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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
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