With modern advancements in pain management, dental extraction or tooth removal can now be as pain-free as possible. The techniques and materials of anaesthesia have evolved over the years. This makes the dental anaesthesia safer and also more comfortable for the patient. At Royal Dental Clinics, we prefer to use all types of modality depending upon various factors. Some are enlisted below.
Common reasons for Dental Extraction
Over-retained or supernumerary tooth
When there is more number of teeth in the mouth or when the milk teeth do not fall in time, then extraction may be warranted.
Orthodontic related extraction
Due to space discrepancy, the orthodontist may decide to extract natural teeth. Usually, it is the 1st premolars. This is done so that additional space may be created to align the remaining teeth in the mouth. Such extractions need to be atraumatic.
Severely decayed or moving tooth
When all methods and procedures to save natural teeth fail then extraction may be the only alternative. Extraction in such cases prevents the spread of infection. After extraction, the missing teeth can be replaced using dental implants.
Impacted 3rd molar
Impacted 3rd molars or pain during the eruption of 3rd molar is one of the reasons for their extraction.
Factors influencing the type of anaesthesia
- Dentist Preference: Many times, due to the complexity of the tooth position, or due to reduced mouth opening and pain, the dentist may prefer a deeper form of anaesthesia. This is discussed in the next section.
- Patient comfort: Dental fear and anxiety are very real. Now, many patients prefer to opt for deeper forms of anaesthesia such as general anaesthesia for extraction. In such cases, the patient is completely unaware of the procedure and is practically sleeping throughout.
- Nature of the Treatment: The complexity, duration, and invasiveness of the procedure play a key decision.Â
- Patient’s Health Condition: The overall health, age, and medical history of the patient influence the choice of anesthesia.
- Allergies: Any history of allergic reactions or adverse effects from anesthesia will influence the decision.
- Type of Surgery: Some procedures, especially those involving delicate or sensitive areas like the eyes or brain, may require specific types of anesthesia for better control
Different Modalities for Anesthesia
Local anaesthesia
Over 90% of anaesthesia in dentistry is Lidocaine-based anaesthesia. But in select cases, where the lidocaine doesn’t act well or results in a reaction, then then Articaine or Bupivacaine can be used. The local anaesthetic is used to numb the local region of the area of treatment.
Sedation
In select cases, Nitrous gas or IV sedation can be administered. This is done to reduce anxiety in patients. The treatment usually begins with sedation and then followed by local anaesthesia. The patient is very relaxed and it is a process which can be done in a dental clinic itself.
General Anaesthesia
In complex cases or uncooperative patients, complete general anaesthesia is preferred. In such cases, with medicines the patient is made to sleep. During this process, the patient is unaware of the pain and pressure.
Side effects of Dental Extraction Anaesthesia
Like with any branch of medicine, anaesthesia can also cause side effects. It is therefore only after years of training and experience that qualified personnel are allowed to administer. Here is a list of conditions and diseases one needs to be careful of when administering any type of anaesthesia.
           1. Kidney or Liver diseases: The elimination of the anaesthesia is done through these organs. In case of any disease in the liver or kidney, the anaesthesia may build up in the blood and cause toxicity.
           2. Cardiac diseases: Anaesthesia contains chemicals which have a direct impact on the blood flow, blood vessels and the heart. Therefore, dosage correction is done by a qualified doctor when administering anaesthesia in patients with a history of cardiac diseases.
           3. Elderly individuals: In the elderly the process of elimination is reduced. Also, there is a higher chance of being medically compromised. And therefore, a separate branch of dentistry, called geriatric dentistry is slowly gaining popularity.
           4. Pregnancy: In this phase of life, the anaesthesia may adversely impact the growing child. However, in case of emergency, the 2nd trimester is considered the safest for any dental procedure requiring anaesthesia.
Other Issues:
1. Allergy – Any known allergy to the contents of anaesthesia. This would result in the avoidance of that group of anaesthesia and using other modalities.
2. Failure to achieve anaesthesia – In some cases, lidocaine-based anaesthesia fails to act. And, in such cases, other treatment modalities may be used.
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