06 November 2019

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Third molar surgery and complications: local anesthesia vs general anesthesia

Lara Figini

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Patient’s anxiety, surgical difficulty, medical background can lead the dentist to choose to perform the wisdom tooth extraction under general rather than local anesthesia. Complications intra- and post-operative rate can depend on the type of anesthesia performed, but there are  few studies comparing the complication rates between local versus general anaesthesia in third molar surgery and have conflicting findings.     

The removal of impacted mandibular third molars is a common dentoalveolar procedure performed in oral and maxillofacial surgery, with differing levels of difficulty depending on several patient-specific and dental-specific factors. Dental factors include the degree of impaction, angulation, anatomical form, relation to vital neurovascular structures and patient related factors include age, weight, medical history and degree of mouth opening. While surgical outcomes are generally predictable, intra and postoperative complication rates have been documented between 1.1% and 4.3%. Intraoperative complications include lesions of the inferior alveolar and lingual nerve, damage to the adjacent second molar, excessive bleeding, alveolar bone fracture and accidental displacement of tooth fragments in fascial planes or spaces. Postoperative complications include alveolar osteitis, secondary infection, post-operative bleeding and persistent nerve damage.  

Materials and Methods 
In an Australian retrospective study published on Oral Surgery  May 2019 the authors compared the incidence of complication rates following a third-molar surgery performed under local or general anesthesia. Data were collected using a combination of computer database and patient records. A total of 277 patients were included in the study (130 local anaesthesia, 147 general anaesthesia). Several variables were collected and assessed including age, gender, method of anaesthesia, radiographic grading and complications.  

Results     
Five hundred and twenty-three mandibular third molars were removed, 284 being removed under general anaesthesia and 239 under local anaesthesia. There were a total of 20 complications (3.8%), nine of those from procedures performed under local anaesthesia and 11 from procedures performed under general anaesthesia. There was a statistically significant increase of alveolar osteitis for procedures performed under LA. However, when assessing overall complication rate, there was no statistically significant difference in LA versus GA.  

Conclusions  
From the data of this study, which must be confirmed in other similar studies, it can be concluded that teeth more severely impacted or angulated tend to be removed under general anaesthesia for reasons such as surgical access and patient experience. This study suggests there is an increase in alveolar osteitis when third molars are removed under LA. However, there was no significant correlation found between the method of anaesthesia and overall complication rate when combining all complications. The present study also suggests that other variables, such as gender and age, may have an important role in determining post-surgical complication rates after the removal of wisdom teeth.      Supports the stance that patient preference & anxiety, surgical difficulty, medical background and economic factors are valid to determine the anaesthetic modality because of similar complication rates. 

For additional informations:  Retrospective multivariable comparison for complications of third molar surgery performed under general versus local anesthesia

Italian version: http://www.odontoiatria33.it/chirurgia-orale/17922/estrazione-dei-denti-del-giudizio-e-complicanze-anestesia-locale-vs-anestesia-generale.html