I recently consulted a dentist about getting a tooth extracted. The dentist recommended getting it done under general anesthetic. I responded, "I've had four wisdom tooth extracted under local anesthetic. I've given birth to two children without medication. I think I can handle it." "Ah, but some patients say dental pain is worse than child birth."
Eventually the dentist agreed to extract the tooth under a local anesthetic, and I was presented with an estimate for procedure - $350. "Why so low?" I asked the receptionist, remembering past estimates for dental work. "It's because you're not having a general anesthetic - if you were the bill would be more like $700." Indeed, I checked against the Alberta Dental Association fee guide (one of the few available on-line). The recommended charge for straightforward extraction done by a general dentist in Alberta is $242.25; the recommended charge for two units of general anesthetic is $228.62. A general anesthetic just about doubles the amount a dentist can charge for an extraction.
Dentists have a strong financial incentive to put patients under a general anesthetic. That's setting aside any other reasons why dentists might prefer to operate on the anesthetized - see this fascinating New York essay which contrasts surgeons' immediate embrace of anesthesia with their grudging admission of the need for sterilization. Hence it is not surprising that some dentists encourage the use of general anesthesia.
And if it makes having a tooth extracted less unpleasant, what's the harm?
Well, the harm may be to your brain. General anesthesia may increase the chance of post-operative cognitive decline. This article using Taiwanese administrative data found a link between dementia and a history of surgery under general anesthetic. On the other hand, this study found no differences between patients receiving a general anesthetic and those receiving epidurals in terms of cognitive functioning three months post-surgery - although patients receiving an epidural had better surgical, as well as better short-term cognitive, outcomes.
Many surgical procedures can be performed either with an epidural or under a general anesthetic. It is hard to find any study suggesting that general anesthesia produces superior results in cases where local anesthetic is a viable option. This study finds that general and local anesthetics produces similar outcomes, but local is cheaper. This one found that epidurals produced better patient outcomes than general anesthetics, and this one also comes down in favour of the local option.
This leaves aside the 40 percent risk of post-operative nausea and vomiting after having a general anesthetic.
Perhaps one day we'll see the Canadian dental association issuing guidelines on the use of general anesthesia. Insurance companies might step up and only reimburse the cost of general anesthesia in exceptional circumstances (Help! Teeth hurt! describes the dental challenges facing some people with disabilities, and why a general anesthetic may be necessary).
In the meantime, do your brain and your wallet a favour: just say no. I did, and I don't regret it.