Anesthesia for dental

procedures
Dr. S. Parthasarathy
MD, DA, DNB, Dip Diab.MD ,DCA, Dip
software based statistics,
PhD (physiology)
 Anesthesia started with dentistry

Horace wells administered himself nitrous oxide – his

colleague extracted his tooth in 1844

In 1846, morton did it again !!

 Usually not called for !!
• Children
• Mentally retarded adults
• Dental phobia
• Acute pus
• Radiotherapy previous –( LA Vs GA)
• Allergy to local anesthetics
• Major surgeries
• (difficult dental extractions or for dental
releasing surgeries)
 Contraindications !!
• Serious medical disease ?? Can we do as an
outpatient ??
Eg. CHF, anticoagulants,

• Swelling of the neck

• Anesthetist – inexperienced
 Three types of anesthesia
• Dental chair anaesthesia,

• Day care anaesthesia

• In-patient anaesthesia.
 Problems in dental chair
• Venous return decrease
• ? Venous embolism
• Unprotected airway
• Aspiration of blood or mucus
• Adrenaline in local anaesthetic can cause
arrhythmias in presence of halothane
• Higher incidence of arrhythmias due to
stimulation of 5 th cranial nerve
 Problems in dental chair
• Nasal bleeding if nasal airway is used to
deliver the anaesthetic
• Fainting due to cerebral hypoxia
• Difficulty in initiating CPCR once cardiac arrest
occurs
• Foreign body obstruction of the airway by
needles or dentures, necessitating removal by
bronchoscopy
• BABA FACE - pnemonic
• Preoperative work up √

• Equipments √

• Nasal airway
ECO mask – goldman mask

Intermittent machines , haloxair ??

Haloxair unit
Newer set ups
 SAFE
short acting fast emergence

• Bowel bladder evacuation

• Inj. Atropine
• Sevoflurane induction – previously halothane
• Nitrous oxygen 65 – 35 + sevo –50% fio2- better
• Action in a few seconds
• Recover !!
SAFE agents !!
 Older children
• Propofol is definite

• Thio and keta ?? are other options

• Suction – two machines
IV sedation with MAC – OK !? Transparent
neonatal
mask
Drooping of upper eye lid over pupil –
patient is under !!- verrill sign
Position on induction !! Maximal time
 Airways
• Nasal masks Devonshire

• Nasal airways - mouth packs !!

• Mouth gag on the opposite side
• The surgeon finishes the
• procedure in a few seconds
Mckesson prop
• Allow to breathe through nose
• If adenoids , nasal airway
• is a must
Intubate ??
 Usually nasotracheal
• Difficult access as in impacted tooth, macroglossia,
short neck
• Excessive uncontrolled bleeding Inpatients ?

• maxillofacial or major dental surgery

• Mentally handicapped
• Obstruction of nasal passages, large adenoids where
nasal mask is not effective
Semi sitting position problems ??
 Intraoperative problem
• There is a possibility of surgical emphysema or
mediastinal emphysema following use of air
turbine dental drills.
• Stop nitrous oxide.
• Diagnose a rare pneumothorax,
• IPPV - ?
• ICD - !
 Intraoperative problems
• Arrhythmias – adrenaline, halo , V th nerve
• Aspiration
• Laryngospasm
• Mouth breathing
• Fainting – oxygen, Iv fluids, stop manipulation
• Single click switch back to supine position

Labile patients !!
• Arrest

• Collapse Think of dental chair

• Anaphylaxis
 Use of the LMA for Dental Anaesthesia

• Young (1991) has discussed the experience of using the

regular nonreinforced LMA for dental work, usually for
extractions and fillings in children.
• Use of the LMA is said to be easier for the anesthetist
than a nasal mask. Reinforced LMA – good- less
interference with dentist
• Throat pack – ok
• Airway problems – more common – surgeons move all
bones !! – manipulate and adjust mild – it becomes
acceptable
 Recovery
• Tooth sockets may continue to bleed.
• Complete awake
• Reflexes
• Left lateral Packs
remove
• Suction
• 30 minutes atleast oxygen
• Nil oral for 3-4 hours
EJOA – precision delivery of local anesthetic
 Nerve blocks

• Posterior Superior Alveolar Nerve Block

• Middle superior alveolar nerve block
• Anterior superior alveolar nerve block
• Inferior alveolar nerve block
 Middle superior alveolar nerve block
• Mucobuccal fold above second premolar
• 5 mm depth – 1 ml
 posterior superior alveolar nerve block
• height of the mucobuccal fold above and distal to
distobuccal root of the last molar present in the arch
• Upward (superiorly at a 45 degree angle to the
occlusal plane).Inward (medially toward the midline
at a 45 degree angle to the occlusal plane).
• Backward (posteriorly at a 45 degree angle to the
long axis of the molar) to a depth of 10-14mm.
 Canine eminence ( infra orbital nerve
block )
• Anterior superior alveolar nerve block
 Inferior alveolar nerve block

• anesthetic solution at the retromolar triangle

which is a triangular area located near to the
distal side of the lower third molar.
• Hypnosis

• Acupuncture

• Had roles but now ??

 Post operative pain
• Extraction of baby teeth is not especially
painful.
• The main problem is the psychological trauma
of waking up uncomfortable in a strange
place.

• Para or syr. Ibuprofen sufficient

 Poswilla report 1990
• IV sedation single drug with nitrous (LA) –
patient talking
• Operator and anesthetist – different
• All monitors including defibrillator
• Experienced
 Summary
• Three types
• Dental chair dangers
• Indications
• Contraindications
• LA alone , IVS with MAC,
Nerve blocks
• Nasal airway – 50 % O2
Poswilla report
• LMA
• Intubate
• SAFE agents
• Recovery
Thank you all

There is no minor
anesthetic
technique

Same vigilance