Introduction:
Most children undergo dental procedures in traditional settings where doctors use behavioral techniques. However, some children fail to cope with in-office procedures like dental rehabilitation procedures, examinations, or radiographs and fail to respond to usual management modalities. Under general anesthesia, young children undergo rehabilitation operations.
For some children, treatment under general anesthesia can be practical and cost-effective. Younger children, worried youngsters, or those with physical, emotional, mental, or cognitive immaturity or disability are advised to undergo treatment under general anesthesia. Under general anesthesia, such individuals can be treated more safely and efficiently.
The US Food and Drug Administration recently warned that exposing children under three years of age to certain sedatives or general anesthetics may harm their brain development, particularly for treatments lasting longer than three hours.
What Is General Anesthesia for Children?
It is a medication that induces a child into deep sleep during dental procedures. Children who receive general anesthesia become asleep and lose their protective reflexes. Anesthesiologists can deliver general anesthetics in dental clinics or hospitals.
What Is the Procedure for Administering General Anesthesia in Pediatric Dentistry?
All the patients requiring general anesthesia must undergo initial screening by taking a detailed history and physical examination. Physical examination determines if it is possible to administer dental treatment under general anesthesia.
When suitable patients are selected, pre-operative instructions are given to parents to keep the child safe and to avoid intra or postoperative complications. Parents are advised on what to eat and drink before the operation day. Psychological care for pediatric patients is necessary to mitigate their suffering and foster positive relationships. Playing games and using other distraction strategies can help to lessen the patient's worry.
Pediatric patients are administered general anesthesia through masks, rectum, oral route, nasal transmucosal agent, intravenous, or intramuscular injections. However, for general anesthesia in children, inhalational anesthetics are favored. Inhalational agents generally used are nitrous oxide, isoflurane, desflurane, and sevoflurane. Sevoflurane is preferred because of its pleasant odor, low blood or gas partition coefficient, and reduced respiratory issues.
A local anesthetic might be used in addition to a general anesthetic for better bleeding control. Additionally, anesthesiology intervention, complications, and postoperative discomfort at the surgical site are all decreased. However, some doctors refrain from using local anesthetics due to worries about lip and cheek biting.
To avoid additional general anesthesia, dental work under general anesthesia is planned until the primary dentition has fully emerged. The duration of the procedure ranges from one to four hours.
Successful treatment depends on having staff who are qualified, talented, and experienced. Well-trained anesthesiologists help maintain physiologic function and maintain adequate breathing. Vital signs must be monitored during the entire operation. In addition to providing traditional care, pedodontists must be trained to provide care while under general anesthesia.
What Are the Pediatric Dental Procedures Performed Under General Anesthesia?
In a single general anesthesia session, procedures such as amalgam or composite restorations, pulp treatments, stainless steel crowns, and extractions are conducted. More extractions and stainless steel crown placement are preferred by healthcare professionals over pulp therapy and amalgam or composite restorations.
More drastic measures, like extracting teeth with a poor prognosis, must be considered when planning treatment. Lowering complications and requirement of subsequent general anesthesia. Administering further general anesthesia can increase morbidity and mortality risk and further enhance behavioral consequences.
Restorative procedures like stainless steel crown placement have more eminent success than multisurface amalgam restorations. Stainless steel crowns are more durable and functional, decreasing the need for retreatment in patients with interproximal caries. Therefore, the procedure is helpful in young children.
When there is doubt about treatment success, such teeth are extracted. Teeth with necrotic pulp are extracted rather than preserved with pulp treatment. Avoid treatments like pulp therapy if the pulp has necrotic or pre-apical lesions. Tooth extraction is preferred in people with underlying medical issues or those who are mentally ill.
What Are the Advantages and Disadvantages of Performing Dental Procedures Under General Anesthesia?
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Advantages
All the procedures are conducted in a single session within the hospital environment. It enables the child to receive adequate pain control in a safe setting. There is a reduced need for child cooperation. Dental general anesthesia is more efficient and saves cost. The quality and durability of treatment under general anesthesia are higher than in-office treatment. As oral health can impact an individual's quality of life, children who undergo dental treatment under general anesthesia have a better quality of life.
2. Disadvantages
The anesthetic agents potentially cause health risks, with some reports of increased morbidity and mortality. Therefore, there must be limitations to dental treatment performed under general anesthesia. There are also reports of injury to lips, teeth, or soft tissues. There is also the risk of dental trauma using laryngoscopy (inserting a tube through the mouth or larynx) or endotracheal intubation. Possible dental trauma includes enamel crack, tooth avulsion, hypoplasia (underdeveloped teeth), and crown dilacerations.
What Are the Postoperative Considerations for Children Who Have Undergone General Anesthesia?
Children who underwent dental treatment under general anesthesia must be monitored closely for 24 hours. Patients are given recommendations for postoperative care and diet to follow. After discharge, parents are asked to administer painkillers for the first 24 hours. The likelihood of leaking from extraction sites or crowns must be disclosed to parents.
Postoperative complaints following dental procedures depend on treatment type, duration of general anesthesia, traumatic intubation, underlying medical condition, and use of local anesthetics. The most common complaints include dental pain, difficulty eating, nasal bleeding, throat discomfort, nose discomfort, sleep alteration, weakness, dehydration, drowsiness, fever, nausea, hoarseness, vomiting, diarrhea, and constipation. Postoperative pain is the most common complaint. Tooth extraction and stainless steel crown placement can invoke the most pain. However, these problems went away shortly after receiving treatment.
What Are the Complications of General Anesthesia in Pediatric Patients?
There are negligible reports of complications from general anesthesia use:
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Arrhythmias (irregular heartbeat).
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Dislodges or obstructed endotracheal tube.
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Intravenous infiltrates.
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Edema of tongue and lips.
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Nasal bleeding.
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Inexperienced staff.
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Inadequate machinery or equipment.
Conclusion:
There is a positive shift in patient's mindset on the need for general anesthesia in dental patients. With proper treatment planning and adequate oral examination, the likelihood of retreatment is minimal.
