DENTISTS extract hundreds of thousands of teeth using only local anesthetics, and that is the best way to go about it. Everyone approaches dental surgery with trepidation, but after the extraction, it is not uncommon for a conscious patient to exclaim, “My God, I hardly felt a thing!” or “It is out already? I can’t believe it.”

Dental surgery, including complex extractions, seldom warrants I-V sedation or general anesthesia. As long as the patient is awake, a doctor is less likely to force the mouth so wide open that the temporomandibular joints are injured, or exert so much pressure with instruments that the jaw is fractured. While these injuries have occurred with local anesthetics, the risk is much less when the patient is present in mind as well as body.

There are a few indications for the use of I-V sedation and general anesthesia in dentistry. Local anesthetics are not always effective in the presence of an acute infection and swelling. Patients with advanced cerebral palsy and Down’s Syndrome may be unable to control their movements. Some patients are so frightened that intravenous sedation or general anesthesia is the only way the dentist can quiet them in the dental chair.

But the Law says that the dentist or physician must inform the patient of the serious risks involved when general anaesthetic is administered. Not all patients can take it, and some even die. Many persons may know that a past president of Guyana, L.F.S. Burnham, was such a patient.

I-V sedation permits extremely anxious patients to tolerate extensive dental treatment over a long period of time. Yet, many dentists work on such patients for four or even six hours at a stretch, depending on good local anesthesia and a caring staff to make the experience tolerable.

But there are some patients for whom I-V sedation is as much a benefit to the dental staff as to themselves. It may be the only way that extensive treatment can be accomplished.

Some children present great difficulty for dentists, particularly two and three-year-olds suffering from baby-bottle tooth decay (nursing caries) of their baby teeth. Virtually all of these infants can be handled in the dental office by a competent general dentist or a children’s dentist – pedodontist or pediatric dentist – specially trained in the treatment of difficult children. The child is sedated, wrapped in a restraining ‘papoose board’, and treated under nitrous oxide analgesia and local anesthetics.

Some pedodontists prefer to have a general anesthetic administered by an anesthesiologist in a hospital in order to treat difficult children. No doubt this is safer than office administration of general anesthetic, but general anesthesia is inherently risky no matter who administers it. If a child is too young, treatment can be postponed for six months or a year, when he or she might be able to be handled in the dental office.

For healthy patients undergoing routine treatment, including oral surgery, local anesthesia should be used for pain control. I-V sedation and general anesthesia are important additional tools, but they should be used only when advantages clearly outweigh the risks.

Recommendations:

1. Avoid prophylactic antibiotics unless recommended for specific preexisting medical conditions.
2. Tetracycline should not be taken by pregnant women or children under age eight.
3. Aspirin is the drug of choice for relief of minor dental pain, but children recovering from chicken pox or flu should not be given aspirin.
4. Request prescriptions for generic rather than brand-name drugs to minimize expense.
5. Avoid unnecessary and excessive use of tranquilizers, sedatives, and narcotics.
6. Avoid nitrous oxide analgesia, and intravenous sedation for routine dental treatment, including extractions and other types of oral surgery.
7. Don’t let the oral surgeon sell you I-V sedation or general anesthesia for routine extractions, including the removal of wisdom teeth.