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Occlusal Assessment and Treatment Planning Under General Anaesthesia in a Patient With Complex Needs: A Case Report
Naomi Murray1, Andrew Geddis-Regan1,2
1University Dental Hospital of Manchester, Manchester University NHS Foundation Trust, Manchester , UK.
Background:
Occlusal assessment under general anaesthesia (GA) is inherently limited, as functional jaw movements and dynamic occlusal loading cannot be replicated intraoperatively. In patients who require GA as the only feasible treatment modality, this may pose challenges for dental professionals planning care intra-operatively.
Case Report:
A 37-year-old male with autism, severe learning disability, and epilepsy underwent extraction of LR6, LR7, and LR8 under GA for gross caries, alongside professional mechanical plaque removal. Just over one year later he presented with self-injurious behaviors attributable to dental pain. His LR5 was grade 3 mobile, with an OPG demonstrating 50% horizontal and near-complete vertical bone loss; prior imaging had shown healthy bone levels. Primary occlusal trauma was the working diagnosis, with LR5 having assumed the entire posterior occlusal load following molar extraction. Extraction under local anaesthesia was not tolerated; a further best interests decision was reached and LR5 was removed under GA with concurrent socket biopsy, which excluded malignancy.
Outcome:
At six-month follow-up the patient remained asymptomatic with no recurrence of self-injurious behaviors, and imaging demonstrated slow but progressive bone fill of the socket.
Discussion:
This case illustrates the inherent difficulty of predicting real-world occlusal function when GA is the only treatment modality available, and the ethical and clinical complexity of best interests decision-making in this patient group.
