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, such as minor soft tissue procedures and simple tooth extractions.
Nitrous Oxide Sedation with Local Anesthetic
Intravenous Sedation (“Twilight Sedation”)
Our office offers our 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 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 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, however, 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, such as nitrous oxide analgesia.
Office-Based General Anesthesia with Local Anesthetic
Medications are administered through an intravenous line (IV). 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.
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 and also 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.
Non-IV Conscious Sedation
Conscious sedation is usually administered for more significant dental procedures or when the idea of going to the dentist for a procedure brings on feelings of fear or anxiety. You will be scheduled to come in prior to your treatment time for the delivery of the oral medication. Oral conscious sedation is as easy as taking an aspirin, and you will feel relaxed and at ease.
For the entire procedure, you are awake and able to ask questions or respond to instructions from the dentist, but you will feel relaxed. Additionally, you may not recall your procedure afterward.
Oral conscious sedation is extremely safe and easy. It’s important to remember that when you receive oral conscious sedation, you will need someone else to drive you to and from our office, as you will be unable to safely handle a vehicle.
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.