Several methods of anesthesia are available. The method of anesthesia that is chosen for or by a patient depends upon the nature of the surgical procedure and the patient’s level of apprehension.
The following table illustrates the choices of anesthesia, a description of the anesthetic technique, and the usual indications for that technique.
MethodTypes of AnesthesiaDescription of TechniqueUsual Indications
Method Local AnestheticDescription of Technique The patient remains totally conscious throughout the procedure. A local anesthetic (e.g. lidocaine) is administered in the area where the surgery is to be performed. Local anesthetic is used in conjunction with the other methods of anesthesia in all oral surgery procedures.Usual Indications Simple oral surgery procedures such as minor soft tissue procedures and simple tooth extractions.
Method Nitrous Oxide Sedation with Local AnestheticDescription of Technique A mixture of nitrous oxide (laughing gas) and oxygen is administered through a nasal breathing apparatus. The patient remains conscious in a relaxed condition. Nitrous oxide has a sedative and analgesic (pain- controlling) effect.More often used for young children who respond well to its effects for minor procedures. Adult who request nitrous oxide should know that they will be awake for the procedure.
Method Office Based General Anesthesia with Local Anesthetic*Description of Technique Medications are administered through an intravenous line (I.V.). The patient is kept at a level of consciousness or unconsciousness, with a decreased level of awareness of the procedure being performed. Medications most commonly used are Fentanyl (opiate), Versed (benzodiazepine), Ketamine, and propofol. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored.Usual Indications General anesthesia is available for all types of oral surgery. A patient may choose general anesthesia for simple procedures depending on their level of anxiety. Most people having their wisdom teeth removed and some having a dental implant placed will choose general anesthesia. General anesthesia may be necessary if local anesthesia fails to anesthetize the surgical site which often occurs in the presence of infection.
Method Hospital or Surgery Center Based General AnesthesiaDescription of Technique A patient is admitted to a hospital or surgery center where anesthesia is administered by an anesthesiologist.Usual Indications Indicated for patients undergoing extensive procedures such as face and jaw reconstruction and TMJ surgery. Also indicated for patients with medical conditions such as heart disease or lung disease who require general anesthesia.
To administer general anesthesia in the office, an oral surgeon must have completed at least three months of hospital based anesthesia training. Qualified applicants will then undergo an in office evaluation by a state dental board appointed examiner. The examiner observes an actual surgical procedure during which general anesthesia is administered to the patient. The examiner also inspects all monitoring devices and emergency equipment and tests the doctor and the surgical staff on anesthesia related emergencies. If the examiner reports successful completion of the evaluation process, the state dental board will issue the doctor a license to perform general anesthesia. The license is renewable every two years if the doctor maintains the required amount of continuing education units related to anesthesia.
Again, when it comes to anesthesia, our first priority is the patient’s comfort and safety. If you have any concerns regarding the type of anesthesia that will be administered during your oral surgery procedure, please do not hesitate to discuss your concerns with your doctor at the time of your consultation.
Our office offers our patients the option of Intravenous Sedation. Some people refer to this conscious sedation as “Twilight Sedation” and will have had a similar anesthetic with a colonoscopy, cosmetic or ophthalmic procedure. Intravenous Sedation. Intravenous sedation or “IV sedation” is designed to better enable you to undergo your dental procedures while you are very relaxed; it will enable you to tolerate as well as not remember those procedures that may be very uncomfortable for you. IV sedation will essentially help alleviate the anxiety associated with your treatment. You may not always be asleep but you will be comfortable, calm and relaxed, drifting in and out of sleep.
If you choose the option of intravenous sedation your IV sedation/anesthesia is administered and monitored by the doctor therefore eliminating the costly expense of having your treatment carried out in an operating room or same day surgical facility.
How is the IV sedation administered?
A thin catheter will be introduced into a vein in your arm or hand. The catheter will be attached to an intravenous tube through which medication will be given to help you relax and feel comfortable. Once again some patients may be asleep while others will slip in and out of sleep. Some patients with medical conditions and/or on specific drug regimens may only be lightly sedated and may not sleep at all.
The goal of IV sedation is to use as little medication as necessary to get the treatment completed. As with all anesthesia, the emphasis is on safety. With IV sedation a constant intravenous access is maintained via the intravenous tube. At any time an antidote can be administered to reverse the effects of the medications if necessary. Along with IV sedation there are also other different “levels” of sedation available to you in our office.
Nitrous Oxide (Laughing Gas)
Nitrous Oxide is an odorless, non irritating, colorless gas which you can breathe. Nitrous Oxide has been the primary means of sedation in dentistry for many years. Nitrous oxide is safe; the patient receives 50-70% oxygen mixed with various levels of nitrous oxide. Patients are able to breathe on their own and remain in control of all bodily functions. The patient may experience mild amnesia and may fall asleep not remembering all of what happened during their appointment.
There are many advantages to using Nitrous Oxide
- The depth of sedation can be altered to increase or decrease sedation.
- There is little after effect such as a “hangover”.
- Inhalation sedation is safe.
- Inhalation sedation minimizes gagging.
- It works rapidly as it reaches the brain within 20 seconds. In as few as 2-3 minutes its relaxation and pain killing properties develop.
Reasons to Not use Nitrous Oxide
Though there are no major contraindications to using nitrous oxide, you may not want to use it if you have had recent laparoscopy or retinal surgery, emphysema, exotic chest problems, M.S., a cold or other difficulties with breathing. You may want to ask your dentist for a “5 minute trial” to see how you feel with this type of sedation method before proceeding.
Oral Sedation is sometimes a patient’s best option. Appropriate patients will need a drive and escort and will be prescribed pills to take prior to the office visit. This technique will not likely cause loss of consciousness but some patients do snooze while awaiting the local anesthetic effect. As with all techniques, local anesthetic will also be administered. Post-op supervision with a family member or trusted friend will be necessary. Oral sedation is usually utilized by older patients and those for whom office general anesthesia is not appropriate.