Anaesthesia at the dentist | The anesthesia

Anaesthesia at the dentist

Anaesthesia and narcosis also play an important role in dentistry. In the case of major procedures, which may go beyond individual dental treatments, appropriate procedures must be used to ensure freedom from pain. However, the necessity of anaesthesia can also be given by very anxious patients who do not want to undergo a dental examination or minor treatments while fully conscious.

There are different types of dental anesthesia. Which one is used is decided by the upcoming procedure and, if possible, the patient’s wishes. A rough distinction is made between local anaesthesia, surface anaesthesia, sedation and general anaesthesia.

Local anesthesia is the most common type of anesthesia used by dentists. This is a local anesthesia that takes place in the area of nerve endings and does not affect consciousness. The anaesthetic is injected by means of a syringe at the desired location.

Within local anaesthesia, a distinction is made between infiltration anaesthesia and conduction anaesthesia. Intraligamentous and intra-oesophageal anaesthesia are also subordinate to infiltration anaesthesia. With infiltration anesthesia, the solution is injected near the root of the tooth or under the mucous membrane.

In this way, individual teeth, the surrounding bone and the overlying skin, e.g. oral mucosa or facial skin, can be anaesthetised. This variant is used especially in the upper jaw. In the lower jaw, conduction anesthesia is a popular choice.

Here, the local anesthetic is placed close to the nerve trunk in order to make the entire supply area of this nerve insensitive to pain. In the lower jaw this usually affects the “N. alveolaris inferior”, i.e. freely translated the nerve of the lower teeth. Similarly, dental treatment of the upper jaw affects the so-called upper jaw nerve (N. maxillaris).

If only a single tooth is to be anaesthetized, this can be done with the above-mentioned intraligamentary method. In this case, the medication is inserted directly at the root into the retaining apparatus of the tooth and finds its own way through the bone to the tip of the root, so to speak. The surrounding tissue is spared.

Intrabony, i.e. in the bone between two tooth roots, a local anaesthetic is rarely administered nowadays, as the increased risk of infection and the availability of better alternatives speak against it. Surface anaesthesia is less invasive. In the form of rinsing solutions, ointments or sprays, only the superficial oral mucosa is anaesthetized.

This method can be useful to reduce the puncture pain of a possible subsequent injection, which is especially indicated for children, or for smaller treatments of the gums. Another alternative is sedation. The patient is put into a twilight sleep by means of sedative substances (sedative), usually in combination with painkillers (analgosedation), in which he/she feels neither fear nor pain.

The administration (application) takes place via veins into the bloodstream (intravenously). Sedatives, however, have a habituation effect and a potential for dependence in the long run. In addition, the patient is unfit to drive after sedation.

In contrast, general anesthesia is much more complex and involves greater risks.The patient must be artificially ventilated and permanently monitored during the procedure. The recovery period after general anesthesia is longer and side effects such as nausea and vomiting are not uncommon. The time after the treatment, during which food and drink must be avoided, ultimately depends on the procedure itself and the form of anesthesia chosen.

This precautionary measure is intended to protect the oral cavity from injury and prevent swallowing of food or liquids. General anesthesia is not necessarily required for the removal of wisdom teeth. The desire for general anesthesia is usually caused by anxiety, but any general anesthesia offers great risks, which are disproportionate in this case.

In addition to the normal risks, the risk of post-operative bleeding increases because, unlike with local anesthesia, no vasoconstrictive drugs can be used. An advantage of general anesthesia is the possibility to remove all four teeth in one procedure. The final decision for a type of anaesthesia must be made jointly by the anaesthetist and the patient.

  • Wisdom tooth extraction under general anesthesia
  • Anesthesia at the dentist