Dental care under anaesthesia
Most dental treatment is done with local anaesthetic alone. General anaesthesia or sedation may be recommended for longer or more complex treatment, such as removal of several teeth or wisdom teeth, extensive restorative work or implant surgery, or for people who find dental treatment very distressing or difficult to tolerate while awake.
When this care is provided in a dental practice, it is often called office-based anaesthesia. It can be convenient and familiar, and it avoids a hospital admission. It is not the right setting for everyone.
The role of your specialist anaesthetist
Your dentist or oral surgeon focuses on the treatment. As your anaesthetist, I focus entirely on you: assessing whether office-based care is safe for you, giving and monitoring the anaesthetic, managing your airway (which is shared with the dentist during mouth procedures), and staying with you until you are safely in recovery. I am not doing the dental treatment, so my attention is not divided.
Patient selection and suitability
Careful selection is the most important safety step in office-based anaesthesia. A dental practice does not have the back-up of a hospital, such as an intensive care unit, blood bank or a team of other specialists close by. Office-based anaesthesia is generally best suited to people who are otherwise well, or whose medical conditions are stable and well controlled.
Treatment in a hospital or day surgery is often the safer choice for people with:
- significant heart disease, such as recent heart attack, heart failure, or a heart condition that limits everyday activity
- significant lung disease, or breathing problems that are not well controlled
- severe or untreated obstructive sleep apnoea
- a high body mass index (BMI), especially with sleep apnoea or other related conditions
- a known or suspected difficult airway, or a previous serious problem with anaesthesia
- a personal or family history of malignant hyperthermia or other rare reactions to anaesthetic drugs
- complex medical conditions that are likely to need monitoring or care after the procedure
- no responsible adult available to take them home and stay with them
These are not fixed rules, and many people with one of these conditions can still be cared for safely. The decision is individual. If I think you would be safer in hospital, I will explain why and discuss the options with you and your dentist.
Preoperative assessment and preparation
Before your appointment, I will review your health, usually through a health questionnaire followed by a conversation, and sometimes a separate consultation. I will ask about heart and lung conditions, snoring and sleep apnoea, your medications, allergies, and any previous experiences with anaesthesia. Information from your GP or other specialists may be requested.
You will be given individual fasting instructions. Please follow them carefully, because an empty stomach reduces the risk of stomach contents entering the lungs. Please do not stop any prescribed medication unless your anaesthetist, dentist, GP or prescribing doctor has advised you. Medicines such as blood thinners, diabetes medicines and GLP-1 medicines need individual advice; see Medications Before Anaesthesia. Wear loose, comfortable clothing and short sleeves, and avoid nail polish, make-up and jewellery.
General anaesthesia in a non-hospital environment
A general anaesthetic in a dental practice is the same type of anaesthetic as in a hospital. The drugs, techniques and monitoring are the same, and the care should be to the same standard. Depending on the treatment, you may receive deep sedation or a general anaesthetic, with a breathing tube placed through the nose or mouth, or another airway device, so that the dentist can work while your airway is protected.
The Australian and New Zealand College of Anaesthetists (ANZCA) sets professional standards for the facilities, equipment and staffing needed wherever anaesthesia is given, including outside operating theatres. These are described in its position statement on minimum facilities for safe anaesthesia (PS55), and in its guidance on procedural sedation (PG09) and on monitoring during anaesthesia (PG18). I work to these standards in every location.
Monitoring, equipment and emergency preparedness
Monitoring and equipment
Throughout your anaesthetic, your heart rhythm, blood pressure, oxygen levels and breathing, including the carbon dioxide you breathe out, are monitored continuously, just as in hospital. The practice has an anaesthetic machine or equivalent equipment, a reliable oxygen supply with a back-up, and dedicated suction.
Emergency preparedness
- A trained anaesthetic assistant who is there to help me, separate from the dental team.
- A full range of airway equipment, including equipment for an unexpectedly difficult airway.
- Emergency drugs, including those for severe allergic reactions and, where relevant, for malignant hyperthermia.
- A defibrillator and resuscitation equipment.
- A recovery area with monitoring, and staff trained to care for patients waking from anaesthesia.
- Regular checks of equipment, and emergency plans that the whole team knows.
Ambulance access and emergency transfer
Serious problems are uncommon, but planning for them is essential. Before I provide anaesthesia in any practice, I confirm that there is a clear plan for calling an ambulance and transferring a patient to hospital if needed. This includes ambulance access to the building and the treatment room, enough space to move a patient on a stretcher, a working way to call for help, and an agreed receiving hospital. In an emergency, I stay with you and continue your care until you are handed over to the ambulance or hospital team.
Postoperative recovery and discharge requirements
After treatment, you will be cared for in the recovery area until you are awake, comfortable, able to drink and walk with help, and your vital signs are stable. Some numbness, swelling, mild bleeding and a sore or dry throat are common. You will be given written instructions about pain relief and mouth care.
If you have heavy bleeding, difficulty breathing or swallowing, or are worried at any time, contact the practice or your dentist. In an emergency, call 000. See also Recovery & Aftercare.
Relevant anaesthetic risks and precautions
The most common side effects are drowsiness, nausea, a sore throat or nose (if a tube was placed through the nose), and a mild headache. Because the dentist works in the mouth, there is a risk of blood or fluid reaching the airway, which is why the airway is protected and suction is always ready. Damage to teeth, lips or tongue can occur. Serious complications such as severe allergic reactions or breathing problems are uncommon, and careful patient selection and preparation are the main ways the risk is reduced. See Anaesthetic Safety & Risks and Understanding Your Anaesthetic & Informed Consent.
Links to additional patient resources
- Preparing for Your Procedure
- Understanding Your Anaesthetic & Informed Consent
- Medications Before Anaesthesia
- Recovery & Aftercare
- Fasting before your surgery, Australian and New Zealand College of Anaesthetists (ANZCA)
- Types of anaesthesia, ANZCA