General Anaesthesia (GA)

General Anaesthesia for Children’s Dentistry

Dental treatment under general anaesthesia is a great solution for children with specific physical and psychological health requirements. Children requiring complex dental treatment and kids who are uncontrollable with sedation must be treated using general anaesthesia. With treatment using general anaesthesia no patient cooperation is necessary. This article is about dental treatment under general anaesthesia for children. For adult’s dental treatment under general anaesthesia including wisdom teeth extraction under GA see Pure Dentistry.

Paediatric dentistry in Hospital by Dr Soha Sharif

Regarding treatments specific to children, the following dental procedures can be undertaken while the child is under general anesthesia:

While treatment under GA is the most expensive form of dental treatment (as the cost of the hospital and an anaesthetist is also added to the cost of dentistry), the demand for this form of treatment is quite high because in some cases, treatment using GA is the most practical and effective treatment method for young children who require extensive dental treatment.

These days many young children are benefiting from the delivery of extensive dental care in a single GA session.

Indications for Dental Treatment under General Anaesthesia

For some children, dental treatment under general anaesthesia is necessary. Dentistry using GA is the management technique of choice for the following patients:

  • Children with disability or special needs
  • Children for whom local anaesthesia cannot be used
  • Extremely uncooperative children
  • Very young and  uncooperative children requiring extensive dental treatment
  • Children who require significant surgical procedures
  • Children with extensive dental trauma 

GA is not the treatment of choice for children with minimal dental needs and when the child is a healthy and cooperative patient.

Medical Contraindication to General Anaesthesia

Dental treatment using general anaesthesia is not permitted when there is a medical contraindication to GA.

Dentistry using GA for Children with Disability

GA provides a safe and efficient method for the dental care of children who are unable to cooperate because of certain physical or mental conditions.

Dentistry using GA for Children with Medically Compromising Disability

Kids requiring dental treatment under GA often have coexisting medical diagnosis. These conditions could be medical or psychological. 

Cerebral Palsy, severe Autism and ADHD, brain injuries are a few examples. Children with severe Autism do not usually fit in the so-called “normalised” dental service. When forced, they may show inappropriate behaviour, they may show uncontrolled movement or aggression during dental treatment. 

When a concern about a medical condition exists, an anaesthetic  consult is recommended. Dental Care using GA when Local Anaesthesia can’t be used

For some children local anaesthesia may not work. The child may require dental restoration or surgical procedure but local anaesthesia may be ineffective when there is an acute infection, anatomic variations or when the child is allergic to local anaesthesia.

Dental Treatment GA for Extremely Uncooperative Kids

For various reasons, a child may become extremely uncooperative, anxious, fearful or physically resistant during dental treatment. Dentistry under GA in such cases is appropriate when there is no expectation that the behaviour of the child will soon improve.

Decision for Dental Treatment under GA

Usually the younger the child, the higher is the likelihood of the need for dental treatment under GA. The decision as to whether a child should be treated under GA depends on a combination of factors. The most important factors include:

  • The age of the child
  • The degree of the surgical trauma involved
  • The level of perceived anxiety
  • The history of the child responding to similar surgeries
  • The complexity of the procedure
  • The medical requirements of the child associated with anaesthesia
  • The number of quadrants involved

Each child has to be assessed individually by the dentist because there are no fast rules. 

Other factors that are involved in the decision making process include:

  • Allergies
  • Physical status and developmental status
  • Medications (current and previous medications)
  • Specific surgical requirements
  • Weight of the child
  • Airway patency
  • Psychological status of the child

GA is used only when other management techniques have failed or are not practical and inappropriate. This means that dental extraction under GA is employed only if it is an appropriate strategy. If the dentist determines that dental treatment under GA is appropriate, then a referral is required to the local GA service provider. Then additional dental and medical assessment will be carried out by the care providers.

Consultation for Dental Treatment using GA

In your consultation appointment, our dentist conducts a preoperative assessment of the teeth and the child. They also provide parents with information and parents sign an informed consent. It is recommended to discuss with one parent at the consultation appointment and also discuss with the other parent who is present on the treatment day.

Treatment Planning for Dental Treatment using GA

The dentist provides a dental treatment plan. Treatment planning is necessary and helps with reducing the need for a repeat procedure during sedation. Where GA is employed for dental treatment in children, the emphasis should be on the procedure quality and outcome. Each procedure will be carefully planned by the dentist with consideration to the medical conditions that may be present in the mouth.

Fasting for Dental Treatment using GA

The dentist or the hospital will provide parents with fasting guidelines. Fasting instructions shall be followed. These instructions lead to the least distress for the child. Accepted practice for fasting before general anaesthesia is:

  • 6 hours of fasting from solids and milk
  • 4 hours from breast milk
  • 2 hours from clear fluids

Each GA provide has different protocols. Always follow the fasting guidelines provided by your GA provider.

The Day of Dental Treatment using General Anaesthesia

On the treatment day, the anaesthetist assesses the child to confirm the child’s fitness for the procedure. The dentist also discusses the treatment plan with the parents and assesses the child. The team checks the equipment and instruments to ensure equipment is operational prior to the dental procedures under general anaesthesia begins.

Induction prior to General Anaesthesia

To minimize the child’s anxiety, a parent is allowed to stay with the child during induction. Induction may be intravenous or gaseous.The anaesthetist will decide which option is best for each child. Following the induction phase parents will be asked to leave the theater until the end of the procedure. They may prefer to stay in the hospital or go home until they are called at the end of the procedure.

Stress during GA procedures

Allowing the child to be with parents during induction can reduce the anxiety both in children and parents.  A child could become upset when in an unfamiliar environment. Treatment under general anaesthesia should be conducted in a comfortable atmosphere.

Stress in Parents

Parents of the children who require general anesthesia usually experience more stress than the child undergoing the GA. Sometimes providing a tour of the operation room prior to surgery can reduce the stress in parents. Also providing parents with the status of the child and letting them know that everything is alright can help reduce the stress. Children are great in sensing apprehension in their parents. Therefore, limiting the anxiety of parents can have a positive effect on the anxiety level in the children as well.

Stress in Children

Following points can reduce the stress level in children:

  • Involving the child in the tour of the facility
  • Allowing the child to bring along a favorite toy, blanket, etc
  • Providing preinduction sedation
  • Providing a child-friendly environment
  • Providing postprocedure sedation as required
  • Allowing the child and parents to rejoin as early as possible

Safety of Dental Treatment under General Anaesthetics

According to Cameron handbook of paediatric dentistry, morbidity in children arising from general anaesthesia is quite low and it can be estimated to be lower than 1:150,000. Dental treatment under GA requires experience and a lot of knowledge and skills to avoid treatment failure or repeat GA. Therefore, GA treatment for children should only be carried out by experienced kids dentists. Your dentist considers many factors when deciding to place a child under general anesthesia.

Pre-anaesthetic Assessment before General Anaesthesia

Before general anaesthesia, a review of the child’s medical history and examination by the anaesthetist is required. For children with complex medical requirements, a separate preoperative anaesthetic assessment may be required prior to the day of the surgery.

Your anaesthetist needs to be aware of:

  • Any behavioural issues including autism, developmental delay
  • Extreme anxiety or needle phobia
  • Syndromes e.g. velocardiofacial or Down syndrome
  • Cardiac disease or heart murmur
  • Previous surgeries
  • Any congenital defects e.g. cleft palate
  • Any respiratory disease or airway problems e.g asthma, history of croup, micrognathia
  • Sleep apnoea, known history of intubation difficulties, previous tracheostomy
  • Neurological disease including epilepsy, or previous brain injuries, cerebral palsy
  • Endocrine and metabolic disorders including diabetes or genetic metabolic disorders
  • Any gastrointestinal issues including reflux, difficulty in feeding or swallowing
  • Haematological e.g. haemophilia,haemoglobinopathies, thrombocytopenia
  • Any Neuromuscular disorders, e.g. muscular dystrophy.

All medication will be documented and also all allergies e.g. allergy to latex.

Post GA

Once the procedure is complete and the child is awake and in stable condition, parents should join the child in the recovery area. This helps reduce the anxiety for the child and parents. The dentist will discuss the outcome of the treatment on the same day and a post-GA follow-up appointment is arranged with the parents.

What is GA in dental?

General anaesthesia ( GA) is recommended in dentistry to perform dental treatment in certain circumstances. Your child’s dentist might decide to use general anaesthesia to keep your child safe and comfortable during a dental procedure and keep the dental procedure less traumatic for the child. It depends on the age and cooperation of a child and also the extent of treatment required. GA is performed at a hospital or at a specially designed general anaesthetic facility.

Do you have to pay for your children’s dental treatment?

There are several options to pay for your child’s dental treatment.
If you are covered by a private health fund, depending on the level of your cover, they should cover an amount of the treatment provided. You can check this by contacting your HF company. Some families are also eligible for Medicare rebates. Medicare pays 1013$ for dental treatment of kids from age of 2-18.
We also offer different payment plan options and early access to Super to make the whole process easier.

How do they Put kids under GA for dental work?

There are different methods to help a child cope with dental treatment.
One option would be Happy Gas which is performed while at the dental practice and in the dental chair, the child will be awake and responsive.
Another method is to use general anaesthesia while at a hospital or special GA facility, this is performed by an anaesthetist and the child would be fully asleep while treatment is being completed by the dentist.

Is it safe for a 3 year -old to go under anaesthesia?

Anaesthesia is very safe and major complications are rare. The anaesthetist will perform a full assessment of your child’s medical condition to reduce the risk of unplanned things happening during and after anaesthesia. Some kids will be at more risk due to ti their medical conditions.

Why do children cry after anaesthesia ?

Several factors contribute to kids crying after anaesthesia:
The Medication used to put kids to sleep is one factor, the stress of surgery and feeling slightly disoriented and frightened after they wake up also plays a role. Kids might cry and even refuse to be comforted.

Is it safe for kids to go under general anaesthesia?

Anaesthesia is very safe and major complications are rare.
The anaesthetist will perform a full assessment of your child’s medical condition to reduce the risk of unplanned things happening during and after anaesthesia. Some kids will be at more risk due to ti their medical conditions.

Is it safe to sedate a child for dental work?

Nitrous oxide or happy gas is a safe way to help reduce a child’s pain and anxiety during dental treatment. Your child will be awake throughout the procedure and will recover very quickly from the effects of the gas when treatment is completed. Some children might feel a little sick or nauseated after treatment.

Is general anaesthesia safe for an 8-year-old?

Anaesthesia is very safe and major complications are rare.
The anaesthetist will perform a full assessment of your child’s medical condition to reduce the risk of unplanned things happening during and after anaesthesia. Some kids will be at more risk due to ti their medical conditions.

How do you know if your child is allergic to anaesthesia?

This is possible but very rare. Many people have been told that they are allergic to certain drugs when they had a reaction that was not a true allergy.
True allergy can manifest as hives, itching, watery eyes and anaphylaxis.
An anaesthetist performs a comprehensive exam of the child prior to the procedure to reduce any risk and identify possible risk factors. Please let them know if you have any family history of allergies or reactions to anaesthetic drugs.

What is bad reaction to anaesthesia?

Many people have been told that they are allergic to certain drugs when they had a reaction that was not a true allergy. True allergy can manifest as hives, itching, watery eyes and anaphylaxis. Sometimes the anaesthetic drugs can cause an increase or decrease in heart rate or blood pressure of the patient, these are expected side effects.

Can you have an allergic reaction to dental anaesthesia?

Allergic reactions to local anaesthetics used in dentistry are very rare.
Many people have been told that they are allergic to certain drugs when they had a reaction that was not a true allergy. True allergy can manifest as hives, itching, watery eyes and anaphylaxis. Dental local anaesthetics are mixed with adrenaline, which constricts the blood vessels and reduces bleeding. This drug can sometimes cause an increase in heart rate. This is not an allergy but rather an expected and side effect.

What are the side effects of too much anaesthesia?

Nausea or vomiting, respiratory distress, hypothermia hallucinations, Seizures and prolonged unconsciousness can occur.