Dental anesthesia for patients with special needs

Abstract

To offer individualized dental treatment to certain patients who cannot tolerate dental treatment, sedation or general anesthesia is required. The needs could be either medical, mental, or psychological. The most common indications for sedation or general anesthesia are lack of cooperation, multiple morbidities, and pediatric autism. In adults, cognitive impairment and multiple morbidities are most commonly encountered indications. Because of suboptimal home care, incomplete medical history, poor preoperative management, lack of cooperation, and developmental abnormalities, it is a challenge to prepare anesthesia for patients with special needs. The American Society of Anesthesiology (ASA) has proposed guidelines for office-based anesthesia for ambulatory surgery. In patients with ASA physical status IV and V, sedation or general anesthesia for treatment in the dental office is not recommended. The distinction between sedation levels and general anesthesia is not clear. If intravenous general anesthesia without tracheal intubation is chosen for dental procedures, full cooperation between the dentist, dental assistant, and anesthesiologist is needed. Teamwork between the dentist and healthcare provider is key to achieve safe and successful dental treatment under sedation or general anesthesia in the patient with special needs.

Analysis of clinical characteristics, dental treatment performed, and postoperative complications of 200 patients treated under general anesthesia in a special needs dental clinic in northern Taiwan

“…Though most of the patients could be treated by behavior control, some patients needed sedation or general anesthesia. 2 Patients who needed general anesthesia for dental treatment used to be scheduled in operation theaters, but most of these patients are now treated in an integrated dental clinic as outpatients. Also, most of the patients who have general anesthesia in operation theaters need intubation general anesthesia (IGA).…”

Training Adults and Children with an Autism Spectrum Disorder to be Compliant with a Clinical Dental Assessment Using a TEACCH-Based Approach

“…This situation worsens if other comorbid conditions are present (ADHD, epilepsy or intellectual disability) (Friedlander et al 2006;Green and Flanagan 2008;Loo et al 2008). For all these reasons, these patients are submitted to general anesthesia or unnecessary high dose sedation, which may lead to different side effects such as nausea, vomits and obstruction of the superior respiratory conducts and other common anesthesia-associated risks (Boynes et al 2010;Lalwani et al 2007;Limeres-Posse et al 2003;Mochizuki et al 2007;Messieha 2009;Wang et al 2012). Moreover, as a result of the above mentioned difficulties, these patients receive less dental care, which could result in more pathological dental conditions and a greater risk of loss of permanent teeth than other patients (Loo et al 2008;Namal et al 2007;Orellana et al 2012).…”

Assessment of Oral Status in Pediatric Patients with Special Health Care Needs receiving Dental Rehabilitation Procedures under General Anesthesia: A Retrospective Analysis

“…The decision of whether to take general anesthesia as a part of dental treatment for CSHCN is an art. Wang et al 16 reviewed the importance in dental anesthesia in patients with special needs. Accordingly, they emphasized that general anesthesia is required in those pediatric patients who cannot bear the dental treatment.…”