Would you perform this procedure under general anesthesia? A scenario-based comparison of dentist and anesthesiologist approaches

BACKGROUND: General anesthesia is increasingly utilized in dentistry; however, interdisciplinary variability in general anesthesia (GA) indication and risk perception remains insufficiently characterized. This study quantitatively compared dentists' and anesthesiologists' decisions regarding general anesthesia indication using standardized clinical scenarios. METHODS: This cross-sectional, scenario-based reader study involved 50 anesthesiologists and 50 dentists who each evaluated 20 standardized clinical scenarios, generating 2,000 decisions. For each scenario, participants selected the anesthesia method (general anesthesia vs. local anesthesia) and classified GA-related risk (low vs. high). A binary generalized linear mixed model (GLMM) was used to identify factors associated with GA indication and GA risk perception. Inter-rater agreement was evaluated using Cohen's kappa and prevalence-adjusted bias-adjusted kappa (PABAK). RESULTS: Across all evaluations, GA was selected in 44.1% of assessments. Anesthesiologists indicated GA more frequently than dentists (48% vs. 40.2%). Specialty was a significant determinant of GA indication, with a pronounced specialty × age interaction (p = 0.009). Pediatric scenarios-particularly those involving impaired cooperation and neurodevelopmental comorbidities-were more frequently associated with GA indication. Perceived GA risk did not differ significantly between specialties, although greater clinical experience reduced perceived GA risk among dentists (p < 0.001). Agreement was moderate for anesthesia method (κ = 0.476) and lower for GA risk (κ = 0.395). CONCLUSIONS: Dentists and anesthesiologists differ significantly in GA indication despite similar risk perception frameworks. Findings highlight the need for standardized GA decision support tools, improved interdisciplinary communication, and evidence-based patient selection criteria in dental anesthesia.