Dental Treatments Performed Under General Anesthetic

Treatment under general anaesthesia for any kind of unpleasant treatment up to complete restoration of the jaws, gums and teeth, with or without implants in the meaning of complete mouth dental rehabilitation and dental treatment are performed as routine selective offers in BERLIN-KLINIK International Hospital and Dental Clinic. But if you have dental anxiety and are looking for general anaesthesia, you might be surprised to know that there are differences! General anaesthesia means unconsciousness, Sedation means diminished consciousness and Nitrous Oxide means sedation! We comprehensively plan every little detail and combine many long and sometimes unpleasant and stressful tooth treatments in a single treatment under anaesthesia. As well as a general anaesthetic for cosmetic surgical treatment under anaesthesia for wellness surgery and aesthetic-plastic surgery. Almost all aesthetic-plastic surgeries, such as facelift procedures of different techniques or all breast enhancement procedures are offered under general anaesthetic at BERLIN-KLINIK International Hospital and Dental Clinic as well. General anaesthetic for performance of all oral and maxillofacial surgeries, including those performed on the nose and ears, are, of course, also offered under general anaesthetic at BERLIN-KLINIK International Hospital and Dental Clinic. Short to say that from a dental hygienist under general anaesthesia up to a complete dental rehabilitation in full ceramic to total jaw replacements in zirconium oxide all imaginable treatments are possible in general anaesthesia here.

Total intravenous anaesthesia in BERLIN-KLINIK Anaesthesiologic Department can be defined as a technique of general anaesthesia using a combination of agents given solely by the intravenous route and in the absence of all inhalational agents including nitrous oxide. TIVA is the most often used general anaesthetic at BERLIN-KLINIK International Hospital. For complete mouth dental treatment therapies we often use Propofol. Propofol was introduced into clinical practice in 1986 and now seems to be taking over that role. It has also become widely used as a component of TIVA. TIVA has become popular, practical and possible only in relatively recent times. There are two main reasons for this. Firstly, unlike other popular intravenous agents of the past, the pharmacokinetic and pharmacodynamic properties of modern drugs like propofol and the newer synthetic, short-acting opioids make them very suitable for administration by continuous infusion. BERLIN-KLINIK dental and implantological treatments in general anaesthesia often last for many hours. Secondly, new concepts in pharmacokinetic modelling and advances in computer technology have allowed the development of sophisticated delivery systems which make control of anaesthesia given by the intravenous route as straightforward and user-friendly as conventional inhalational techniques. Intravenous drug administration to provide anaesthesia has evolved to become a popular alternative to inhalational anaesthesia. This evolutionary process is a result of improved understanding of pharmacokinetics, pharmacodynamics and the interactions which take place during continuous drug administration. Understanding these processes has facilitated the development of computerised syringe drivers that allow optimal drug selection and combinations. New intravenous drug delivery systems allow anaesthetists to vary anaesthetic depth in response to clinical signs in a manner intuitively similar to conventional volatile systems; thus simplifying the administration of intravenous anaesthesia. The result is an easy to use modern system of providing anaesthesia, which allows rapid, precise and independent control of amnesia, hypnosis and analgesia.

Pharmacokinetics is a potentially complex subject but an understanding of the basic concepts in relation to anaesthetic drugs can help to clarify the clinical implications of using a particular drug for TIVA and so assist optimal drug selection and combination. In BERLIN-KLINIK Anaesthesiologic Department the use of Propofol is daily routine with up to 10h general anaesthesia treatments and more since over than 10 years. The science of pharmacokinetics is simply the use of mathematics to describe how the body ‘handles’ particular drugs. Data can be gathered by performing plasma assays of specific drugs after administration by either single dose or infusion to examine how the plasma concentration changes over time. There is a mathematical relationship between an administered dose of a drug and the resulting observed changes in plasma concentration. This relationship allows mathematical pharmacokinetic models to be constructed that may then be used to facilitate the calculation of dosing regimens and to guide pharmacotherapeutic management. The system of intravenous drug delivery used during TIVA must help to achieve the following goals: smooth induction, reliable and titratable maintenance and rapid emergence. In addition, a system that uses the skills the anaesthetist has already learned administering inhalational anaesthetics would seem logical. Target controlled infusion BERLIN-KLINIK TCI-devices have been developed to meet these requirements.

We at the BERLIN-KLINIK Zahnklinik treat many patients that come to us with dental anxiety and are looking for a general anaesthesia. One of the methods we use is balanced anaesthesia, in which injection narcotics and the very gentle, well compatible TIVA total intravenous anaesthesia using only injected anaesthetics are usually used. In these, a soporific like Propofol is combined with an analgesic like Fentanyl or used pure if needed. This combination can be controlled relatively well. No gas is used. Except of the seldom use of laughing gas anaesthesia. At BERLIN-KLINIK, where general anaesthesia is regularly used, patients can look at the anaesthesia workplaces within the surgery areas if they wish. In practices where anaesthesia is used rarely, a “mobile anaesthetist” will bring in a mobile workplace. Dont hesitate to ask us about all your themes and thoughts about General anaesthetic Treatments concerning basic anaesthesia techniques, basic monitoring, general anaesthesia, cannulation small gauge, cannulation large gauge, surgical scrub, ketamine in general anaesthetic, intubation, extubation , techniques for intubation and extubation, Intubation nonrsi, rapid sequence induction, measures to improve larynscopic view, intubation with bougie nonrsi, extubation techniques, airway, laryngeal mask and cricothyroidotomy basic airway maneuvers, oropharyngeal airway insertion, holding paediatric Airway, aryngeal mask insertion, LMA insertion failure, cricothyroidotomy, giving spinal anaesthesia, spinal anaesthetic sitting, spinal anaesthetic lateral, high spinal anaesthetic, basic principles of immunity, outlining the innate and acquired immune responses, providing a summary of the main cells involved in the immune system, important immunoglobulins and the principles of the complement system.

A scientific description of anaesthesia is “pharmacologically induced, reversible coma.” Artificial anaesthesia therefore causes a temporary, reversible functional inhibition of the central nervous system, causing loss of consciousness, sleep and deactivation of perception of pain (analgesia). In many cases, flaccid paralysis of the controlled muscles is desired as well. Anaesthesia also causes reduction of reflexes. Anaesthesia is part of anaesthesiology, which is performed routinely at BERLIN-KLINIK International Hospital and Dental Clinic by specialists with special further training: Specialist physician for anaesthesiology and intensive care, anaesthetist. Like all medical processes, anaesthesia requires active contribution not only from the physician, but also from the patient! The patient cooperates with the anaesthetist for his safety. In particular for out-patient treatment under anaesthesia, the medical team requires the patient’s cooperation. Before surgery the patient learns everything that is important about the upcoming anaesthesia and his stay at BERLIN-KLINIK from the anaesthetist and receives answers to his questions. The physician assesses the possibility of using anaesthesia and the anaesthesia risk. Together with the patient, the best anaesthesia procedure (general anaesthesia, regional anaesthesia or a combination of the two) is selected. The patient is informed in detail of the risks of the anaesthesia procedure sand signs an informed consent. Because of the pre-medication prescribed during this meeting, the pre-surgery doctor’s visit is also called pre-medication meeting.

The current recommendations on medication to be taken in the context of surgery and anaesthesia/regional anaesthesia are complex. In this context, medication effects, co-morbidities, the type of surgery and anaesthesia/regional anaesthesia must be considered. This particularly refers to medication for hypertension/arterial hypertension, antidiabetics and substances that influence blood clotting. Therefore, the procedure may have to be coordinated with the treating physician and the anaesthetist before the surgery. These medical productions are available in a liquid, dissolved form. They must be injected. The highly popular and very well compatible product Propofol, for example, is well compatible even for longer anaesthesia and poses a low strain on the body. Absorption and elimination of an injection narcotic are generally different from those of inhalation narcotics. While the gases are mainly supplied to and removed from the organism by breathing, injection narcotics are supplied by injection and eliminated by metabolisation in the liver or elimination through the kidneys. The intraoperative monitoring measures for Germany are stipulated in the medical products act (Medizinproduktegesetz) and the medical device operator ordinance (Medizingerätebetreiberverordnung). Both laws implement the European standard EN 740. The recommendation of the Deutsche Gesellschaft für Anästhesie und Intensivmedizin DGAI on monitoring anaesthesia and equipping anaesthesia workplaces is used as a standard.

These are the reasons for fasting before surgery: General anaesthetic anaesthesia temporarily switches off the patient’s consciousness in a controlled fashion. This includes failure of important protective reflexes, such as the inhalation reflex, gag reflex, cough reflex. The cough reflex usually serves to free the trachea of foreign bodies or contamination. To avoid aspiration, i.e. entering of stomach contents into the breathing tract, it is important for the stomach to be empty. In case of regional anaesthesia, complications may occur that require intubation and subsequent general anaesthetic. For planned surgeries, the patient therefore has to fast even if regional anaesthetic is used. For emergency surgery, not having an empty stomach may be an argument for preferring regional procedures to keep the danger of aspiration low.

General anesthesia dental treatments a medical procedure that renders the patient unconscious, allowing for the safe and humane provision of medical and dental diagnostic and surgically invasive procedures. Dental treatment under general anesthesia is an effective way to provide medically necessary care to all patients who have no time for many long term visits or may be highly anxious or fearful, have special needs, or medically-compromised and unable to receive treatment in a traditional office setting in local anaesthesia. Delivering dental treatment in BERLIN-KLINIK under general anesthesia can have significant positive effects on the quality of life for patients and their families and can improve access to regular dental care. general anaesthesia may be medically necessary when treating some dental patients and, therefore, should be included as an essential health benefit under private medical insurance coverage for these patients. While general anesthesia is necessary for only a small subset of dental patients, insurance coverage is not needed in general so that necessary dental procedures can be accomplished in a humane, appropriate, efficacious, and safe manner. Much attention has recently focused on the use of general anesthesia to enable dentists to perform extensive or long term dental treatment. BERLIN-KLINIK offers the sleep-wake-up-ready treatment no matter what dental need or dental whish the patient has. These inpatient treatments sometimes take up to 10hours or more. However, sedation and general anesthesia have been utilized in the practice of dentistry and medicine since the 18th century. Dentistry, especially surgical dentistry has continued to build upon this foundation and has been instrumental in developing safe and effective sedative and anesthetic techniques that have enabled millions of people to gain access to dental care. The use of general anesthesia in BERLIN-KLINIK for dental care contin­ues to have a remarkable record of safety.

While most dental care is provided in a traditional dental office setting utilizing local anesthesia and, when indicated, a variety of adjunctive pharmacologic and behavioral guidance techniques, a subset of patients cannot benefit from routine approaches. Therefore BERLIN-KLINIK offers general anaesthesia dental treatment and general anaesthesia rehabilitation of tooth, jaws and joints as a regular treatment option. Some children and patients with special health care needs have treatment conditions, acute situational anxiety, uncooperative age-appropriate behavior, immature cognitive functioning, disabilities, or medical condi­tions that definitely require deep sedation or general anesthesia to undergo dental procedures in a safe and humane fashion. Included in this group are patients who have not yet developed the ability to comprehend the need for their treatment nor the effective and appropriate skills to cope with invasive and potentially uncomfortable and psychologically threatening procedures. For many of these patients, inpatient or outpatient treatment under general anesthesia in a hospital like BERLIN-KLINIK or ambulant treatment in a dental office or practice represents the optimum or only venue to deliver necessary oral health care. To effectively address the challenges associated with these patients, dentists and other professionals have developed a variety of patient management techniques, including the provision of dental care under general anesthesia in the dental office and in the hospital, ambulatory surgicenter, or other accredited surgical facility. In fact, instruction and experience in providing dental care under general anesthesia is a required component of the curriculum in all surgical dental residency training, as well as in many other dental post-doctoral programs like the german “Facharzt”/”Fachzahnarzt” here: Oral Surgeon or TMJ Surgeon.

by allowing for extensive dental rehabilitation in patients who are experiencing dental pain and difficulties in eating and sleeping, and whose partners, children, parents have concerns related to the health, nutrition and behavior. Facilitating dental access for very young patients, patients with special health care needs and or patients with a high degree of dental fear or anxiety. General anaesthesia in BERLIN-KLINIK providing an enhanced opportunity for patients, parents and children education on positive oral health behaviors which can lead to positive behavioral changes and improved oral health.

General anesthesia dental treatment in BERLIN-KLINIK is a clinician-controlled state of patient 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 sometimes is necessary to provide quality dental care for demanding patients or for long term or extensive treatments. Depending on the patient and other factors, general anesthesia can be done inpatient/outpatient in a hospital like BERLIN-KLINIK or an ambulatory setting, including some dental offices. The need to diagnose and treat, as well as the safety of the patient, practitioner, and staff should be specialized and performing general anaesthesia in daily routine like in BERLIN-KLINIK. They should be professionally considered in the professional use of general anesthesia. The decision to use general anesthesia must take into consider­ation: Alternative behavioral guidance modalities, dental needs of the patient, the effect on the quality of dental care, the patient’s emotional development and basically the patient’s anamnestic and clinical medical status

For patients with dental anxiety, general anaesthesia provides a safe, efficient, and effective dental care and dental and tmj-rehabilitation. Eliminate anxiety. Reduce untoward movement and reaction to dental treatment. Aid in treatment of the anatomic, mentally, physically, or medi­cally compromised patient. Eliminate the patient’s pain response.

Dental treatment under general anesthesia provides a safe approach for demanding patients and persons with extensive dental treatment needs or -whishes or special health care needs who cannot accept treatment in a conventional office setting. Provision of dental treatment under general anesthesia for uncooperative, young children with dental needs has significant positive effects on quality of life for both these children and their families. Oral health related quality of life is measured in relation to how the mouth and teeth affect physical, psychological and social well-being and daily activities such as eating, chewing, swallowing, speaking, playing, learning, happiness, embarrassment, and social interactions.

According to federal and international satisfaction surveys, patients who underwent dental rehabilitation under general anesthesia demonstrated improvements in pain relief, as well as in their ability to smile, laugh, eat and sleep. Patients with medical or compromising devel­opmental conditions were significantly more likely to have improved abilities to eat and sleep, and have a significantly improved overall health status. Partners and relatives have also reported improved social function, including more smiling, improved performance in business or education, and increased social interaction after receiving dental care under general anesthesia and that general anesthesia has a high degree of acceptance among all ages. Many patients and relatives express “fear,” “worry,” and “concern,” as well as some level of anxiety during general anesthesia and prior to treat­ment. However, after treatment under general anesthesia in BERLIN-KLINIK is complete, people reported a lessening and improvement in the amount of dental pain, sleeping pattern, eating habits and tooth brushing. Additionally, research indicates that postoperative discomfort is mild and subsides substan­tially over the first week after surgery. In fact, a systematic review of the literature found that “oral rehabilitation under general anesthesia results in the immediate improvement of the people’s oral health and physical, emotional and social quality of life. It also has a positive impact on the family.”Additionally, peoples acceptance of general anesthesia especially in the health care capital Berlin and its premium institution BERLIN-KLINIK over more physical management techniques has increased dramatically, because of many scientific reports, publications and growing expectations in public of safe and compassionate treatment.

Analgesia – the diminution or elimination of pain. Local anesthesia – the elimination of sensation, especially pain, in one part of the body by the topical application or regional injec­tion of a drug. Minimal sedation – a minimally depressed level of consciousness, produced by a pharmacologic method that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Moderate sedation – a drug-induced depression of consciousness during which patients respond purposefully to verbal com­mands, either alone or accompanied by light tactile stimulation. Deep sedation – a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purpose­fully following repeated or painful stimulation. General anesthesia – a controlled state of un-consciousness 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 sometimes is necessary to provide quality dental care for patients with fear or extended treatment needs. Special healthcare needs – Special health care needs include any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs. The condition may be developmental or acquired and may cause limitations in performing daily self-mainte­nance activities or substantial limitations in a major life activity. Healthcare for individuals with special needs requires specialized knowledge, increased awareness and attention, adaptation, and accommodative measures beyond what are considered routine.