How to minimize repeat dental general anaesthetics

Dental caries is a preventable disease, yet it is still the most common reason a child between five to nine years old is admitted to hospital in England and Scotland.¹ Dental caries can have a significant impact on children‧s lives; they may suffer pain, difficulty eating, sleepless nights, have time off school and it can affect their body weight, cause communication difficulties and impaired cognitive development.² Dental caries is often treated under general anaesthetic (GA), particularly if the patient is pre-cooperative, anxious, medically compromised or because of the nature of the treatment.

In addition to the impact of caries on a child‧s life there are also risks associated with a GA and therefore it should only be undertaken when absolutely necessary.³ Short-term effects include nausea, vomiting, headache, sore throat, dizziness and mild allergic reaction; these usually resolve in 48 hours but can take up to a fortnight.⁴ Recent research⁵ has identified pre-, peri- and post-operative impacts of dental general extractions from a child‧s perspective. Interestingly, the most negative physical impact described was not pain but hunger and disturbed eating and, in some cases, the children reported greater discomfort from the cannula post-operatively than from the extractions. A dental general anaesthetic (DGA) has been said to carry a risk of a life-threatening problem of about 1 in 400,000, which is considerably less than a child being seriously injured in a road accident.⁶ With correct assessment, treatment planning and preventive care the number of children undergoing a repeat DGA can be markedly reduced.