About 16% of all general anesthetics administered in the United States annually are administered in order to provide dental care.
About General Anesthesia
General anesthesia is a controlled state of unconsciousness accompanied by a loss of protective reflexes, including the ability to maintain an airway independently and respond purposefully to physical stimulation or verbal command. The use of general anesthesia sometimes is necessary to provide quality dental care for the child. This is administered and done safest in a hospital setting
The decision to use general anesthesia must take into consideration: alternative modalities; age of the patient; risk benefit analysis; treatment deferral; dental needs of the patient; the effect on the quality of dental care; the patient’s emotional development; and the patient’s medical status.
Objectives: The goals of general anesthesia are to: provide safe, efficient, and effective dental care; eliminate anxiety; reduce untoward movement and reaction to dental treatment; aid in treatment of the mentally, physically, or medically compromised patient; and eliminate the patient’s pain response.
Indications: General anesthesia is indicated for: patients who cannot cooperate due to a lack of psychological or emotional maturity and/or mental, physical, or medical disability; patients for whom local anesthesia is ineffective because of acute infection, anatomic variations, or allergy; the extremely uncooperative, fearful, anxious, or uncommunicative child or adolescent; patients requiring significant surgical procedures; patients for whom the use of general anesthesia may protect the developing psyche and/or reduce medical risk; and patients requiring immediate, comprehensive oral/ dental care.
Contraindications: The use of general anesthesia is contraindicated for: a healthy, cooperative patient with minimal dental needs; a very young patient with minimal dental needs that can be addressed with therapeutic interventions (e.g., ITR, fluoride varnish) and/or treatment deferral; patient/practitioner convenience; and predisposing medical conditions which would make
general anesthesia inadvisable.
Why General Anesthesia?
Objectives: The goals of general anesthesia are to: provide safe, efficient, and effective dental care; eliminate anxiety; reduce untoward movement and reaction to dental treatment; aid in treatment of the mentally, physically, or medically compromised patient; and eliminate the patient’s pain response.
Indications: General anesthesia is indicated for: patients who cannot cooperate due to a lack of psychological or emotional maturity and/or mental, physical, or medical disability; patients for whom local anesthesia is ineffective because of acute infection, anatomic variations, or allergy; the extremely uncooperative, fearful, anxious, or uncommunicative child or adolescent; patients requiring significant surgical procedures; patients for whom the use of general anesthesia may protect the developing psyche and/or reduce medical risk; and patients requiring immediate, comprehensive oral/ dental care.
Dental treatment under GA is an effective way to provide medically necessary care to those children who may be cognitively immature, highly anxious or fearful, have special needs, or medically-compromised and unable to receive treatment in a traditional office setting.
Delivering dental treatment under GA can have significant positive effects on the quality of life for children and their families
Who Benefits from General Anesthesia?
Some children and patients with special health care needs have treatment conditions, acute situational anxiety, uncooperative age-appropriate behavior, immature cognitive functioning, disabilities, or medical conditions that require GA to undergo dental procedures in a safe and humane fashion.
Included in this group are infants and children who have not yet developed the ability to comprehend the need for their treatment nor the effective and appropriate skills to cope with invasive and potentially uncomfortable and psychologically threatening procedures.
Research indicates that GA has additional benefits to children and families, including:
- Improvement in the quality of life by allowing for extensive dental rehabilitation in children who are experiencing dental pain and difficulties in eating and sleeping, and whose parents have concerns related to the child’s nutrition and behavior.
- Facilitating dental access for very young patients, patients with special health care needs and/or patients with a high degree of dental fear or anxiety.
- Significantly less burden on insurance companies, hospitals, ERs, FQHCs
Is General Anesthesia Safe?
There are always inherent risks where general anesthesia is used, and although they represent a small percentage of patients, cases are carefully screened to ensure the best outcome for our patients. A pre-surgical work up is always needed, along with medical clearances from any medical specialists. Nurses and anesthesiologists screen and interview/asses all patients. The risk of a serious reaction to general anesthesia in toddlers is less than the risk to the child from riding in a car. There are special rules for eating and drinking at home before the procedure which further minimize risks. Pre-existing medical conditions, such as asthma or diabetes, can raise the risk of complications, and in rare cases, patients may have allergic reactions to the drugs. Side effects of anaesthesia include nausea, vomiting and dizziness. By utilizing a board certified pediatric anesthesiologist in an outpatient hospital setting, we minimize the risks to the child to as low as possible. Children go home the same day of surgery, and return to school the next day.
Illinois Legislation
Section 10 of the Illinois Public Act 92-0764 (215 ILCS 5/356z.2 new), and effective 1/1/2003:
“Amends the Insurance Code, Health Maintenance Organization Act, Voluntary Health Services Plans Act, and the State Employees Group Insurance Act of 1971 to require policies of individual and group insurance provide coverage for charges incurred for hospital care and anesthetics which are provided in conjunction with dental care provided in a hospital, ambulatory surgical treatment center or by a certified anesthesiologist.
This legislation limits coverage to:
- children under the age of 6
- individuals with a medical condition that requires hospitalization or general anesthesia for dental care
- or for disabled individuals…”