Not a dentist, and I don’t mean to sound like an asshole or know-it-all but I’m worried
My boyfriend (22M, generally healthy/ASA II) had a wisdom-teeth consultation today with an oral and maxillofacial surgeon. He has three completely impacted third molars, one partial (photo attached) He does not have dental phobia, is cooperative, and has no major medical conditions that I know of.
I had all four of mine removed about 3–6 months ago under IV moderate sedation, and general anesthesia was never presented to me as necessary.
At his consult, the nurse initially just said he would “go to sleep,” and it was only later after they showed the treatment plan that we understood they meant GA.
We were shown a video covering risks, but the surgeon did not personally walk us through the procedure, risks, benefits, and alternatives.
They said it would be FULL general and he would be intubated or they’d use an LMA.
When I asked why GA instead of moderate sedation, the explanation was essentially that if the patient moved during a difficult extraction and a nerve were injured, that could create liability for the surgeon, but under GA he would be still.
That explanation did not sit right with me. I understand nerve injury is a real risk with lower third molars, especially if the roots are close to the inferior alveolar nerve, but I didn’t think “patient might move” was a reason to use GA if the patient is otherwise calm and cooperative. I also thought moderate sedation would be generally be less invasive and risky because he would maintain his own airway and breathing.
I pushed back in the office (probably more intensely than I should have) and asked for his records to be emailed to us. They said they have a CRNA and that they have not had anesthesia complications in 10 years.
Also just wanted to say that the surgeon said part of his hands and fingers were numb and his hands were very shaky
So my questions are:
- Is GA a normal/reasonable recommendation for four impacted wisdom teeth, even for a calm, healthy 22-year-old?
- Is “we prefer GA so the patient does not move and we do not injure a nerve” a legitimate clinical reason, or does that sound more like surgeon preference/liability avoidance?
- If the teeth are fully bony impacted and rotated, is moderate IV sedation still usually feasible?
- Should a patient be able to request moderate sedation if there is no clear contraindication?
- What questions should we ask before consenting especially regarding airway management (ET tube vs LMA), anesthesia provider, monitoring, emergency equipment, and hospital transfer?
Is it a red flag that the office said they have had no anesthesia complications in 10 years? I find it hard to believe they’ve never called EMS in 10
years.
I’m not anti-anesthesia or anything and I’m not saying GA is never appropriate I just felt like the actual anesthetic plan was not clearly explained, and I want to make sure we are not agreeing to a higher level of anesthesia than he needs. Would you get a second opinion, or is this pretty standard OMFS practice?