Dental Treatment Under GA Safe for Special Needs Population

A new study has found that administering general anesthesia (GA) for dental treatment as a way to avoid risks of injury and excessive stress in special needs patients is safe, with very low morbidity.

Researchers at the University of Illinois Chicago Medical Center (USA) retrospectively evaluated comprehensive dental rehabilitation (CDR) treatment performed on 363 patients for intraoperative and postoperative complications both related to anesthesia and surgery, as related to the American Society of Anesthesiology Physical Status (ASAPS) classification. One hundred and eight-three patients were classified as ASAPS I, 127 as ASAPS II, and 53 as ASAPS III. The researchers examined some of the unexpected anesthetic challenges for the special needs population, which include limited preanesthesia assessment of airway and general physical condition; limited medical risk assessment due to lack of cooperation or lack of access to medical support systems; and lack of a compliant caretaker network to ensure preanesthesia and postanesthesia compliance. Other challenges addressed included surgical complications such as surgical "surprises,” making the stratification of risk and the estimate of procedure time difficult to asses; undiagnosed dental and oral diseases requiring more aggressive intervention; and poor after-care and compliance which can complicate what otherwise would be considered routine care.

The researchers found that despite the possible "surprises” and complications, only two complications resulted among the study subjects. One complication happened to a16-year-old ASAPS I boy, which was airway related, and a second complication occurred in a 22-year-old ASAPS III woman, which was surgically related. Both led to unplanned inpatient admission and the two were treated successfully with no residual morbidity. The study was published in the Winter 2007 issue of Anesthesia Progress.

"Dental rehabilitation of special needs patients under general anesthesia is safe,” concluded lead author Zakaria Messieha, M.D., D.D.S., and colleagues of the department of anesthesiology. "It is important to compare the level of risk versus benefit and make this clear to the patient or family member.”

Patients with mental and physical limitations often pose a challenge when needing dental treatment. Lack of cooperation, combative behavior, and physical limitations can make conventional treatment under local anesthesia very difficult and sometimes impossible. To avoid injury and excessive stress as well as the inability to provide high quality and well-delivered dental care, dentists often resort to the management of special needs patients who need comprehensive dental rehabilitation under GA.


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University of Illinois Chicago Medical Center