The boy was in a coma for 40 days after tooth extraction. Is there a risk for tooth extraction?
West China Expert: Tooth extraction itself will not cause coma
A few days ago, Red Star News received the news from Mr. Su Xi’an that his 7-year-old son Xiaojun (a pseudonym) was in a coma for more than 40 days after tooth extraction.
According to the medical profile presented by the boy’s father, Mr. Su, Xiaojun’s admission was diagnosed as "superior maxillary teeth", and "relevant examinations were perfected after admission, and preoperative examinations did not indicate contraindications."
On April 13, the person in charge of the Surgical Intensive Care Unit of Xi’an Children’s Hospital told reporters that this matter was true, and Xiaojun was still in a coma. “This is a small probability event that we really don’t want to see and really didn’t expect. ."
So, under what circumstances does tooth extraction require general anesthesia?
What are the risks associated with tooth extraction under general anesthesia?
Do people with a history of epilepsy have stricter anesthesia contraindications during tooth extraction?
This reporter interviewed Ji Yang, deputy director of the Department of Anesthesiology, West China Hospital of Stomatology, Sichuan University.
Ji Yang said, “Tooth extraction is a minor operation and a very low-risk operation. As long as you go to a regular dental medical institution, there will be no major problems. Don’t worry about it.”
The risk of general anesthesia is not directly related to the patient’s age
Extraction of multiple teeth is a relatively simple operation
Reporter: Under what circumstances does tooth extraction require general anesthesia?
Ji Yang: Younger children, such as only two years old, have a tooth injury. Generally, children cannot cooperate because they are too young and age is a problem.
Some children, even though they are older, can't cooperate at all for character reasons, and can only do it under general anesthesia.
There are also some children with illnesses, such as cerebral palsy, etc., for sure there is no way to cooperate, and they usually choose general anesthesia.
At the same time, some children, because there are more bad teeth, and the treatment workload is relatively large, there is definitely no way to cooperate. Under general anesthesia, all the bad teeth can be fixed at one time.
Reporter: This is for children.
For adults, when is general anesthesia required?
Ji Yang: Some adults are particularly afraid of pain and cannot do it under local anesthesia.
In some patients, the pharyngeal reflex is relatively severe.
When the tooth is extracted, the doctor has to operate in the oral cavity. Before the forceps are put in, the patient begins to retching, and it is impossible to continue the operation like this.
Pharyngeal reflex, some patients are (because) relatively nervous, if sedation, it may be relieved.
But there are some things that can't be solved by conventional means, and the tooth must be extracted, so it can only be done under general anesthesia.
Most people do it under local anesthesia.
Reporter: What risks does a 7-year-old child face when he has a tooth extraction under general anesthesia?
Ji Yang: For a 7-year-old child who has general anesthesia for tooth extraction, the risk is mainly whether the child has some basic diseases, whether there are some contraindications for surgery and anesthesia.
It needs to be emphasized that age is not actually an issue.
Of course, the younger the age, the greater the risk, but there is no absolute way to say how old it is (there is no risk).
In fact, many 7-year-old children can be induced by behavior. In our Sichuan dialect, it is "coaxing", and they can do it without general anesthesia.
Tooth extraction in the elderly and patients with epilepsy is not contraindicated
Need to consult with a specialist for overall assessment
Reporter: Who can't extract teeth?
Ji Yang: In terms of anesthesia, there are some elderly people who are very old. The most important thing is that there are some basic diseases, such as severe coronary heart disease, uncontrolled high blood pressure, and more serious cardiovascular and cerebrovascular diseases. For these patients, tooth extraction is not an absolute contraindication, but the risk is relatively high.
In this case, we have to make some trade-offs, and make an overall assessment of the impact, benefits or risks of tooth extraction on elderly patients.
Reporter: Do people with a history of epilepsy have stricter anesthesia taboos during tooth extraction?
Ji Yang: Epilepsy is not actually a contraindication to anesthesia.
Some children have epilepsy themselves, and treatment of epilepsy requires anesthesia.
Can children with epilepsy be anesthetized?
We think this way: If the frequency of epileptic seizures can be controlled by medication, and there are no frequent seizures, that is to say, we can control it and can accept anesthesia.
But there is a prerequisite, whether you can accept anesthesia and the degree of epilepsy control, you must have a specialist doctor—a neurology doctor to make an assessment.
Tooth extraction is a minor operation with very low risk
It is recommended to go to a dental hospital with a professional anesthesiologist
Reporter: What could be the cause of coma after tooth extraction?
How to avoid such a small probability event from happening?
Ji Yang: According to the diagnosis in the news report, the doll developed a coma due to diffuse ischemic hypoxic encephalopathy caused by asphyxia and hypoxia.
Tooth extraction is a minor operation with very low risk. As long as you go to a regular dental medical institution, there will be no major problems, so don't worry about it.
Tooth extraction did not cause a coma, but the child eventually developed a coma due to other reasons.
Tooth extraction in our hospital often encounters patients with syncope. As long as the syncope is not caused by the patient's own serious comorbidities, the patient will recover immediately by simply treating the symptoms.
Reporter: What kind of examinations are required before tooth extraction?
What advice do you have for tooth extraction for people with special physical conditions?
Jiyang: Outpatient tooth extraction usually requires routine blood tests, blood coagulation function and a full set of examinations for infectious diseases (hepatitis B, AIDS, and hepatitis C). If the patient is older than 50 years old, routine electrocardiogram examinations are required.
If the patient has other diseases, relevant specialist examinations are required.
Hypertension patients without formal treatment and patients with heart problems need to go to the cardiology department to see a specialist clinic.
If you need treatment, go for some related treatments; if there are no major problems, you can arrange an appointment to our clinic that specializes in tooth extraction. Our anesthesiologist will perform ECG monitoring during the tooth extraction process, including the patient’s Blood pressure, electrocardiogram, oxygen saturation and other indicators.
If the patient’s vital signs fluctuate, the anesthesiologist will take corresponding control measures to ensure the safety of the patient.
For patients who need to extract their teeth under general anesthesia, I suggest that they must go to a specialist dental hospital or a hospital with a professional anesthesiologist.
Stomatological treatments are performed in the oral cavity, and the anesthesiologist's operations such as tracheal intubation are also performed inside the oral cavity.
If you have not received professional training and have no experience in anesthesia management in this area, it is easy to have respiratory problems.
Chengdu Commercial Daily-Red Star News Correspondent Peng Li