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.
Method of Anesthesia
Description of Technique
|Local Anesthetic||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.||Simple oral surgery procedures such as minor soft tissue procedures and basic tooth extractions. Patients may elect to have wisdom teeth removed with local anesthetic.|
|Nitrous Oxide Sedation with Local Anesthetic||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.||Simple oral surgery procedures to more involved procedures such as removal of wisdom teeth and placement of dental implants.|
|Office Based Intravenous Anesthesia with Local Anesthetic*||Medications are administered through an intravenous line (I.V.). The patient falls asleep and is completely unaware of the procedure being performed. Medications most commonly used are Fentanyl (opiate), Versed (benzodiazepine), Ketamine, and Diprivan. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored.||Intravenous anesthesia includes I.V. sedation and general anesthesia for all types of oral surgery. A patient may choose intravenous anesthesia for simple procedures depending on their level of anxiety. Most people having their wisdom teeth removed or having a dental implant placed will choose intravenous anesthesia. General anesthesia and/or I.V. sedation may be necessary if local anesthesia fails to anesthetize the surgical site which often occurs in the presence of infection.|
|Hospital or Surgery Center Based General Anesthesia||A patient is admitted to a hospital or surgery center where anesthesia is administered by an anesthesiologist.||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.
Intravenous Sedation (“Twilight Sedation”)
Oral and Maxillofacial Surgery offices offer their patients the option of Intravenous Sedation or Dental Intravenous Anesthesia or to some it is referred to as “Twilight Sedation” for their dental treatment. Intravenous Sedation or “twilight sleep” helps you to be comfortable and calm when undergoing dental procedures. Your treatment can be completed under intravenous sedation. Intravenous sedation or “IV sedation” (twilight 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 – a “twilight sleep”.
If you choose the option of intravenous sedation your IV sedation/anesthesia is administered and monitored by your Oral Surgeon 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 needle will be introduced into a vein in your arm or hand. The needle will be attached to an intravenous tube through which medication will be given to help you relax and feel comfortable. At times a patient’s vein may not be maintainable, in these situations the medications will be administered and the needle retrieved – both scenarios will achieve the same desired level of conscious sedation. 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 possible to get the treatment completed. It is very safe, much safer than oral sedation. With IV sedation a constant “drip” 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. There is nitrous oxide analgesia.
Sedation Dentistry for the Elderly
As we age, our oral health becomes more important than ever. Periodontal disease can lead to bone and tooth loss, which affects nearly every part of our daily lives. To lead full and active lives, we need our teeth and gums. They allow us enjoy food, support speech and good conversation, and facilitate digestion. Your Oral Surgeon is dedicated to treating elderly patients with care and commitment to comfort and health.
Elderly patients as a group tend to avoid dental visits for a variety of reasons, including: more pressing medical concerns, anxiety about treatment, the hardship of transportation, or fixed incomes. Once their oral health has reached an unmanageable point, fear and embarrassment further keep these patients away from the dentist.
For elderly patients embarrassed or fearful of their current oral state, sedation dentistry provides the opportunity for your Oral Surgeon to treat these conditions while the patient remains relaxed and unaware until “awaking” to an improved oral state!
Sedation Dentistry for the Disabled
It may be especially difficult for people with disabilities to obtain access to proper dental care. They must find a dentist who is skilled and compassionate, and who can provide services for which some dentists may not be qualified. Your Oral Surgeon provides the expertise, state-of-the-art-equipment, and dedication to assisting special-needs patients necessary to ensuring great oral care for our patients.
Disabled patients may face added challenges in maintaining their oral health. Their disability may make it difficult to brush or floss regularly; they may also suffer a severe gag reflux, or dry mouth as a result of medication. Your Oral Surgeon meets these challenges with sedation dentistry for the disabled. He/she is skilled in anesthesia for special-needs patients, and can ease the fear associated with out-of-control oral hygiene with one visit.
Sedation Dentistry for the Fearful
Dental phobia is a real, often overwhelming reality for thousands of people. Negative previous dental experiences, fear of needles or drills, and severe gag refluxes are just some of the reasons people feel extreme anxiety when thinking about visiting the dentist.
If you suffer from dental phobia- fear no more! Your Oral Surgeon is committed to understanding the very real nature of your fears. Not only will our staff treat you with delicacy and care, but IV sedation will allow you to experience dentistry in a whole new way. While engaging in a pleasant sleeplike experience, your Oral Surgeon will be hard at work making sure you “wake up” with the results you desire.
Nitrous Oxide (Laughing Gas)
Nitrous Oxide is a sweet smelling, 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 with no less than 30% 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 at any time to increase or decrease sedation.
- There is no after effect such as a “hangover”.
- Inhalation sedation is safe with no side effects on your heart and lungs, etc.
- Inhalation sedation is very effective in minimizing 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 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.