Which one is the most preferred anesthesia type in dental treatments of patients with special needs: sedation or general anesthesia?

Abstract

Aim: Patients with special needs, who have mental, physical or medical disabilities, were reported to have worse oral hygiene than their healthy peers. Disabled patients are usually uncooperated, and dental treatments of these patients are completed under several anesthesia types. Our aim was to compare anesthesia types in dental treatments of patients with special needs. Material and Method: The study included review of uncooperated patients, who had physical or mental disabilities, between June 1, 2021 and June 1, 2022. Patients were divided into three groups due to their anesthesia types; sedation (Group S), laryngeal mask airway (LMA) (Group L), and nasotracheal intubation (Group N). Results: In total 80 patients were analyzed; 4 patients excluded, 45 patients were in Group S, 19 patients were in Group L, and 12 patients were in Group N. Anesthesia times were significantly different between groups; 20 min in Group S, 25 min in Group L, and 45 min in Group N. Propofol use was significantly low (p<0.001) and ketamine use was significantly high in Group S (p=0.002). Number of tooth extractions was not significantly different between groups, but number of filling tooth was significantly high in Group N (p=0.002). Conclusion: Sedation was the most preferred anesthesia type in dental treatment of patients with special needs. Although all three types of anesthesia can be used safely in dental treatments, we suggest that sedation can be considered as the first choice in tooth extraction in patients deemed appropriate by the anesthesiologist and dentist.

Keywords

• anesthesia
• general anesthesia
• dentistry
• tooth
• disabled person

References

1. Tesini DA. An annotated review of the literature of dental caries and periodontal disease in mentally retarded individuals. Spec Care Dentist 1981; 1: 75‐87.
2. Roeters J, Burgersdijk R. The need for general anesthesia for the dental treatment of mentally handicapped patients: A follow‐up study. ASDC J Dent Child 1985; 52: 344‐6.
3. Prabhu NT, Nunn JH, Evans D, Girdler N. Development of a screening tool to assess the suitability of people with a disability for oral care under sedation or general anesthesia. Spec Care Dentist 2008; 28: 145-58.
4. Messieha Z. Risks of general anesthesia for the special needs dental patient. Spec Care Dentist 2009; 29: 21-5.
5. Wang YC, Lin IH, Huang CH, Fan SZ. Dental anesthesia for patients with special needs. Acta Anaesthesiol Taiwan 2012; 50: 122-5.
6. Jamjoom M, Al‐Malik M, Holt R, El‐Nassry A. Dental treatment under general anaesthesia at a hospital in Jeddah, Saudi Arabia. Int J Paediatr Dent 2001; 11: 110-6.
7. Lim MAWT, Borromeo GL. The use of general anesthesia to facilitate dental treatment in adult patients with special needs. J Dent Anesth Pain Med 2017; 17: 91-103.
8. British Society for Disability and Oral Health. The 
Provision of Oral Health Care under General Anaesthesia in Special Care Dentistry: A Professional Consensus Statement. British Society for Disability and Oral Health. 2009. 


9. Intercollegiate Advisory Committee for Sedation in Dentistry. Standards for conscious sedation in the provision of dental care. 2015.
10. American Dental Association. Guidelines for the use of sedation and general anesthesia by dentists. Chicago, ADA House of Delegates. 2012.
11. Voytus ML. Evaluation, scheduling, and management of dental care under general anesthesia for special needs patients. Dent Clin North Am 2009; 53: 243-54.
12. Weaver JM. Special considerations concerning general anesthesia for dental treatment of handicapped patients. Anesth Prog 1995; 42: 93.
13. Garcia-Miguel F, Serrano-Aguilar P, Lopez-Bastida J. Preoperative assessment. Lancet 2003; 362: 1749-57.
14. Glassman P. A review of guidelines for sedation, anesthesia, and alternative interventions for people with special needs. Spec Care Dentist 2009; 29: 9-16.
15. Dougherty N. The dental patient with special needs: A review of indications for treatment under general anesthesia. Spec Care Dentist 2009; 29: 17-20.
16. Messieha Z, Ananda RC, Hoffman I, Hoffman W. Five year outcomes study of dental rehabilitation conducted under general anesthesia for special needs patients. Anesth 
Prog 2007; 54: 170-4.
17. Vargas Román Mdel P, Rodríguez Bermudo S, Machuca Portillo G. Dental treatment under general anesthesia: a useful procedure in the third millennium? Med Oral 2003; 8: 129-35.
18. Infante P, Gutierrez JL, Martín MJ, Hernández JM, García M. La cirugía oral y maxilofacial en pacientes especiales con discapacidad psíquica. Odonto- logía Práctica y Clínica 2000; 3:10-6.
19. Kim YJ, Hyun HK, Kim JW, et al. Clinical Usefulness of Proseal Laryngeal Mask Airway for Anesthesia during Dental Procedures in Children. J Clin Pediatr Dent 2015; 39: 179-82.
20. Loyola-Rodriguez JP, Aguilera-Morelos AA, Santos-Diaz MA, et al. Oral rehabilitation under dental general anesthesia, conscious sedation, and conventional techniques in patients affected by cerebral palsy. J Clin Pediatr Dent 2004; 28: 279-84.
21. Hulland S, Sigal MJ. Hospital-based dental care for persons with disabilities: a study of patient selection criteria. Spec Care Dentist 2000; 20: 131-8.

22. Ouchi K, Sugiyama K. Required propofol dose for anesthesia and time to emerge are affected by the use of antiepileptics: prospective cohort study. BMC Anesthesiol 2015; 15:34.
23. Keles S, Kocaturk O. Postoperative discomfort and emergence delirium in children undergoing dental rehabilitation under general anesthesia: comparison of nasal tracheal intubation and laryngeal mask airway. J Pain Res 2018; 11: 103-10.
24. Campbell RL, Shetty NS, Shetty KS, Pope HL, Campbell JR. Pediatric dental surgery under general anesthesia: uncooperative children. Anesth Prog 2018; 65: 225-30.