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||Usual Indications|
|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 simple tooth extractions.|
|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 General Anesthesia with Local Anesthetic*||Medications are administered through an intravenous line (I.V.) and/or a mask. The patient falls asleep and is completely unaware of the procedure being performed. Medications most commonly used are Fentanyl (opiate), Versed (benzodiazepine), and Propofol. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored. For young children and those afraid of needles, anesthetic gases can be used to induce sleep.||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 or 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.|
|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.
General anesthesia (“Twilight Sedation”)
Our office offers our patients the option of light General Anesthesia in the office. Some refer to this as “Twilight Sedation”. General anesthesia allows you to be comfortable and calm when undergoing surgical procedures. It will enable you to tolerate as well as not remember those procedures that may be very uncomfortable for you. General anesthesia will essentially help alleviate the anxiety associated with your treatment. You may not always be totally asleep but you will be comfortable, calm and relaxed, drifting in and out of sleep and remembering nothing– a “twilight sleep”. We usually give our patients going to sleep a sedative to take orally before coming to the office to further relax them before they even arrive here.
For those patients with medical problems that make general anesthesia in the office too risky, simple intravenous anesthesia can be administered to relax them somewhat but not actually put them to sleep.
If you choose the option of general anesthesia or intravenous sedation your IV sedation/anesthesia is administered and monitored by the doctor and his staff who are well trained in this field. Having the surgery performed in the office eliminates the costly expense of having your treatment carried out in an operating room or same day surgical facility which is often not covered my insurances today.
How is the General anesthesia Administered?
A thin needle with a cannula 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, feel comfortable and fall asleep. For patients who are too afraid of needles (particularly children) or who have veins that are too small or fragile for a cannula to be inserted, we can also induce anesthesia with an inhalation anesthetic through a mask. We will then sometimes start an IV once the patient is asleep.
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 also nitrous oxide analgesia.
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. Most patient however remain awake and just feel a tingly sensation that distracts them from the surgery.