As technology advances, so the nature of dentistry has changed. It’s not that long since the only reason to visit a dentist’s surgery, unless you were due for a check-up, was because you were suffering pain caused by infection, decay or damage suffered accidentally. A modern clinic, on the other hand, has an ambience akin more to an upmarket health spa or beauty parlour, and the treatments offered range from a quick and simple clean-up to orthodontic measures which can take many months to reach full fruition.
The complex nature of some cosmetic dental surgery means that extra attention needs to be paid to the correct use of anaesthetic. Oral surgery, particularly when dealing with a procedure such as removing a wisdom tooth or dealing with an infected root canal, can be long and complicated, and it’s imperative that the anaesthetic provided does the job of keeping the patient relaxed, comfortable and pain free, whilst also allowing for a relatively speedy recovery time. In many cases a local anaesthetic, delivered via injection, can be used, but sometimes sedation is called for, particularly if the patient is more than usually anxious about dental treatment. If you visit a leading dentist in London then you can rest assured that they will be working at the cutting edge of technology, taking advantage of the latest research into dental anaesthesia, and in particular the work being done with combined anaesthetics.
A study, which was recently published in ‘Anaesthesia Progress’, looked into the use of two differing drug combinations which were chosen to produce a state of heavy sedation in patients. The level of sedation in question was of the type required when longer or more complex procedures are being attempted. One of the chief factors to bear in mind when considering the use of anaesthetic is the fact that the average dental clinic, even one of the more advanced and modern facilities, will lack the kind of space, equipment and staffing required to cope with a long drawn out recovery process. It’s vital, therefore, that the anaesthetic used should, whilst providing deep levels of sedation, allow for a speedy return to full consciousness. In the experiment featured in the magazine, dentists ran a double blinded test, which means that none of the 37 patients taking part, nor the dentists, knew which of two different types of anaesthetic were being used.
In both cases the anaesthetic used was delivered via an on-going intravenous transfusion. Some of the patients received a dose of propofol and remifentanil whilst the others were given propofol and ketamine. All of the patients were monitored throughout to keep track of their blood pressure, heart beat and respiratory activity. After the treatment, the time taken to emerge from the effects of the sedative was noted, as was the total recovery time, and the patients and dentists were asked to give their views on how effective each anaesthetic was. In terms of personal satisfaction, both combinations came out roughly the same, but, whilst patients who received ketamine took 13.6 minutes to emerge from its’ effects, those given remifentanil only took 7.1 minutes. The total recovery time was 42.9 minutes for those in the ketamine group and 24.5 minutes for the others. Whilst the sedative effect for both was similar, it was noted that the patients given ketamine did experience an increase in their heart rate.
The overall conclusion to be drawn from the study was that, whilst ketamine is less expensive and thus more cost effective, the speedier recovery experienced with remifentanil makes it the better overall choice for more in depth and complicated dental procedures.