Have you extracted your wisdom teeth? I’ll have mine removed next Tuesday! At first I chose the General Anesthesia option i.e totally unconscious during the procedure. Then I was told that GA isn’t recommended unless it’s really needed. I also freaked out after reading this website! So I immediately changed my mind and opted for local anesthesia instead! Two teeth will be removed next week and the other two some other day. Total cost for all 4 teeth is about $900+ …

* I actually went through the Poly Clinic on Tuesday morning to get a referral letter so that I can get a subsidized rate. They referred me to the National Dental Centre (NDC). I called NDC immediately and was lucky enough to get an appointment on Tuesday itself in the afternoon! The dentist at NDC checked my teeth and x-rayed them. My lower right tooth must be extracted. If they extract the lower right, they must also extract the upper right. As for the rest of my wisdom teeth, I can remove them now or later.

Why is General Anesthesia not used very much for dental work?

General anesthesia is a procedure which is never without risk (including the risk of death). Apart from the risk of death (which, while very small, is still significantly higher than for conscious IV sedation), general anesthesia has a few major disadvantages:

(1) Complications are more likely with GA compared with conscious sedation both during and after the procedure. GA depresses the cardiovascular and respiratory systems. For some groups of medically compromised patients, it is contraindicated for elective procedures.

(2) It’s not recommended for routine dental work like fillings. The potential risk involved is too high to warrant the use of GA. For things like fillings, a breathing tube must be inserted, because otherwise, little bits of tooth, other debris or saliva could enter the airway and produce airway obstruction or cause illnesses like pneumonia.

(3) Laboratory tests, chest x-rays and ECG are often required before having GA, because of the greater risks involved.

(4) Very advanced training and an anesthesia team are required, and special equipment and facilities are needed. GA introduces a number of technical problems for the operator (i. e. dentist), especially when a “breathing tube” is involved: the tongue is brought forward more into the dentist’s way by the airway tubing, the muscles are paralysed so the operator is working against a dead weight all the time and there are postural problems because the patient can’t be moved about much. The operator can get very tired very quickly when doing a session. It’s physically the most demanding kind of dentistry (usually standing, hot lights, compromised patient position).

(5) You can’t drink or eat for 6 hours before the procedure (otherwise, vomiting is possible and this would be extremely dangerous during GA).

(6) It’s expensive.

(7) GA does nothing to reduce dental anxiety. The next time you need any work, or even a routine check-up, you’ll most likely be as afraid as ever. This may not be applicable to all situations - as mentioned below, GA can be useful or even indicated for certain situations.

As a means of anxiety management however, GA is next to useless. Anecdotal evidence suggests that people who have treatment done under GA as a means of anxiety-control are less likely return for regular check-ups and cleanings which are necessary to maintain dental health. Obviously, there may be exceptions.

Are there any circumstances under which general anesthesia should be used?

Exceptional circumstances include treatment for certain groups of special needs patients, procedures which would be very unpleasant if you were conscious (such as very complex extractions of bony impacted wisdom teeth), certain other types of oral surgery, and people with an extreme anxiety of dental procedures for whom conscious IV sedation isn’t enough (although IV sedation works fine for about 97% of people with a high anxiety of dental procedures).

If it’s extractions that really terrify you, it may be possible to be put to sleep for the extractions and then have fillings etc. done under conscious sedation with local anesthetic. However, general anesthesia is not widely on offer, and must be carried out in a hospital, in the UK at least.

How is it administered?

GA is usually started off with an injection in the hand or arm. It can be supplemented by a face mask but if a face mask is used you probably won’t remember it.

If post-op pain is expected, the normal practice is to inject a long acting local anesthetic during the GA, so that when you wake up everything is nice and numb for a good few hours (say 6 hours?) afterwards, which should give you time to take some painkillers and allow them to kick in. It’s much better to premptively stop pain than it is to try to deal with it once it has started.

“I need to have severely impacted wisdom teeth taken out, and the oral surgeon strongly recommends GA - but I’m scared to death of being ‘put to sleep’ and not waking up!”

If GA has actually been recommended because the surgeon anticipates that the removal will be difficult, general anesthesia will make things much easier for you. Provided that a qualified anesthesist oversees the procedure, the risk of death is very small. A study from 1982 entitled “Deaths associated with dentistry” (British Dental Journal) put the mortality rate at 1:338,536 for outpatient general anesthesia.