Foreword:

• Only in Germany is the word "anaesthesia" automatically associated with general anaesthesia.

• In Hungary, France and many other countries, the word "anaesthesia" is never associated with general anaesthesia. Anaesthesia is always associated with pain reduction by injection, nitrous oxide, twilight sleep, sedation, etc.

General anaesthesia is only possible in dental practices in the DACH countries - i.e. Germany, Austria and Switzerland.
A precondition for general anaesthesia in dental practices in the DACH countries is compliance with the safety standards (premises, staff, access to the premises, equipment, ...) of the GERMAN SOCIETY FOR ANAESTHESIA AND INTENSIVE MEDICINE (DGAI).
In all other countries, general anaesthesia is only possible in a public clinic or hospital. At best, there is a dental chair for dental surgery. At best, teeth can be extracted. Even in a public clinic or hospital, dentists need a full range of equipment for their complex treatments. Such equipment is almost never available in the areas accessible to dentists.
In addition, dentists in private practice are generally not allowed to treat their patients in clinics/hospitals for legal reasons.

Dentists praise the various sedation methods (minimal, moderate or deep sedation) as an alternative to general anaesthesia.
Sedation for lengthy dental treatments is either almost ineffective or dangerous.
The frequent incidents after sedation remain hidden from the patient. The patient cannot remember anything. This retrograde amnesia is a characteristic of sedation.
Vigilance (alertness or sustained attention), spontaneous breathing, circulation and protective reflexes (swallowing reflex, cough reflex) suddenly stop without warning during sedation. And then it becomes dangerous.

Ferdinand von Schirach - describes a true incident in his book "STRAFE" - page 14":

".... the dentist injected her with a sedative.
It was too strong, she lost consciousness and only woke up in hospital"

Twilight sleep or sedation in dentistry is regularly trivialised on the internet.
In addition to the actual risks, there are two very unpleasant after-effects - which of course are not mentioned:

• Severe headaches the next day

• Mendelsohn's syndrome – pneumonia

• In Germany, the word "anaesthesia" is generally understood to mean general anaesthesia. This is always performed by the anaesthetist and his team of anaesthetists.

• In other countries such as Hungary, France, etc., the term "anaesthesia" is almost never understood to mean general anaesthesia.

• There, anaesthesia is usually understood to mean anything that has anything to do with the elimination of pain:

  • twilight sleep

  • Local anaesthesia

  • Sedation

  • ....

• As the name suggests, twilight sleep is a twilight state in which the patient breathes. Consciousness is only partially switched off so that the patient is aware of part of the treatment.

Twilight sleep is more suitable for short procedures. For longer treatments in particular, it is difficult to maintain the twilight state continuously, as the patient is usually not able to tolerate the long period of lying in the dentist's chair with their mouth permanently open when they are semi-conscious. After a certain period of time, patients become restless, which is a particular hindrance during sensitive tooth preparations.

• Sedation must not be too deep so that the patient's own breathing does not stop and the protective reflexes do not come to a standstill. The swallowing process is reduced and "choking" with subsequent coughing can occur, especially when grinding the tooth.

• In addition, as only 20% of the pain is reduced during twilight sleep, the patient must be given a local anaesthetic for the tooth area. However, this harbours the risk of an accidental arterial injection being noticed too late. A resulting circulatory or neurological reaction remains unnoticed due to the semi-coma.

• The contra-indication of prolonged sedation, which was not known until very recently, is also an argument against this procedure:: Twilight sleep slows down the patient's own breathing. As a result, less CO2 is exhaled, the CO2 rises in the body and leads to a shift in the acid-base balance in the body. Among other things, this leads to an increase in pressure in the brain, which can cause severe headaches after the treatment.

• General anaesthesia, however, enables deep sedation in which the patient is completely pain-free and does not experience any unpleasant sensations during the procedure. This is extremely advantageous for complex, painful and long operations where the practitioner needs to be extremely focussed. Local anaesthesia is no longer necessary. Long treatment times are therefore also very well tolerated by patients with constant back pain.

• As consciousness is completely switched off, the anxious patient does not hear any noises such as drilling or milling and 5 hours of treatment seem like 5 minutes.

• General anaesthesia uses exactly the same medication as twilight sleep, but in a higher dosage.

• The current, modern drugs are broken down very rapidly by the body and the patient regains consciousness within a short time.

Comparison of the risks of general anaesthesia versus sedation:

While sedation is always associated with incidents, anaesthesia today is incredibly sophisticated and safe.

In particular, general anaesthesia is always performed by anaesthetists around the world.

On the other hand, sedation is usually performed by the dentist/ oral surgeon without an anaesthetist. This is particularly dangerous in the case of intravenous sedation.

The DGAI/ GERMAN SOCIETY FOR ANESTHESIA AND INTENSIVE MEDICINE announced in the Stuttgarter Zeitung on 31 December 2021:

The number of serious incidents during and after general anaesthesia is so low that it is barely measurable.

In nonstationary dentistry, only healthy people are treated under general anaesthesia. Each patient is subjected to an ASA risk analysis by the anaesthetist in advance to assess the perioperative risk.

The DGAI press release includes all general anaesthesia - including that given to very old people, seriously ill people and victims of serious accidents. And yet practically no serious anaesthesia incidents happen anymore.

We would ban sedation for longer dental procedures in the mouth as a matter of principle!

It is incomprehensible that prolonged oral surgery is not prohibited by law.

Safety should always be an absolute priority.

The dentists, oral surgeons and anaesthetists of the Dr Leu Group have treated several thousand adults with dental anxiety under general anaesthesia in Germany alone.

Since around 2010, the decision to undergo dental treatment under general anaesthetic has been preceded by around 240,000 (as of 2023) so-called PRE-T1 telephone conversations with adults with dental anxiety in Germany alone. These telephone conversations were mainly conducted by Andrea HEROLD - my former adult with dental treatment anxiety. She had extreme anxiety.

Today, Andrea Herold goes to the dentist without any problems thanks to the 3-appointment therapy developed by Dr Leu. She was completely restored in 7 hours under general anaesthetic - just like all the other 4,000+ patients.

During her 240,000 telephone calls, Mrs Herold observed a previously unknown fact: Mrs Herold learnt that there are two types of adults with dental anxiety:

o Type-1

o Type-2

Type 1 goes to the dentist at some point and is treated according to the guidelines.

Mrs Herold classifies herself as type 2. She suffered endlessly for many years, wishing for nothing more than to go to the dentist - but she never went and would never have gone until she heard about Dr Leu.

There are some dentists for type 1 people. They have acquired their knowledge from their own anxiety patients.

Type 2 people almost never go to the dentist - at best in an extreme emergency to reduce pain. So no dentist can acquire specific experience.

Internet research shows time and again:

To this day, Dr Leu is still the only specialist for type 2 patients with colleagues and anaesthetists specially trained for type 2 and the world's only PRE-T1.