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 IV Sedation with Local Anesthetic*Description of Technique Medications are administered through an intravenous line (I.V.). The patient is relaxed, sleepy and less aware of the procedure being performed. Medications commonly used are Fentanyl (opiate) and Versed (benzodiazepine). Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored.Usual Indications IV sedation is available for all types of oral surgery. A patient may choose IV Sedation for simple procedures depending on their level of anxiety.
To administer IV Sedation in the office, a periodontist must have completed additional, extensive anesthesia training and must complete regular continuing education to maintain the license. Qualified applicants 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 IV sedation.
Again, when it comes to anesthesia, our first priority is the patient’s comfort and safety. 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. Patients are able to breathe on their own and remain in control of all bodily functions. If you have any concerns regarding the type of anesthesia that will be administered during your procedure, please do not hesitate to discuss your concerns with your doctor at the time of your consultation.
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. 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 keep you relaxed and comfortable to get the treatment completed. It is very safe and, in fact, safer than oral sedation. With IV sedation a constant “drip” is maintained via the intravenous tube. At any time a reversal medication can be administered reverse effects of the medications if necessary.
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 generally receives 50-70% oxygen. 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 can reduce the gag relfex.
- It works rapidly wears off quickly as it reaches the brain within 20 seconds. In as few as 2-3 minutes its relaxation and anesthetic properties develop.