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Specialties in Dentistry - Dental Anesthesiology

I was to start alphabetically last week with the specialties in dentistry. I happened to start with the one that was on my mind instead. This week, I will start with the first one alphabetically which is Dental Anesthesia.

Dental Anesthesia is the newest specialty in dentistry in Canada. It is less than two years old as a recognized specialty here. As such, it will be difficult to access someone who is a certified specialist in this field for a few years. Usually when a specialty is new, its first members work primarily at dental schools to train members of the clinical part of the profession both as general dentists and as specialists in the same discipline as themselves. Continuing Education training to dentists already practicing in the community is also a priority.

Dental Anesthesia (also called Dental Anesthesiology) is concerned with local anesthesia, sedation, and general anesthesia for use when doing dental procedures. The most common form of anesthesia in dentistry is local anesthesia. Local anesthesia is when a small area of the body is made numb so it will not feel pain, with the patient still awake. This is the way most dental procedures are done. Usually, local anesthetic (freezing) is placed and a few teeth or a somewhat larger part of the jaw is anesthetized and the work is done in that area. However, sometimes anesthesia of a different type is needed. Take, for example, extraction of wisdom teeth. Often, people are afraid of this procedure. As well, the mouth needs to be opened quite wide to make as much space in the operating area as possible. Both of these considerations can be addressed by sedating the person. Local anesthetic is used in addition to the sedative agent. Another example when anesthesia in addition to local anesthesia would be necessary is with a very young patient like someone with nursing caries (baby bottle cavities). The person is usually under 4 years old—often only 2—and has extensive work that has to be done. General anesthesia (putting the person to sleep) is usually the method of choice for these patients. Another example is a person who is very afraid of getting work done. Work can be accomplished without any anxiety using nitrous oxide gas (laughing gas) in addition to local anesthetic (freezing). The person often swears no “needles” were ever used, but the gas does not provide anesthesia when used in the dosages allowed today so local anesthetic is always used. This method is very effective on adults but has varying results on children. Even oral anti anxiety medications like ativan provide a nice adjunct to local anesthetic for the anxious patient.

Of the examples above, only the use of a single anti anxiety oral medication (like ativan) along with local anesthetic is allowed in Ontario by a general dentist without additional training. Along with the techniques of use of these various agents and many others, a dental anesthesiologist is trained in deciding which agent would be most useful for a certain case given the procedure to be done and the medical history of the patient. This is a new field. We are also expecting that dental anesthesiologists will provide further training and expertise to dentists about enhanced effectiveness of local anesthetic and new techniques. In fact, it is likely that your dentist will receive additional training from a dental anesthesiologist that will make your treatment more comfortable and second injections less likely. This is one of the dental specialists a regular patient will likely never meet, but the work of this person will make the treatment you receive from your dentist easier. We are awaiting the opportunity to hear from one of these specialists in our area.

- This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)

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