Not a Disease Entity
Patients with underlying psychological disorders are highly significantly more likely to experience fear of dental treatment than healthy persons (1). For the affected patients, anesthesiological support with general anesthesia for dental treatment is often very important, as otherwise, avoidance behaviors may be expected to result in severe dental disorders with possible deterioration of the psychological disorder.
In contrast to phobia, “fear of dental treatment” is not in itself a disease. No indication exists for uncritically prescribing general anesthesia (2), especially in view of a multitude of other, effective therapeutic measures. Health insurers and associations of health insurance companies understood this as early as in 2007 and will reimburse anesthetic services for dental procedures in patients with fear of dental treatment only in cases where a specialist has certified the presence of a psychological or psychiatric disorder (Chapter 5, EBM).
Giving general anesthesia for dental treatment is often trivialized as being more comfortable for the patient, but from the perspective of anesthesiology a critical view is indicated because general anesthesia is not suitable for helping to reduce fear of dental treatment and additionally entail the risk of serious complications. Dental treatment can be more difficult in inactive patients (3), and additional medical equipment and space would be required in the dental surgery.
Regardless of all this, the indication for general anesthesia is uncontroversial, among others, for dental treatment in children younger than 12 years, in patients with disabilities, in cases where local anesthesia is contraindicated, or in cases of major surgery.
The indication “fear” should, however, be reserved exclusively for patients with psychiatric disorders who are receiving treatment. No anxiety disorder should be diagnosed and certified in healthy patients for billing purposes.
It is imperative, however, that patients with a phobia are referred for early detection and treatment. This is the only way in which such patients can be provided with adequate dental treatment and oral health.
On behalf of the board of the interdisciplinary working group Zahnärztliche Anästhesie (IAZA, dental anesthesia) of the specialist medical societies DGZMK and DGAI
Prof. Dr. med. Grietje Beck
Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie
Dr. Horst Schmidt Kliniken GmbH
Klinikum der Landeshauptstadt Wiesbaden
|1.||Lenk M, Berth H, Joraschky P, Petrowski K, Weidner K, Hannig C: Fear of dental treatment—an underrecognized symptom in people with impaired mental health. Dtsch Arztebl Int 2013; 110(31–32): 517–22 VOLLTEXT|
|2.||Gordon D: A critical review of approaches to treatment of dental anxiety in adults. J Anxiety Disord 2013; 27: 365–78 CrossRef MEDLINE|
|3.||Lee HH: Trends in death associated with pediatric dental sedation and general anesthesia. Pediatr Anaesth 2013; 23: 741–746 CrossRef MEDLINE|