University of Utah Health Sciences Center
Dental Clinic, Clinic #7
50 North Medical Drive
Salt Lake City, UT 84132

Phone 801-581-2220
FAX 801-585-2391

Dental Treatment Performed Under General Anesthesia

Introduction
The dental clinic at the University of Utah Health Sciences Center has a general anesthesia program that provides dental treatment for medically compromised and developmentally challenged patients. The following sections describe the 

1. Indications,

2. Dental treatment plan, 

3. Risks, 

4. Consent, 

5. Required medical information, 

6. Scheduling, 

7. Financial considerations, and 

8. Post-operative care for dental treatment performed under general anesthesia.

1.) Indications for Treatment
Comprehensive dental treatment under general anesthesia is available for patients who are unable to cooperate, comprehend, or tolerate treatment in the dental office setting. This should be done once every three years under normal circumstances or sooner if problems are evident.

2.) Dental Treatment Plan
A treatment plan is not usually completed prior to the general anesthesia appointment because physical, behavioral, or cognitive disorders impede the dentist’s ability to complete necessary examinations and x-rays. All necessary dental examination and treatment will be completed during the general anesthesia appointment. Extraction of all remaining teeth with no future replacement may be indicated for persons with advanced dental disease and severe cognitive, behavioral, physical, or medical limitations.

3.) Risks

a.) Risk of Dental Treatment
There are risks involved for all routine dental and oral surgical procedures. These risks are typically small and they occur infrequently. These risks include, but are not limited to: pain, bleeding, swelling, infections, displacement of teeth into the sinus, damage to nerves of face/lip/tongue/chin causing temporary or permanent numbness, jaw fracture, dislocation of the temperomandibular joint, and the need for additional procedures. Please contact the hospital dental clinic if you have any questions or concerns.

b.) Risk of General Anesthesia
The risks of general anesthesia include, but are not limited to: nausea, prolonged sedation, transient low blood oxygen levels, and temporary delirium. Medical concerns and the patient’s ability to tolerate general anesthesia are addressed in an evaluation prior to the general anesthesia appointment. A person with dementia is not at higher risk that other patients for developing complications from general anesthesia. Please contact the Department of Anesthesiology if you have any questions or concerns.

c.) Risk of Not Performing Dental Treatment
There are also risks involved in the decision to refuse dental and oral surgical treatment. Untreated dental disease (dental cavities, gum and bone diseases) can result in acute infections which can be painful, disfiguring, and life-threatening. The mouth normally has a large number and variety of bacteria, and their overgrowth can result in both oral and systemic infections (for example, pneumonia and septicemia). Some persons may be unable to express oral or dental discomfort due to their cognitive, behavioral, or medical condition. These untreated infections can result in the individual’s inability to maintain nutritional health, since he/she may refuse to eat and drink. Frequently, these persons do not permit caregivers to provide adequate oral hygiene.

4.) Consent for Treatment
Written informed consent must be obtained in order for dental treatment to be performed under general anesthesia. The hospital must have the original signed consent form. It cannot be faxed. If the patient is unable to consent to treatment, a legal guardian must review the risks and benefits of the procedures and give written consent for the patient. Consent to treatment must include consent to extract all remaining teeth without replacement, if indicated. As previously mentioned, if an oral examination and diagnostic intraoral radiographs have not been obtained prior to general anesthesia, a definitive treatment plan cannot be completed until the patient is under general anesthesia.

5.) Medical Information Required
It is essential to evaluate the patient’s ability to tolerate the planned procedure and to anticipate and avoid potential complications. Therefore, several medical examinations and reports are required before general anesthesia:

1. A history and physical examination report containing medical diagnoses, and current medications and allergies.

2. A complete blood count with differential and platelets obtained within thirty days of date of surgery.

3. A chest x-ray if there is a history of pulmonary disease.

4. An EKG report if there is a history of cardiac disease or the patient is male over forty-five or female over fifty.

5. A pregnancy test if the patient is female and physically capable of being pregnant.

6. Other laboratory tests (depending upon the patient's health history).

If the patient’s primary care physician cannot provide these reports, we need to schedule the appropriate examinations/tests at the UUHSC clinic 1B prior to the day of general anesthesia. The required reports will be reviewed by us and the Department of Anesthesiology two weeks before the appointment. If the determination is made that the patient is unable to tolerate the procedures under general anesthesia, alternative treatment options will be discussed.

6.) Scheduling Considerations
Please see the pre-operative instruction sheet for scheduling instructions. Due to the variability of time required for each patient’s procedure and recovery, it is not possible to predict when the patient will be discharged. Please plan to spend the entire day, since many patients return home in the late afternoon.

7.) Financial Considerations
There are three costs associated with dental treatment performed under general anesthesia:

(1) general anesthesia,
(2) dental and oral surgical treatment, and
(3) hospital charges.

The patient’s medical insurance or Medicaid will usually cover the cost of general anesthesia. Hospital charges may be covered by medical insurance, depending upon the specific insurance plan. The dental treatment is not covered by medical insurance. Private dental insurance or Utah Medicaid is acceptable for payment of these services but a pre-authorization of treatment is required. The Hospital billing department can assist with specific questions about insurance coverage and payment plans. The patient is required to pay all costs not covered by insurance or Medicaid.

8.) Post-Operative Care
Post-Operative instructions and prescriptions will be given to the patient and caregivers upon discharge on the day of the appointment. Depending on the treatment performed and future planned treatment, the patient may or may not be scheduled for a return appointment. In order to maintain the health of the teeth and mouth after general anesthesia, plans must be initiated to provide daily mouth care and diet supervision

 

USDC OUTPATIENT DENTAL CLINIC

Refer to Outpatient Clinic Page

 

PRIMARY CHILDREN’S MEDICAL CENTER – DENTAL CLINIC

 

The Primary Children’s Medical Center (PCMC) has a dental clinic to provide services for children with mental retardation or developmental disabilities.  Dr. Duane Yamashiro, an orthodontic doctor, is the director of the clinic, and they have a staff of competent and compassionate dentists of every specialty. 

If you do not have insurance, please call Primary Services first at 801-588-2968.  The people in that office will help you fill out the paperwork required to get services for your child, then all you will need to do is call the Dental Clinic at 801-588-3620 to explain what your child needs and make an appointment to get those needs met. 

Office hours are from 9:00 a.m. until 4:30 p.m., Monday through Thursday, and 9:00 a.m. until 12:00 noon on Friday. 

New patients are seen, and exams given, only on Mondays, so if you have Medicaid coverage, or private insurance, it might be quicker to go to another dentist for services.  You can get a list of those doctors by calling either the Dental Clinic directly at the number listed above, or by calling the MRAU office at 801-763-4008.  You can also contact MRAU through e-mail at mrau@utah.gov to receive the information. 

Many of these dentists are bilingual, speaking both English and Spanish, to further help their patients.