Sedation and General Anesthesia
Sedation or general anaesthesia can be administered in cases where local anaesthesia alone does not provide enough pain relief, for patients who are prone to dental anxiety and fear, children with inability to cooperate, or persons with mental or physical disabilities. General anaesthesia is a medically induced coma administered by specialist doctors called anaesthetists or anaesthesiologists. It must be administered in operating theatres equipped with every necessary device and drug or in facilities where surgical operations are carried out in a sterile environment. Sedation and general anaesthesia help increase patient comfort during long surgical procedures, especially in patients with severe anxiety. It is mostly required in paediatric patients.
Sedation used to be defined as “a part of the spectrum of general anaesthesia depressing anxiety and agitation by administration of sedative drugs, but allowing patients’ awareness of the environment”. Although this definition is considered correct in principal, it needs further clarification. Moderate sedation, deep sedation and general anaesthesia in dental patients are defined as follows:
Moderate Sedation (Conscious Sedation): Moderate sedation helps patients feel calm and relaxed, depresses patients’ anxiety about the procedure by administration of sedative drugs. During moderate sedation, patients’ breathing and heart rate do not change. They stay awake, thus they are able to follow commands and respond to questions during the procedure.
Deep Sedation: Patients in deep sedation do not respond to commands or stimulus and do not experience any pain or remember the procedure. In deep sedation, patients respond only to painful or repeated stimuli as their response to external stimuli becomes limited. Given that loss of airway control and respiratory depression are common adverse effects associated with sedative drug administration, patients cannot be woken up easily during deep sedation and may need help for breathing.
General Anesthesia: General anaesthesia is a medically induced, reversible state of unconsciousness. Patients under general anaesthesia do not respond even to painful stimulant and they mostly require a breathing mask or breathing tube.
Dental care of children with disabilities or children with severe dental anxiety and fear is a major problem requiring utmost attention of paediatric dentists in Turkey. Dental decay rate in Turkish children currently remains above the criteria set by the World Health Organization. Especially, the deciduous teeth, commonly known as baby teeth or temporary teeth, which are extracted due to failure to carry out dental treatment of uncooperative children increases the need for orthodontic treatment. As is well known, orthodontic treatment are complex and expensive dental treatments.
There are psychological and pharmalogical approaches to the dental treatment for children exhibiting disruptive or uncooperative behaviour. These approaches include psychological techniques designed for behaviour-shaping are commonly used by a number of dentists. Success of the treatment will depend on the dentist’s ability to personally interact with the children and gain their trust. As for the pharmalogical approach to the issue, it mainly comprises the administration of sedative drugs or general anaesthesia, as a last resort, in cases where psychological methods fail. Sedation is part of various techniques that are used by dental practitioners worldwide, especially for uncooperative paediatric patients. In Turkey, paediatric patients with severe dental anxiety or phobia mostly have untreated and extensive decay, prolonging the duration of the treatment and causing paediatric patients to undergo dental procedures under general anaesthesia.