In modern anaesthesia, sleep anaesthesia can be performed at the dentist’s office on an outpatient basis.
In cases of great dental anxiety (dental phobia), the dentist is often required to perform an analgosedation, which is commonly referred to as twilight sleep or sleep anesthesia. In sleep anaesthesia (analgosedation), a combination of pain-relieving medication with soothing substances eliminates pain and relaxes the dentist to sleep, and painkillers are added during dental sedation to prevent toothache, jaw pain and swelling after the operation.
Hospital stays are usually no longer necessary for dental treatments, because the development of new narcotics has greatly improved the tolerability, so that normally no side effects are to be feared.
With controlled sedation (twilight sleep / slumber anaesthesia), a sedative is injected over a venous access in addition to a local anaesthetic.
This leads to a relaxed twilight sleep. See treatment methods for dental phobia. In contrast to general anaesthesia, no ventilation tube is inserted into the trachea for ventilation and the patient breathes independently during the whole time. Nevertheless, important bodily functions are monitored with modern devices for safety reasons.
Dental treatment under analgosedation
If the anxiety feeling is too deeply anchored and the tooth patient shows physical anxiety symptoms, such as trembling, restlessness, tachycardia, nausea and irritability, the treatment can be performed under analgosedation (sedation).
This is carried out and monitored by an anaesthetist. The patient is put into twilight sleep by a medication. Analogosedation (analog sedation) is carried out especially for short procedures, for procedures on several teeth a general anaesthesia is carried out due to the time required. During analgosedation, the anaesthetists administer painkillers (analgesics) and sedatives or sleeping pills (sedatives) via a vein access under the supervision of the cardiovascular functions. During the dental treatment one is responsive and breathes by oneself, but is in a twilight sleep. The relaxed and sleepy situation prevents unwanted fear reactions and puts very little or no strain on the cardiovascular system. For the safe elimination of pain, a local anaesthetic is also sometimes administered.
Sedation with nitrous oxide during dental treatment
The analgesic (analgesic) and sedative (soothing) effects of nitrous oxide (chemically N2O, nitrous oxide, nitric oxide) were discovered as the first sedative as an anaesthetic. During the dental treatment, the patient can let go of the nitrous oxide sedation and pursue pleasant thoughts.
Sedation with laughing gas or narcosis with laughing gas is considered obsolete today under the anaesthetists “dental treatment in twilight sleep”. The advantage of nitrous oxide analgesia compared to other sedation methods (oral or intravenous) is its optimal controllability. At the end of the dental treatment, the patient breathes pure oxygen for about five minutes, after which the laughing gas completely eliminates its effect. Laughing gas was the first anaesthetic gas discovered by an American dentist in 1844 and had a good analgesic and calming effect. The dosage of the laughing gas-oxygen mixture requires special controlled equipment and, like all anaesthesia, belongs in the hands of the appropriately trained doctor. A mixture of oxygen and laughing gas is administered through a small nose mask, whereby the effect begins after just a few breaths. During dental treatment, the dentist can change the intensity of the sedation via the variable mixture of oxygen and laughing gas and thus adapt it individually to the patient. Sedation with laughing gas gives you the feeling of lightness and relaxation, you reach a pleasant trance state. When sedating with laughing gas, you are always responsive and in control of your senses. During sedation one feels the need to close one’s eyes, but during dental treatment one opens one’s mouth when the dentist gives the order. Fear and tension give way to a calming feeling of security, so that no jaw cramps arise. A suggestive calming music can support and intensify the hypnotic effect of laughing gas. The headphones with music sounds simultaneously attenuate the unpleasant treatment noises. At the same time as the dentist’s anxiety, the sensitivity to pain also decreases, so that the placement of an anaesthetic injection in the mouth, for dental patients (especially with anxiety) is not noticed, which otherwise becomes a nightmare. Also the choking stimulus (impression taking) and strong swallowing reflexes are almost completely eliminated by the sedation with laughing gas during the dental treatment, which facilitates the work of the dentist.
General anesthesia at the dentist only in case of phobia
For dental patients who have a severe disability, so that they cannot control the mouth muscles themselves, such as opening the mouth or keeping it open, general anesthesia is also used during dental treatment.
In such cases, however, the dentist works with an anesthesiologist who is a specialist in anesthesia who monitors the anesthesia. Some parents would like to have a general anaesthetic for their anxious, screaming children during dental treatment. General anesthesia is not suitable for this. There are medical reasons against dental treatment for non-phobic patients. For the sensitive organism of small children, general anaesthesia is a great burden and can result in undesirable side effects. If a child is only treated under general anaesthesia, this is memorised as experience. It does not experience the success to have overcome its fears with own strength and to have endured the treatment consciously and to have survived and child remains presumably always a (fear patient) which wishes a general anaesthesia. This will probably mean an unnecessarily large number of damages to teeth and gums in the future, because necessary treatments will always be postponed to the limit of what is bearable.
Dental treatment under general anesthesia for children
General anaesthesia is a condition in which certain active substances temporarily completely eliminate consciousness, sensitivity to pain and muscle tension.
The ability to remember is temporarily and completely switched off during general anaesthesia. For children and mentally handicapped people as well as patients with poor cooperation, treatment under general anaesthesia may be indicated so that the success of the therapy is not endangered. Dental treatment under general anesthesia for children is possible, but often not advisable. In the case of complex dental restorations of the dentition, the treatment method for children may be suitable for dental treatment under general anaesthesia at the dentist. Due to the rapid development of anaesthesia and intensive medicine, anaesthesia, general anaesthesia or twilight sleep have become safer if the prescribed preliminary examinations are adhered to. Unwanted effects of general anaesthesia have become very rare, however, there can be incidents with general anaesthesia which must be regarded as considerable. The dental treatment of patients with disabilities requires a great deal of medical knowledge, empathy and a high level of social competence. Physically and mentally handicapped people are often unable to perform optimal oral hygiene due to their reduced motor skills and therefore belong to the high-risk group for dental diseases. During general anesthesia, an anesthesiologist must also be present to determine whether the general anesthesia can be performed. The patient’s general state of health plays a major role in the assessment, as the risk is higher in surgery than in dentistry, for example. A general anaesthetic can be an inhalation anaesthetic, in which the active ingredient is inhaled through a mask, or an intravenous anaesthetic, in which the drug is injected into the body through an access to the vein. Undesirable conditions caused by general anaesthesia can be cardiovascular problems, allergies or very rarely nausea and vomiting after waking up.