5.4 Advanced Behavior Guidance Techniques—Continued
General Anesthesia
Description: General anesthesia is a controlled state of unconsciousness accompanied by a loss of protective reflexes, including the ability to maintain an airway independently and respond purposefully to physical stimulation or verbal command. The use of general anesthesia is sometimes necessary to provide quality oral health care for children. Anesthesia can be administered in a hospital or in an ambulatory setting. (Read more about preparing children with special health care needs for the hospital experience.) The need to treat the child, as well as the safety of the child, dentist, and staff, and the understanding and acceptance
of the parents should be considered when deciding whether to use general anesthesia.
The decision to use general anesthesia should take into consideration (1) alternative techniques that could be used instead, (2) the child’s oral health needs, (3) the effect of general anesthesia on the quality of oral health care, (4) the child’s emotional and cognitive developmental levels, and (5) the child’s medical status.
Objectives:
- provide safe, efficient, and effective oral health care
- manage anxiety or dental phobias
- reduce untoward movement and reaction to oral health procedures
- eliminate the child’s pain response
Indications:
- A child who is unable to cooperate owing to a lack of psychological or emotional maturity and/or cognitive, physical, or medical disability
- A child for whom local anesthesia is ineffective because of acute infection, anatomic variations, or allergy
- An extremely uncooperative, fearful, anxious, or uncommunicative child
- A child requiring significant surgical procedures
- A child for whom the use of general anesthesia may protect the developing psyche and/or reduce medical risks
- A child requiring immediate, comprehensive oral health procedures.
Contraindications:
- a healthy, cooperative child with minimal oral health needs
- a predisposing medical condition that would make general anesthesia inadvisable
Written informed consent from a parent must be obtained and documented in the child’s record before general anesthesia is used. The child’s record should include (1) informed consent and (2) indication for the use of general anesthesia.
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