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General anaesthesia in special care dentistry. Part 2: delivering dental care

From Volume 52, Issue 1, January 2025 | Pages 35-40

Authors

Zahra Shehabi

BDS, MFDS, MSc, MSpecCareDent

BDS, MFDS, MSc (Sed Spec Care), MSCD, MSc (Health Management), Consultant in Special Care Dentistry, Bart's Health NHS Trust

Articles by Zahra Shehabi

Mili Doshi

BDS (Hons), MSc (Sed Spcare), Consultant in Special Care Dentistry, Surrey and Sussex NHS Health Care Trust

Articles by Mili Doshi

Email Mili Doshi

Sophie Liu

MBBS, FRCA, Consultant Paediatric Anaesthetist, Sheffield Children's Hospital

Articles by Sophie Liu

Andrew Geddis-Regan

BChD, BSc(Hons), MFDS RCS Ed, DSCD RCS Eng, PGCTLCP, PGCert

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

Articles by Andrew Geddis-Regan

Abstract

The use of general anaesthesia (GA) in dental care needs to be cautiously justified and considered. Preparation for GA can take a considerable degree of planning, especially as the increased prevalence of coexisting systemic diseases in people with disabilities can increase the risks and challenges of care delivery. When a GA has been deemed appropriate and consent has been gained for relevant treatment, providing treatment this way requires further considerations related to anaesthesia and dental care. There is also a recovery period after GA, and there can be additional post-operative considerations. This paper details the ‘how’ of delivering care under GA, including the dental team's role in supporting an anaesthetic team, the delivery of dental procedures, and the logistics of post-GA care.

CPD/Clinical Relevance: The use of general anaesthesia for patients with disabilities and complex needs requires careful consideration and planning.

Article

As detailed in Part 1 of this series, a substantial amount of planning and preparation goes into delivering dental care under general anaesthesia (GA).1 Many of the aspects described below are considered before the day of treatment under GA. However, they are discussed herein as they often present challenges, despite meticulous planning, when care comes to be delivered. Many aspects of this article relate to those individuals with the most significant behavioural or medical requirements for general anaesthesia, such as those with severe learning disabilities, autism and mental health conditions. The nature of dental treatment planning and treatment delivery is detailed briefly, but is not the primary focus of this article.

A range of reasonable adjustments to support patients with additional needs was discussed in Part 1 of this series.1 It is essential that all staff involved in the GA care pathway, including admitting and recovery staff, are aware that the patients have additional needs. The Health and Care Act 2022 introduced a requirement that staff receive learning disability and autism training appropriate to their role, for example, the Oliver McGowan Mandatory Training on Learning Disability and Autism.2

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