Several methods of anesthesia are available. The method of anesthesia chosen for or by a patient depends upon the nature of the surgical procedure and the patient’s level of anxiety.
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.Local anesthetic is used for 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 effect.Usual IndicationsNitrous oxide is used alongside local anesthetic for some oral surgery procedures that are not as involved to more complex procedures, such as removal of simple wisdom teeth and dental implant placement.
Method Office Based Conscious Sedation or General Anesthesia with Local AnestheticDescription of TechniqueDifferent levels of sedation are achieved depending on the type and amount of medication given. Medications are administered through an IV. The patient falls asleep and is completely unaware of the procedure being performed. Medications most commonly used are Fentanyl (opiate), Versed (benzodiazepine), Ketamine, Methohexital, and/or Diprivan. Supplemental oxygen is delivered through a nasal breathing apparatus, and the patient’s vital signs are closely monitored.Usual IndicationsConscious Sedation or general anesthesia is available for all types of oral surgery. A patient may choose this form of anesthesia for simple procedures depending on their level of anxiety. Most people having their wisdom teeth removed choose general anesthesia, and some having dental implants placed may choose to as well. Conscious sedation or 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.This type of general anesthesia is indicated for patients undergoing extensive procedures, such as face and jaw reconstruction and TMJ surgery. It is also performed 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 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.
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”)
Our office offers our patients the option of Intravenous (IV) Conscious Sedation, or “Twilight Sedation” to some, for their dental treatment. IV Sedation or “twilight sleep” helps you be comfortable and relaxed when undergoing dental procedures. It will enable you to tolerate and not remember procedures that may be very uncomfortable for you otherwise. 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 as you drift in and out of a “twilight sleep.”
IV sedation 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 needle will be introduced into a vein in your arm or back of your hand (usually the latter). The needle will be attached to an IV 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. 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 or 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. 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, such as nitrous oxide analgesia.
Nitrous Oxide (Laughing Gas)
Nitrous oxide is a sweet-smelling, nonirritating, colorless gas you can breathe. It 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. In some cases they may experience mild amnesia, a sense of euphoria, or tiredness.
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.”
- It is safe with no side effects on your heart, lungs, etc.
- Gagging is minimized.
- It works rapidly and 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
Although there are no major contraindications to using nitrous oxide, you may not want to use it if you have emphysema, chest problems, multiple sclerosis (MS), a cold, or other difficulties with breathing. You may want to ask your doctor for a “five-minute trial” to see how you feel with this type of sedation method before proceeding.