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.Usual Indications Simple oral surgery procedures to more involved procedures such as removal of wisdom teeth and placement of dental implants.
Method Office Based Intravenous Anesthesia with Local AnestheticDescription of Technique Medications are administered through an intravenous line (I.V.). The patient falls asleep and is unaware 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.IV anesthesia is available for all types of oral surgery. A patient may choose IV 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 IV anesthesia. IV Anesthesia may be necessary if local anesthesia fails to anesthetize the surgical site which often occurs in the presence of infection.
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 for their dental treatment. 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 access allows the administration of sedatives in a very controlled manner to achieve the desires level of relaxation. Local anesthesia can then be administered when patients don’t have any recollection. Patients continue to breathe on their own and are fully monitored to create a very safe and extremely comfortable procedure.
To administer intravenous 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. Our surgeons maintain Advanced Cardiac Life Support certification requiring continued training and education every 2 years.
Nitrous Oxide (Laughing Gas)
Nitrous Oxide (mixed with oxygen) 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 for most all patients. The patient may experience mild amnesia yet this is not predictable. The depth of relaxation is somewhat variable between patients and tends to provide more impressive sedation in many children. Although Nitrous Oxide can be very a very useful option, for longer procedures where deeper sedation and better control is desired, IV anesthesia may be a better alternative. We will review your anesthesia options during the consultation to ensure you have the correct choice that is right for your needs.
Some advantages to using Nitrous Oxide
- The depth of sedation can be altered at any time to increase or decrease sedation to some degree.
- 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 can lessen gagging.
- It works rapidly as it reaches the brain within 20 seconds. In as few as 2-3 minutes its relaxation and analgesic properties develop.