Grisolia BM, Dos Santos APP, Dhyppolito IM Prevalence of dental anxiety in children and adolescents globally: a systematic review with meta-analyses. Int J Paediatr Dent. 2021; 31:168-183 https://doi.org/10.1111/ipd.12712
Aburas S, Pfaffeneder-Mantai F, Hofmann A Dentophobia and dental treatment: an umbrella review of the published literature. Spec Care Dentist. 2023; 43:163-173 https://doi.org/10.1111/scd.12749
Mac Giolla Phadraig C, Newton T, Daly B BeSiDe time to move behavior support in dentistry from an art to a science: A position paper from the BeSiDe (Behavior Support in Dentistry) Group. Spec Care Dentist. 2022; 42:28-31 https://doi.org/10.1111/scd.12634
Glassman P, Caputo A, Dougherty N Special Care Dentistry Association consensus statement on sedation, anesthesia, and alternative techniques for people with special needs. Spec Care Dentist. 2009; 29:2-8 https://doi.org/10.1111/j.1754-4505.2008.00055.x
Geddis-Regan AR, Gray D, Buckingham S The use of general anaesthesia in special care dentistry: a clinical guideline from the British Society for Disability and Oral Health. Spec Care Dentist. 2022; 42:(S1)3-32 https://doi.org/10.1111/scd.12652
Doshi M, Liu S, Shehabi Z Pain, anxiety control and behavioural support for older people. In: Doshi M, Geddis-Regan A (eds). Cham: Springer International Publishing; 2022
Roberts GJ, Mokhtar SM, Lucas VS, Mason C Deaths associated with GA for dentistry 1948–2016: the evolution of a policy for general anaesthesia (GA) for dental treatment. Heliyon. 2020; 6 https://doi.org/10.1016/j.heliyon.2019.e02671
Walker EMK, Bell M, Cook TM Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study. Br J Anaesth. 2016; 117:758-766 https://doi.org/10.1093/bja/aew381
Sury MR, Palmer JH, Cook TM, Pandit JJ The state of UK anaesthesia: a survey of National Health Service activity in 2013. Br J Anaesth. 2014; 113:575-584 https://doi.org/10.1093/bja/aeu292
Sury MR, Palmer JH, Cook TM, Pandit JJ The state of UK dental anaesthesia: results from The NAP5 Activity Survey. A national survey by the 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. SAAD Dig. 2016; 32:34-36
King TA, Duffy J Peri-operative care of elective adult surgical patients with a learning disability. Anaesthesia. 2022; 77:674-683 https://doi.org/10.1111/anae.15691
Pradhan A, Gryst M The use of lateral oblique radiographs in dental treatment planning for patients with special needs. J Disability Oral Health. 2016; 7:154-158
Chapter 2: guidelines for the provision of anaesthesia services for pre-operative assessment and preparation. 2019. https://rcoa.ac.uk/gpas/chapter-2 (accessed November 2024)
Bailey CR, Ahuja M, Bartholomew K Guidelines for day-case surgery 2019: Guidelines from the Association of Anaesthetists and the British Association of Day Surgery. Anaesthesia. 2019; 74:778-792 https://doi.org/10.1111/anae.14639
Chapter 6: Guidelines for the provision of anaesthesia services for day surgery 2021. https://rcoa.ac.uk/node/18556 (accessed November 2024)
Northway R, Rees S, Davies M, Williams S Hospital passports, patient safety and person-centred care: a review of documents currently used for people with intellectual disabilities in the UK. J Clin Nurs. 2017; 26:5160-5168 https://doi.org/10.1111/jocn.14065
National Institute for Health and Care Excellence. Routine preoperative tests for elective surgery. 2016. www.nice.org.uk/guidance/ng45 (accessed November 2024)
Clough S, Shehabi Z, Morgan C, Sheppey C Blood tests for people with severe learning disabilities receiving dental treatment under general anaesthesia. Dent Update. 2016; 43:849-858 https://doi.org/10.12968/denu.2016.43.9.849
Burke S, Kwasnicki A, Thompson S Consent and capacity: considerations for the dental team part 1: consent and assessment of capacity. Dent Update. 2017; 44:660-666
Burke S, Kwasnicki A, Thompson S Consent and capacity: considerations for the dental team part 2: adults lacking capacity. Dent Update. 2017; 44:762-772
National Institute for Health and Care Excellence. Shared decision making. NG197. 2021. www.nice.org.uk/guidance/ng197 (accessed November 2024)
Clough S, Shehabi Z, Morgan C Reducing health inequalities in people with learning disabilities: a multi-disciplinary team approach to care under general anaesthesia. Br Dent J. 2016; 220:533-537 https://doi.org/10.1038/sj.bdj.2016.378
Lasky B, Doshi M, Bradley N, Bewaji A Providing additional procedures for people with learning disabilities receiving dental treatment under general anaesthesia. Learning Disability Practice. 2022; https://doi.org/10.7748/ldp.2022.e2188
General Anaesthesia in Special Care Dentistry. Part 1: Justifying and Planning the Use of General Anaesthesia Mili Doshi Zahra Shehabi Sophie Liu Andrew Geddis-Regan Dental Update 2025 51:11, 780-785.
Authors
MiliDoshi
BDS (Hons), MSc (Sed Spcare), Consultant in Special Care Dentistry, Surrey and Sussex NHS Health Care Trust
BSc (Hons), BChD, DSCD RCS Eng, MSCD RCS Ed, PhD, Consultant in Special Care Dentistry, University Dental Hospital of Manchester; Honorary Senior Lecturer in Dentistry, University of Manchester
General anaesthesia (GA) is sometimes necessary or appropriate to safely deliver comprehensive dental care for patients with disabilities and complex needs. GA may be indicated as a result of severe anxiety or cognitive dysfunction, where treatment with sedation or local anaesthesia has not been satisfactory or is contraindicated, or where a substantial amount of dental treatment is required. This article is the first of a three-part series that aims to expand upon some of the key practical considerations related to the planning and use of GA in dental care.
CPD/Clinical Relevance:
The use of general anaesthesia for patients with disabilities and complex needs requires careful consideration and planning.
Article
General anaesthesia (GA) is a medically induced loss of consciousness with concurrent loss of protective reflexes owing to anaesthetic agents.1 The nature and use of general anaesthesia has changed significantly over the past 30 years. The use of GA outside a hospital setting was banned in 2000 following a number of safety concerns.2
Dental anxiety is a common reason for not seeking or cooperating with dental care, and this state is highly prevalent worldwide.3,4 Various dental behaviour support (DBS) tools exist to support patients receiving dental care.5 Pharmacological and non-pharmacological approaches to manage anxiety and their appropriateness are summarized in NHS England commissioning guidance.6 Conscious sedation or other techniques detailed in this guidance are suitable to support most patients with dental anxiety. However, GA is necessary and appropriate for a smaller number of patients,7 particularly as GA is arguably one of the most complex and high-risk techniques available.8,9
Register now to continue reading
Thank you for visiting Dental Update and reading some of our resources. To read more, please register today. You’ll enjoy the following great benefits:
