Sir, a recent study highlights the most likely reason for a child undergoing general anaesthesia (GA), in the NHS, is for dental extractions.1 This report was unsurprisingly greeted with shock by both public and media. However, little is mentioned of the continued over prescription of GA for dental extractions in adults, particularly with regard increased GA-related morbidity and mortality in adults.

We continue to prescribe GA rarely for dental surgery (Table 1), and this is achievable with appropriate prescription of IV sedation when indicated. An internal audit confirms that 76% of our patients require sedation for the dental extractions when assessed using the indication for sedation need tool.2

Table 1 Table of anaesthetic prescription for third molar surgery/dental extractions (% patient cases not teeth)
Full size table

Our data supports that with adequate IV sedation provision, GA prescription can be minimised thus improving safety for patients. With the intended commissioning shift of oral surgery to primary care, commissioners must understand that many patients require anxiolysis to undergo often quite difficult and unpleasant surgical procedures. Cost implications for the provision of sedation, including team training and facilities, are significant and not reflected in current NHS remuneration or contracting of services. If this underfunding for sedation in primary care persists, more patients will be referred to secondary care for GA, reversing the positive trend in patient safety reported here.