Anesthesia-Online

General anesthesia at the dentist

introduction

Many people fear a visit to the dentist. The reasons for this are often negative experiences during childhood or past painful treatment appointments.

The possibilities of performing particularly painless treatment methods at the dentist have improved significantly in recent years. In most cases it is sufficient to locally anesthetize individual sections of the oral cavity.

In the case of particularly extensive sessions, general anesthesia can even be considered.

You might also be interested in: Anesthesia at the dentist

The term general anesthesia is understood both in the clinic and at the dentist to mean the elimination of consciousness and the sensation of pain.

At the dentist in particular, general anesthesia has several goals. The consciousness of the patient to be treated is completely switched off in order to completely hide negative experiences. Not being aware of pressure and pain sensations can be particularly relieving, especially for anxious patients. In the last few years, general anesthesia at the dentist's has proven to be a particularly popular method, especially in the treatment of children.

Read more on the subject at:

General anesthesia in children.
General anesthesia for a wisdom tooth operation

execution

In general, general anesthesia at the dentist is divided into three stages. However, the patient must first be prepared for general anesthesia. In this context, a detailed discussion takes place between the patient and a specialist in anesthesia.

During this conversation, possible risk factors such as heart disease and impairment of lung function should be uncovered.
In addition, various blood values must be checked at the dentist before general anesthesia is initiated.

Even in the case of general anesthesia at the dentist, a food abstinence beginning the previous evening must be observed, i.e. the complete renunciation of food from dinner onwards.
In addition, the affected patients should neither drink nor consume nicotine in the morning before general anesthesia.

Before the actual general anesthesia can be initiated at the dentist, the patient is connected to various devices that measure the most important organ functions. Especially the oxygen saturation (using a clip on the finger) and the regular heart activity (medium EKG) must be observed.

In addition, the patient must be provided with a venous access through which the drugs to induce and maintain the anesthesia can be administered.

Before the actual general anesthesia is initiated, the patient is given pure oxygen through a breathing mask.
During this time the anesthetic is administered.
Once the patient is unconscious, a breathing tube can be inserted through the nose.

Risks

Whether general anesthesia is carried out in a clinic or at the dentist's is generally irrelevant when the patient is closely monitored.

However, people who choose to have a general anesthetic at the dentist should be aware that this method is relatively safe, but not entirely risk-free.

Especially for people who suffer from heart or lung diseases, general anesthesia should only be carried out after weighing all possible alternatives and only if there is a strict medical indication.

The most common after-effects of general anesthesia include nausea and vomiting after anesthesia.
About every fourth patient complains of such symptoms after waking up from general anesthesia.
In addition, inserting the tube into the windpipe can lead to coughing, hoarseness and difficulty swallowing.
More serious side effects can lead to dysfunction of the cardiovascular system.

In addition, ventilation problems can arise at the dentist's during general anesthesia.
During the actual intubation (Insertion of the ventilation tube) gastric contents can flow back through the esophagus into the windpipe.

This danger exists especially for patients in whom intubation is difficult to carry out due to the inability to see the upper airways.
Furthermore, during general anesthesia at the dentist's office, allergic reactions to the individual medications administered can occur.

Find out more at: The risks of general anesthesia

Alternatives to general anesthesia

Performing general anesthesia at the dentist's should be carefully considered in advance.
In most cases, there are alternatives that can bypass general anesthesia and use less extensive anesthetic methods.

A possible alternative to general anesthesia at the dentist is to carry out a local pain relief (local anesthesia).
With this method, a local anesthetic is administered to the respective patient in the area of the teeth to be treated.

Learn more about this at: Local anesthesia at the dentist

If the treatment area is in the lower jaw, the entire branch of the mandibular nerve must be anesthetized. These methods are perfectly adequate for most treatment measures at the dentist.

Another alternative to general anesthesia at the dentist's is the use of nitrous oxide.

You might also be interested in that: Types of anesthesia - Which are there?

costs

Carrying out a local anesthesia at the dentist, both statutory and private health insurance companies reimburse without exception.

However, particularly complex procedures often require the induction of general anesthesia.
Especially with Anxiety patients or children, this form of sedation often seems particularly useful.

However, general anesthesia at the dentist's is not always reimbursed by health insurance companies. Only in certain cases do the insurance companies agree to fully cover the costs of general anesthesia.
In general, the statutory health insurances only cover the costs of performing general anesthesia if there is a medical indication (need) is present.

The justified reasons were determined accordingly by the health insurance companies. For children who have not yet reached the age of 12 and who defend themselves against dental treatment, the costs of general anesthesia are covered without any problems.

General anesthesia can also be carried out at the dentist for patients with intellectual disabilities or severe movement disorders, which is paid for by health insurance companies.
In addition, the statutory health insurance companies bear the costs of a general anesthetic at the dentist's if the patient to be treated is under severe, medically approved Fear reactions suffers and for this reason cannot be adequately treated under local anesthesia.

The type of dental procedure to be performed can justify the induction of general anesthesia. Because of this, be major surgical Treatments at the dentist are in most cases carried out under general anesthesia.

However, if general anesthesia at the dentist's is not medically necessary, the health insurance companies are not obliged to cover the costs.
If the patient nevertheless wishes to carry out the treatment under general anesthesia, he must pay for it himself.
The exact costs vary greatly depending on the dental practice. In addition, patients who wish to be treated by the dentist under general anesthesia should inform themselves in advance whether this form of sedation is actually carried out in the general dentist's practice.

Costs with a private health insurance

The assumption of costs in the case of general anesthesia for dental treatment is covered by private health insurance (PKV) depending on the respective tariff. General anesthesia may or may not be included in your own insurance and therefore be paid for in full, in part or not at all.

As a rule, a general anesthetic is taken over by this, especially if there is a medical need for such a treatment (e.g. allergies to narcotics or extreme fear of the dentist (Phobias)). Nevertheless, you should always inquire about the prerequisites for cost coverage before treatment. The costs for a general anesthetic are between 250 euros and 1000 euros and vary according to duration and effort.

In private health insurance, dental services are assessed and billed using the fee schedule for dentists. Each individual treatment step is measured with a monetary value and the dentist calculates a fee factor of 1.0 to 3.5. This is multiplied by the value and depends on how demanding the treatment was and how willing the patient was. For a treatment that lasts longer due to difficult conditions, a higher point value is then assessed, for example.

It is advisable for the insured to inquire with the private health insurer in advance how expensive the upcoming procedure would be. The dentist prepares a cost estimate, which the patient can use to inquire with his insurance company.

Duration of general anesthesia

The duration of a general anesthetic depends on the extent of the dental treatment and can vary from a few minutes to several hours. After a detailed examination, the dentist can estimate how long the anesthesia will last.

Basically, there are three phases in general anesthesia: Sleep phase, Maintenance phase and Wake up phase. The length of the sleep phase and the wake up phase in particular differ from patient to patient.

Read about it too: Anesthesia - procedure, risks and areas of application

After completion of the treatment, the anesthesia is diverted and a "Antidote“Injected, which cancels the anesthetic effect again. After waking up from anesthesia, a feeling of drowsiness may prevail until the brain is fully active again. This condition can last for one to two hours, which is why the patient should rest during this time. The anesthetist monitors the awakening phase so that complications can be counteracted quickly. As a rule, there are hardly any known complications after anesthesia during dental interventions, as the drugs used are well tolerated.

Propofol for sedation

In dental interventions, the "small anesthetic" is often used. The patient is sedated, which means that the central nervous system is slowed down and your own consciousness is less active as a result.

Propofol is a drug that belongs to the group of general anesthetics. It is mainly used to induce anesthesia, e.g. general anesthesia. It is administered through the veins on the arm or hand. Propofol is characterized by its rapid onset of action and its relaxing effect.

Propofol inhibits certain brain areas that are responsible for short-term and long-term memory and decision-making, so that a hypnosis-like state arises. It is given directly into the vein and works much faster than anesthetics that are inhaled. After the injection, hypnosis is achieved after only thirty seconds, due to the rapid spread of the active ingredient into other tissues, but it only lasts five to ten minutes. Propofol must therefore be administered continuously for longer periods of operation. However, since propofol has no analgesic effect, an opioid is also administered to suppress pain. As a rule, the "small anesthesia" is very well tolerated and side effects such as nausea or vomiting rarely occur. Nevertheless, side effects such as a drop in blood pressure occurs. The drug should not be used in patients suffering from circulatory disorders, as well as pregnant women and breastfeeding women.

Learn more about this under: Short anesthesia with propofol