Indications of general anaesthesia in dentistry 3, 7, 8, 12

Decisions about general anaesthesia can only be made on an individual patient basis, but its
use in dentistry should be limited to:

1. Acute infection: In such clinical situations it would be impossible to achieve adequate

local anaesthesia and so complete treatment without pain, e.g. management of acute dento-
alveolar abscess and severe pulpitis. In these conditions, drug therapy or drainage procedures
with other methods of pain relief are inappropriate or unsuccessful. The local anaesthetic may
not be effective in such conditions because of local change in pH and there is a risk of
spreading infection also.

2. Children: Majority of out-patient general anaesthesia in dentistry is administered to small

children who may not tolerate dental surgery under local anaesthesia or some may be failures
of attempts using local anaesthesia. It is recommended that only specialist paediatric
anaesthetists should administer general anaesthesia to very young children.

3. Mentally challenged patients: Such patients, because of problems related to

physical/mental disability, are unlikely to allow safe completion of treatment under local
anaesthesia.

4. Dental phobia: Patients in whom long-term dental phobia will be induced or prolonged
are administered general anaesthesia in first sitting. The long term aim in such patients should
be the graduated introduction of treatment under local anaesthesia using, if necessary,
conscious sedation and behaviour management techniques.

5. Allergy to local anaesthetics: It is rare and is due to amide group of local anaesthetics.
The preservative methylparaben can also cause allergic reactions. However, allergic reaction
should be differentiated from vasovagal attacks, palpitation and flushing occurring as a result
of absorption of adrenaline present in local anaesthetic solution.

6. Extensive dentistry & facio-maxillary surgery: Local anaesthesia is unsuitable in an

awake patient when the dentistry is likely to be extensive.

These indications include cases of acute infection, where achieving adequate local anesthesia
for pain-free treatment is challenging, especially in managing acute dento-alveolar abscess
and severe pulpitis, where alternative pain relief methods may prove unsuccessful due to
local pH changes and a risk of infection spread.

Furthermore, small children who may not tolerate dental surgery under local anesthesia or
those who have experienced failures with local anesthesia attempts may benefit from
outpatient general anesthesia, with specialist pediatric anesthetists recommended for very
young children.

Additionally, patients with cognitive impairments may not safely tolerate treatment under
local anesthesia due to their physical or mental disabilities. Dental phobia sufferers can
undergo general anesthesia in their initial session, with the ultimate goal being a gradual
introduction to treatment under local anesthesia using conscious sedation and behavior
management techniques if necessary.
For rare cases of allergy to local anesthetics, particularly those from the amide group or the
preservative methylparaben, distinguishing true allergic reactions from other responses is
essential, as well as considering extensive dentistry and facio-maxillary surgery in which
local anesthesia may be unsuitable for awake patients.