An interesting article titled “Retrospective multivariable comparison for complications of third molar surgery performed under general versus local anaesthesia” written by Beteramia et al. appears in Oral Surgery in 2019 (vol. 12, pp. 96-103). The article seeks to explore if there is a difference in the amount of complications that occur during or after wisdom teeth surgery when using local anesthesia or when using general anesthesia.
In the article the authors discuss complications that can happen during wisdom teeth removal including excessive bleeding, injury to the inferior alveolar and lingual nerves, damage to the adjacent second molar, alveolar bone fracture, and displacement of tooth fragments into fascial spaces and complications that can happen after wisdom teeth removal including alveolar osteitis (dry socket), a secondary infection, and hemorrhage. These complications are discussed more over at http://www.teethremoval.com/complications.html. The authors further discuss how wisdom teeth removal can be peformed using different types of anesthesia including only local anaesthetic or local anesthesia with with oral sedation or general anaesthesia. These different modes of anesthesia are discussed over at http://www.teethremoval.com/differences_between_anaesthesia_sedation.html. The authors state that the majority of prior studies have show that higher complications when using general anesthesia but this could be because more complicated cases are performed using this type of anesthesia.
In the article the authors devised a study using 277 patients who presented to the Royal Dental Hospital of Melbourne in Australia having at least one lower wisdom tooth extracted with 130 patients receiving local anesthesia alone and 147 patients receiving general anesthesia. The type of anesthesia given for each patient was decided upon based on patient preference, the assessed difficulty of the surgery, and any existing comorbidities. A total of 523 wisdom teeth were extracted with 239 performed under local anesthesia and 284 performed under general anesthesia. The authors collected information from each patient regarding age, gender, date of surgery, method of anesthesia, perceived difficulty of extraction, and complications. The perceived difficulty of extraction was assessed using an orthopantomogram and the Pell and Gregory and Winter classifications. Nerve damage was noted as a complication when a patient returned two weeks after surgery for a visit and said they had altered sensation in either the inferior alveolar nerve or lingual nerve. An infection was noted as a complication when a patient returned for an unscheduled visit and had any symptoms including malaise, fever, chills, fatigue, erythema, purulence, swelling, and cervical lymphadenopathy.
The authors found that 20 of the wisdom teeth extracted or 3.8% resulted in complications from surgery with 9 of these wisdom teeth extracted under local anesthesia and 11 of these wisdom teeth extracted under general anesthesia. When extracting a wisdom tooth under local anesthesia the most common complication was alveolar osteitis or dry socket which occurred in five patients followed by temporary inferior alveolar nerve paraesthesia which occurred in two patients, and then followed by infection or hemorrhage which each occurred in one patient. When extracting a wisdom tooth under general anesthesia the most common complication was infection which occurred in seven patients, followed by temporary inferior alveolar nerve paraesthesia which occurred in three patients, and then followed by temporary lingual nerve paraesthesia which occurred in one patient. When combining both types of anesthesia the likelihood of temporary inferior alveolar nerve paraesthesia or temporary lingual nerve paraesthesia was 1% (5/523) or 0.19% (1/523) respectively. The authors found that only one complication rate had a statistically significant difference between the two types of anesthesia and that was for alveolar osteitis, which happened more often with local anesthesia. The authors also explored if gender, age, and perceived difficulty of extraction had any effect on the complication rate when comparing between local anesthesia and general anesthesia but did not find any significant differences. The authors state
“Based on the results, the method of anaesthesia does not play a significant role in the overall post-operative complication rate.”
Based on their analysis of the data the authors believe that surgeons primarily used two main variables when determining case difficulty including the spatial relationship of the wisdom tooth to the ramus and the angulation of the tooth (such as vertical, horizontal, mesioangular, distoangular, buccolingual, or inverted) which influenced which type of anesthesia was given. The authors mention that prior studies regarding which type of anesthesia to use for wisdom teeth surgery has produced conflicting results. The author thus say
“The conflicting data highlight the need of further research in this area to determine whether anaesthetic modality can indeed influence third molar [wisdom teeth] surgical complications. Until this data are available, it is reasonable to suggest that the decision on whether to perform third molar [wisdom teeth] surgery under local versus general anaesthesia should not be based on complication rates, but rather on importing clinical factors such as patient preference, surgical difficulty, medical background and economic factors”
The authors also explored the complication rate based on age, grouping patients into one group if they were under 25 and another group if they were 25 or older. Based on their study they found that patients under 25 had 35% of the total complications while patients 25 or older had 65% of the complications. Based on the patient age across all patients in their study they extrapolated to say that if patients were 25 or older they were three times as likely to experience a complication when compared to someone under 25. They also stated that from their study females were twice as likely as males to have a complication after wisdom teeth surgery. The authors also point out some limitations with their study including many patients not attending any consultations after surgery which could have led to an underestimation of the amount of complications.