The recent decision by health authorities in Britain to ban the use of general anaesthesia in dental surgery is a welcome move from the perspective of patient safety. However, for the significant number of dental phobics who cannot face dentistry under local anaesthetic alone, it represents one fewer option in the dreaded visit to the dentist.
It comes as somewhat of a surprise to my patients to hear of my own needle phobia, and in particular, my dread of seeing the dentist. I will happily stick needles into various parts of other people's anatomy - but as soon as I visualise the anaesthetic-filled needle of a dentist, I become unwell. My heart rate and blood pressure rise, and if I do not shut my eyes rapidly, a cold sweat breaks out. Next up is a buzzing in the ears, as voices disappear into the distance; if I were not already lying on the dentist's chair, I would pass out completely.
I am fortunate to have found a dentist who possesses a great skill in gentle reassurance and explanation. I think the last quality is what really makes the difference - he does nothing to you without telling you exactly what it is and also how long it will take. Each step of the treatment is prefaced with a clear and gentle explanation. I have found that this has helped enormously; to the point where going to the dentist has lost most, if not all, of its previous dread.
A general anaesthetic should only be administered within the confines of a hospital. The reason is the risk of a sudden, life-threatening cardiac event, which is estimated to occur in one per cent of all anaesthetics given. If an adverse event occurs in a properly equipped environment, then the chances of successfully resuscitating the patient are significantly increased.
The Dental Council in this State takes a dim view of practitioners undertaking anaesthetic procedures without appropriate back-up. They do draw a distinction between intravenous sedation and general anaesthesia, however.
A Dublin oral surgeon and dentist has set up a state-of-the-art theatre in his own surgery. He now offers a service for patients using a drug called Midazolam. This agent is administered intravenously by a consultant anaesthetist, with full monitoring equipment at his disposal. In the unlikely event of a problem, the facility is equipped with resuscitation facilities of an equivalent standard to that found in a hospital.
The patient receiving Midazolam is sedated, but not anaesthetised. He also benefits from a most interesting and valuable side effect. Midazolam induces amnesia, so that the dental patient does not remember anything of the procedure, even though they will have been conscious throughout. As the drug wears off after 45 minutes, it is possible to return home shortly after the surgery.
A facility such as this not only offers hope to dental phobics, but also allows the removal of wisdom teeth and the implanting of false teeth, which hitherto required a general anaesthetic. These procedures are highly invasive from the patient's perspective, and in the case of wisdom teeth, the issue is one of accessibility to the conscious patient for the dentist. One oral surgeon says: "This approach to anaesthesia allows me to carry out procedures which previously entailed bringing a patient into hospital".
From a consumer's point of view, any dentist offering intravenous sedation should have a second qualified doctor available throughout the procedure. The equipment required to ensure patient safety also goes beyond that required for dentistry under local anaesthetic.
This surgery-based dental anaesthesia is not yet covered by BUPA or VHI. It is undoubtedly cost-effective, offering the opportunity of quick recovery and less time off work.
It is important to ask any dentist offering intravenous sedation about these facilities and the qualifications of the medical personnel who will be administering the drugs. In the absence of firm Department of Health guidelines on this issue, it is well worth investigating the best and safest where dental anaesthesia is concerned.
Contact Dr Houston at mhouston@irish-times.ie or leave messages on tel 01-6707711, ext 8511.