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. articaine) 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 procedures such as scaling and root planing. Any procedure you feel comfortable with. Most patients choose this option.
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.Usual Indications Simple oral surgery procedures to more involved procedures. If you have to drive yourself or have just a little anxiety about a procedure.
Method Conscious Sedation with Nitrous Oxide and Local AnestheticDescription of Technique Medication is prescribed and you will take the pill(s) 90 minutes prior to your appointment. You will still be awake during the procedure but will not care what we are doing. Some people fall asleep. You may not remember much of your appointment. Medication most commonly used is Halcion (Triazolam). Oxygen and nitrous oxide are added through a nasal breathing apparatus to give you a deeper sedation. Your vital signs are closely monitored.Usual Indications Conscious sedation is available for all types of oral surgery. You may choose conscious sedation for simple procedures depending on your level of anxiety. Most people having multiple teeth removed or having periodontal surgery in multiple areas in one visit will choose conscious sedation. Conscious sedation may be necessary if you are unable to keep your head still or if you frequently kick your legs. It is very helpful if you have a strong gag reflex.
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.
We will always numb you for every procedure no matter which sedation option you choose. Even if you are asleep your body can still feel pain. Nitrous oxide and conscious sedation will not numb you. If you have a heart condition we may require approval from your physician to use epinephrine when numbing you. Some people are sensitive to epinephrine and may feel anxious or have an increased heart rate. Let us know if you have had these feelings in the past. For some procedures we can use an anesthetic that does not have epinephrine. For procedure that require epinephrine we can administer oxygen throughout the procedure which counteracts these feelings. If you have naturally red hair or are difficult to get numb please let us know. Never hesitate to ask for more anesthetic. We prefer our patients to be comfortable. Sometimes an infected tooth can be difficult to numb. In this case we add a “base” to the anesthetic. This brings the anesthetic up to physiological pH and you will be numb much quicker and it is very effective.
Conscious Sedation (“Twilight Sedation”)
Our office offers our patients the option of Conscious Sedation or to some it is referred to as “Twilight Sedation” for their dental treatment. Conscious Sedation or “twilight sedation” helps you to be comfortable and calm when undergoing dental procedures. Conscious 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. Conscious 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 conscious sedation you will be 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 conscious sedation administered?
You will take 1-3 pills of sedation medication 90 minutes prior to your appointment. We will send a prescription for the sedation medication 1-2 weeks before your appointment. Make sure you pick it up from the pharmacy. We do not dispense the medication in this office. If you do not take the prescribed medication as directed you will not be sedated. The medication most commonly used is Halcion (Triazolam). We will determine your dose based on your age and weight. When you arrive at the office we will add nitrous oxide (laughing gas) if you want. Nitrous oxide helps you achieve a deeper level of sedation. Some people don’t like the “floaty” feeling of nitrous oxide and just taking the medication for conscious sedation is enough. 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. See specific pre-operative instructions can be found here. Follow them exactly to achieve the best level of sedation.
The goal of conscious sedation is to use as little medication as possible to get the treatment completed. It is very safe, much safer than IV sedation or general anesthesia. At any time an antidote can be administered to reverse the effects of the medications if necessary. Along with conscious sedation there are also other different “levels” of sedation available to you in our office. There is nitrous oxide analgesia.
Reasons to Not use Conscious Sedation
If you have restless leg syndrome it may increase the symptoms during treatment resulting in you kicking your legs or “jumping” in the chair. If you have restless leg syndrome and want to be sedated it is advised to take your restless leg medication for the procedure. If you have trouble breathing through your nose nitrous oxide will not be effective. Using the oral sedative without nitrous oxide will be a great alternative. Let us know if you have a history of drug or alcohol abuse or if you have had difficulty with general anesthesia in the past. If you do you may not be able to achieve your desired level of sedation.
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 35-70% oxygen with no less than 30% oxygen. Patients are able to breathe on their own and remain in control of all bodily functions. You will not feel “high” or fall asleep but you will feel relaxed and more comfortable about the procedure. Nitrous oxide is highly effective in people 25 and younger. We use special clear masks sized to your nose. You are able to move your head around and will not give the claustrophobic effect of traditional nitrous oxide masks. You may feel “floaty” or your hands and feet may tingle. If at any time you are feeling nauseated or dizzy just let us know and we can decrease the amount of nitrous oxide. We also offer nitrous oxide for regular cleanings and periodontal maintenance cleanings. If you have dental anxiety this can be a wonderful way for you to be comfortable at the dentist and maintain good oral health.
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 is very effective in minimizing gagging.
- It works rapidly as it reaches the brain within 20 seconds. In as few as 2-3 minutes you will feel relaxed. Within 5 minutes of discontinuing nitrous oxide you will be able to function as normal.
- Because nitrous oxide leaves your body quickly you will be able to drive and go back to work if you wish. There is no need to have someone monitor you after.
Reasons to Not use Nitrous Oxide
There are few major contraindications to using nitrous oxide. Do not use nitrous oxide if you are pregnant. This can result in having a miscarriage. Conscious sedation without nitrous oxide may be a better option. Consult your OBGYN for the safest and most effective medication for conscious sedation. You may not want to use it if you have emphysema, chest problems, M.S., a cold or other difficulties with breathing. Nitrous oxide is a gas you inhale and if your nose is blocked or you have difficulty breathing through your nose you will not be able to inhale the gas. Do not use nitrous oxide if you have recently had eye surgery. Using nitrous oxide within 2 months of having eye surgery can result in complete blindness. Do not use nitrous oxide if you have recently had middle ear surgery or a small bowel obstruction.