who work in either the Richmond or Fredericksburg offices.
What type of monitoring devices is used?
The type of anesthesia planned and the medical condition of the patient dictates the type of monitoring used. If the patient has serious medical problems even if local anesthesia alone is planned for the surgery, the anesthesia care provider may decide that pulse oximetry, blood pressure and electrocardiograph monitoring would be in the patient’s best interest. The depth of anesthesia might range from conscious sedation (minimal sedation), deep sedation (half awake and half asleep), or general anesthesia (fully asleep). There are specific anesthesia care guidelines published by several organizations including: American Dental Association (ADA), American Academy of Pediatric Dentists (AAPD), American Association of Oral and Maxillofacial Surgeons (AAOMS), and the American Board of Anesthesiologists (ASA). These guidelines are published by the organizations web sites or appear in their official publications and were developed for the protection of the patient undergoing office anesthesia. Our office complies will ALL the different guidelines.
Why are so many questions being asked about the patient’s health history?
Because anesthesia and surgery affect the entire body, it is important for the anesthesia care provider to be able to anticipate the effects of all anesthetics in relation to the drugs and medications that the patient is taking and may have been used in the recent past. This includes all prescription or non-prescription drugs: over-the-counter, herbals, or “street drugs”. Even marijuana, alcohol and tobacco use affects the way anesthetic drugs work in the body.
How will the anesthesia care provider handle medical problems under anesthesia?
Frequently, patients requiring office surgery have some medical problems such as diabetes, heart disease, Alzheimer’s or have medical conditions such as being physically handicapped or mentally challenged, that may affect the type of anesthesia administered. Rarely, a patient may also need to be admitted to the hospital after anesthesia if something unplanned occurs during anesthesia. Our offices utilize full hospital-grade monitoring including capnography, oximetry, defibrillators, transcutaneous pacing, and all the required emergency drugs including dantrolene and amiodarone with trained anesthesia care providers who can use these emergency treatments. All the office staff is basic life support trained and the doctors are all advanced or pediatric life support trained. Twice a year our staff undergoes anesthesia emergency training in the office to maintain readiness.
Are there any special instructions to follow before an anesthesia appointment?
It is very important that the oral intake (solid food and liquids) restrictions be understood and followed. Patients cannot eat any solid foods after midnight the night before the anesthesia/surgery. NO BREAKFAST on the day of surgery! For adults, clear liquids may be taken up to 3 hours before the dental appointment and for children (up to age 12 years old), clear liquids may be taken up to 2 hours before the appointment. The reason for the difference is that children empty their stomachs faster than adults. Clear liquids include: water, apple juice, tea or coffee with no milk or sugar. If the patient is taking any medication on a regular basis either the anesthesia care provider or the dental surgeon should approve it. Medications may be taken at any time before surgery with only small sips of water. These restrictions are to protect the patient from inhaling food during surgery. If this occurs the risk of pneumonia is very high and could be life threatening! If the restrictions are not followed, it may require postponing the surgery.
Smoking is strongly discouraged on the day of surgery. This sometimes decreases the amount of oxygen in the body for up to 4 hours after a cigarette!
All patients should have a responsible adult(s) stay in the office during the surgery. This allows the doctors to discuss any unexpected changes in the surgery planned.
Can the patient go to work or school the same or the next day?
It is important that a competent home caregiver (responsible adult) be with the patient throughout the day of surgery. Anesthetic drugs have after effects including nausea, dizziness, sleepiness, and loss of normal body coordination, or other signs or symptoms. Pain medication may even make these problems worse.
Usually there are no limitations on activity 24 hours after discharge from the office. The majority of patients even have no dizzy spells or bodily weakness the next morning. The decision to continue one’s daily activities should be based upon the presence or absence of any unusual signs or symptoms.
If there are any questions about postoperative issues, the patient should immediately contact the office or answering service of the appropriate doctors.
Is the anesthesia expensive and does insurance pay for some of the costs?
Price is not the most important consideration when a patient is deciding whether to have general anesthesia or sedation. What matters most is whether the surgery can be done well under local anesthesia alone! The dental surgeon will answer any questions about the entire anesthesia plan. Since the services are performed in the office, there is a considerable cost savings compared to the hospital. Usually insurance will not pay for office general anesthesia. But there are some exceptions. A statement of costs can be submitted to the applicable insurance, dental or medical, to aid in obtaining the estimated benefits allowed under the insurance plan. Generally a deposit for the anesthesia fees has to be paid at the time of scheduling the date of surgery. An estimate of benefits will then be assessed. The fees for the anesthesia can be paid with most major credit cards or the patient may be eligible for a care credit program. Fee information is available upon request, but is not discussed on-line.
©2009 Virginia Dental & Anesthesia Associates