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Monday, 16 November, 1998, 11:37 GMT
Dental anaesthesia
The UK is the only country in the world where general anaesthesia is commonplace for dental treatment.

Every year 350,000 British patients - mainly children - have their dental work carried out under a general anaesthetic.

The practice was normal everywhere once, but, over the years, other countries have restricted the use of general anaesthetics to hospitals.

In the UK, a combination of professional resistance to change among dentists and patient demand for general anaesthesia prevented this happening.

Doctors warn that a general anaesthetic is not the best way to overcome fear of the dentist.

In the past, dental patients would think nothing of "being put to sleep" while they had a tooth extracted.

It can, after all, be a very traumatic experience.

However, modern techniques mean that no dental surgery requires more than local anaesthesia, perhaps used in combination with sedation.

Yet it was not until 10 November 1998 that the General Dental Council (GDC), the regulatory body for dentists, restricted UK dentists' ability to operate on patients under general anaesthetic in the humble setting of the dental surgery.

Unconscious state

Under general anaesthesia the patient loses consciousness entirely. Although they are extremely safe, there are risks attached.

Some people can suffer allergic reactions to the drugs involved, while others can have difficulties with their heart rate or breathing.

The safest place to have a general anaesthetic is in a hospital, where an emergency team is ready to resuscitate any patients who have problems.

Yet the UK has persisted with general anaesthesia in dental surgeries - where there is little or no support - since the middle of last century.

Perhaps this is because the first successful anaesthesia is thought to have been induced by a dentist - William Thomas Morton. In 1846 he used ether to send a patient to sleep for a difficult tooth extraction.

Variations in practice

Professor Leo Strunin is president of the Royal College of Anaesthetists, which is responsible for overseeing the training of anaesthetists.


He said the practice of general anaesthesia varied between hospitals and dental surgeries.

In a hospital, general anaesthetic can only be given by three types of doctor.

First, there are consultant anaesthetists, who before they get their post must gain a place on the General Medical Council's specialist register.

To do this they will have to train in the specialty for at least six years after qualifying as a doctor.

Second, there are trainees in the specialty, but they will be supervised by a consultant.

Third, there are non-consultant career-grade doctors. They may or may not have completed their training.

Again, they have to be supervised by a consultant before they can put a patient under general anaesthesia.

"But outside the hospital," said Professor Strunin, "there is a wide range of people - some of whom are consultants, which is fine, some of whom are not."

He said that it was those who were not who created the cause for concern.

Guidance


Although the majority of dentists who offered general anaesthetics were qualified to give them, he said, this year had seen a rise in the number of cases where things went wrong in dental surgeries.

"Things have been going wrong on a fairly regular basis, but this year there has been too much going wrong," he said.

Professor Strunin wrote to Professor Sir Kenneth Calman, the chief medical officer, to express his concern earlier this year.

At the same time the General Dental Council became aware that something was wrong with the current guidelines.

It said there were too many ambiguities about where responsibility lay for the safety of patients.

Recommendations

It set up a working group in May to examine the issue and November's restrictions were placed on the basis of the group's recommendations.

However, many dentists who have hitherto practised general anaesthesia have extremely sophisticated high tech surgeries.

Professor Strunin said that they should focus their resources on procedures requiring local anaesthesia.

They could use sedation techniques, where patients are calmed so a local anaesthetic can be injected, to help anxious patients overcome their fears, he said.

But he added: "General anaesthesia in the UK is very safe. However, without the proper facilities, when things go wrong, they go wrong very quickly."

See also:

15 Oct 98 | Health
12 Jun 98 | Health
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