1. Anesthesia for dental procedures
Dr. S. Parthasarathy
MD, DA, DNB, Dip Diab.MD ,DCA, Dip software based statistics,
PhD (physiology)

2. Anesthesia started with dentistry
Horace wells administered himself nitrous oxide – his colleague extracted his tooth in 1844
In 1846, morton did it again !!

3. Usually not called for !! Children Mentally retarded adults
Dental phobia
Acute pus
Radiotherapy previous –( LA Vs GA)
Allergy to local anesthetics
Major surgeries
(difficult dental extractions or  for dental releasing surgeries)

4. Contraindications !!
Serious medical disease ?? Can we do as an outpatient ??
Eg. CHF, anticoagulants,
Swelling of the neck
Anesthetist – inexperienced

5. Three types of anesthesia
Dental chair anaesthesia,
Day care anaesthesia
In-patient anaesthesia.

6. Problems in dental chair
Venous return decrease
? Venous embolism
Unprotected airway
Aspiration of blood or mucus 
Adrenaline in local anaesthetic can cause arrhythmias in presence of halothane
Higher incidence of  arrhythmias due to stimulation of 5 th cranial nerve

7. Problems in dental chair
Nasal bleeding if nasal airway is used to deliver the anaesthetic
Fainting due to cerebral hypoxia
Difficulty in initiating CPCR once cardiac arrest occurs
Foreign body obstruction of the airway by needles or dentures, necessitating removal by bronchoscopy
BABA FACE - pnemonic

10. Preoperative work up √
Equipments √
Nasal airway

11. Intermittent machines , haloxair ??
ECO mask – goldman mask
Intermittent machines , haloxair ??

12. Haloxair unit

15. Newer set ups

16. SAFE short acting fast emergence
Bowel bladder evacuation
Inj. Atropine
Sevoflurane induction – previously halothane
Nitrous oxygen 65 – 35 + sevo –50% fio2- better
Action in a few seconds
Recover !!
SAFE agents !!

17. Transparent neonatal mask IV sedation with MAC – OK !?
Older children
Propofol is definite
Thio and keta ?? are other options
Suction – two machines
Transparent neonatal mask
IV sedation with MAC – OK !?
Drooping of upper eye lid over pupil – patient is under !!- verrill sign

18. Position on induction !! Maximal time

19. Airways Intubate ?? Nasal masks Nasal airways - mouth packs !!
Mouth gag on the opposite side
The surgeon finishes the
procedure in a few seconds
Allow to breathe through nose
If adenoids , nasal airway
is a must
Devonshire
Mckesson prop
Intubate ??

20. Usually nasotracheal
Difficult access as in impacted tooth, macroglossia, short neck
Excessive uncontrolled bleeding
maxillofacial or major dental surgery
Mentally handicapped
Obstruction of nasal passages, large adenoids where nasal mask is not effective
Inpatients ?

21. Semi sitting position problems ??

22. Intraoperative problem
There is a possibility of surgical emphysema or mediastinal emphysema following use of air turbine dental drills.
Stop nitrous oxide.
Diagnose a rare pneumothorax,
IPPV - ?
ICD - !

23. Intraoperative problems
Arrhythmias – adrenaline, halo , V th nerve
Aspiration
Laryngospasm
Mouth breathing
Fainting – oxygen, Iv fluids, stop manipulation
Single click switch back to supine position
Labile patients !!

24. Arrest
Collapse
Anaphylaxis
Think of dental chair

25. Use of the LMA for Dental Anaesthesia
Young (1991) has discussed the experience of using the regular nonreinforced LMA for dental work, usually for extractions and fillings in children.
Use of the LMA is said to be easier for the anesthetist than a nasal mask.
Throat pack – ok
Airway problems – more common – surgeons move all bones !! – manipulate and adjust mild – it becomes acceptable
Reinforced LMA – good- less interference with dentist

26. Recovery Tooth sockets may continue to bleed. Complete awake Reflexes
Left lateral
Suction
30 minutes atleast oxygen
Nil oral for 3-4 hours
Packs remove

27. EJOA – precision delivery of local anesthetic

28. Nerve blocks Posterior Superior Alveolar Nerve Block
Middle superior alveolar nerve block
Anterior superior alveolar nerve block
Inferior alveolar nerve block

29. Middle superior alveolar nerve block
Mucobuccal fold above second premolar
5 mm depth – 1 ml

30. posterior superior alveolar nerve block
height of the mucobuccal fold above and distal to distobuccal root of the last molar present in the arch
Upward (superiorly at a 45 degree angle to the occlusal plane).Inward (medially toward the midline at a 45 degree angle to the occlusal plane).
Backward (posteriorly at a 45 degree angle to the long axis of the molar) to a depth of 10-14mm.

31. Canine eminence ( infra orbital nerve block )
Anterior superior alveolar nerve block

32. Inferior alveolar nerve block
anesthetic solution at the retromolar triangle which is a triangular area located near to the distal side of the lower third molar.

33. Hypnosis
Acupuncture
Had roles but now ??

34. Post operative pain
Extraction of baby teeth is not especially painful.
The main problem is the psychological trauma of waking up uncomfortable in a strange place.
Para or syr. Ibuprofen sufficient

35. Poswilla report 1990
IV sedation single drug with nitrous (LA) – patient talking
Operator and anesthetist – different
All monitors including defibrillator
Experienced

36. Summary Three types Dental chair dangers Indications Contraindications
LA alone , IVS with MAC,
Nasal airway – 50 % O2
LMA
Intubate
SAFE agents
Recovery
Nerve blocks
Poswilla report

37. There is no minor anesthetic technique
Thank you all
There is no minor anesthetic technique
Same vigilance