General anaesthetic (GA) is not without its risks so local anaesthetic (LA) is preferred where possible.
There are different types of sedation available- the question is simply, ‘which is most appropriate for you.' Your dentist will discuss which may be the most appropriate.’
The choice depends on the following criteria, relating to the level of difficulty and the risk of complications:
- Is the procedure complex and likely to take over an hour?
- Are you anxious to the point where the procedure would not be possible under local anaesthetic? Everybody is anxious (and that's totally understandable), but a general anaesthetic is serious, time consuming and very expensive, as it requires not just an oral surgeon but a hospital setting, a registered anaesthetist, nurses etc. This normally sorts out those of you who are truly anxious from the more apprehensive.
- Is the procedure possible under local anaesthetic? For children and the medically handicapped it may not be possible to complete the extractions in the chair and if extractions were necessary, general anaesthetic would have to be considered. Has local anaesthetic failed for some reason? It may not be possible if a true allergy exists or if a significant spreading infection would prevent you from going numb.
- Are multiple extractions required? It is very unusual to have all four teeth out under local anaesthetic - one side at a time (2 teeth) is preferred. These tend to be simpler cases- your dentist will discuss if local or general anaesthetic is appropriate as part of your assessment.
Whilst general anaesthetic can be performed on anybody, its risks increase if you suffer from certain medical conditions such as those listed below.
This list is by no means complete; it just gives an idea of some of the major ones:
(i) Heart attack
(v) Deep vein thrombosis
(vi) Severe hyper-tension
(viii) Severe asthma or lung problems
(ix) Previous reaction to general anaesthetic
(x) Renal failure
General anaesthetic can be performed as an outpatient when you stay in for the day, or as an inpatient. The choice depends on how long the procedure is likely to take, your medical history (above), if monitoring is necessary, and the availability of someone to care for you and take you home.