Letters to the editor

I have read with great interest the article by Jennifer Lawson et al,¹ which emphasizes the importance of comprehensive pre-operative treatment planning for dental care under general anaesthetic. A more radical treatment-planning approach, combining primary, secondary care and medical considerations, is vitally important to avoid the second and subsequent dental general anaesthesia (DGA).² Dentists who make referrals for DGA have to be confident that they have considered, and in some instances tried, alternative methods of treatment. This is particularly important in young patients and children who need DGA. Considering the fact that, currently, general dental practitioners are able to provide safe sedation alternatives for children and special needs adults, there is no doubt that DGA should be avoided, when possible.³ Intranasal sedation, combined nitrous oxide and sevoflurane or ketamine and midazolam conscious sedation techniques^4,5,6 bring a new operational approach for our profession, instead of the DGA which involves the highest risk of potential complications.