Anesthetic Options for Oral Surgery

 

Local anesthesia

Local anesthetic (modern day novacaine) is administered by injection to numb surgical areas.  Topical anesthetic get is applied prior to injection.  Under normal circumstances, once an area is numb, surgical pain is not felt.  Patients will feel pushing, pressure and vibration; patients will also be aware of surgical noise.

Limitations of local anesthesia

  1. Some patients will interpret pushing pressure and vibration as pain.  Local anesthetic will not block these sensations.
  2. Local anesthetic does not work completely when inflammation and / or infection is present.  A tooth that is painful tender or infected may not get numb and the patient will subsequently feel pain regardless of how much local anesthetic is used.
  3. Each patient will respond differently to medications.  Adverse reaction to a medication is always possible, as is allergy.  No medication is 100% safe; because of this, our office maintains current equipment and training for use.

   

Nitrous oxide sedation with local anesthesia

Nitrous oxide (laughing gas) is administered by nasal hood to the nose.  Nitrous oxide will reduce anxiety associated with dental procedures.  Nitrous oxide works particularly well with children.  Patients receiving nitrous oxide will remain awake and alert, but will tend to ignore non painful stimuli.

Limitations of nitrous oxide

  1. All limitations of local anesthesia apply
  2. Patients must breathe through their nose for the nitrous to work.. Patients who breathe through their mouth will not gain any benefit from the administration of nitrous oxide gas.
  3. Nitrous oxide will not prevent the patient from feeling pain.
  4. Patients remain awake and alert during dental procedures
  5. Patients are strongly encouraged to not eat before their appointment to reduce the chance of nausea and vomiting.
  6. Each patient will respond differently to medications.  Adverse reaction to a medication is always possible, as is allergy.  No medication is 100% safe; because of this, our office maintains current equipment and training for use.

   

Oral sedation with local anesthesia

Oral sedative medication (modern day valium) is taken by the patient the night before and one hour before the planned dental appointment.  This medication will reduce anxiety associated with dental treatment and will provide very light conscious sedation; some amnesia (memory loss) may occur.  Patients remain awake during their dental treatment but they will tend to ignore non painful stimuli

Limitations of Oral sedation

  1. All limitations of local anesthesia apply
  2. Patients should not eat for 6 hours prior to their dental appointment; patients may drink clear fluids up to 2 hours prior to their dental appointment.  Patients who do not comply with this request will likely not get the maximum benefit from the medication due to poor or delayed uptake into the body
  3. Patients must have an escort / driver who will drive the patient to and from the dental appointment.
  4. Patients may not drive, operate dangerous tools or equipment or make important decisions for 12 hours after taking this medication
  5. Patients will still feel and react to pain
  6. Patients will remain awake during treatment, although they may have some degree of amnesia
  7. Each patient will respond differently to medications.  Adverse reaction to a medication is always possible, as is allergy.  No medication is 100% safe; because of this, our office maintains current equipment and training for use.

 

Oral sedation, nitrous oxide and local anesthesia

These three anesthetic modalities may be used to together to maximize anti-anxiety and sedative effects.

Limitations of treatment

  1. All limitations of local anesthesia, nitrous oxide and oral sedation apply.
  2. Each patient will respond differently to medications.  Adverse reaction to a medication is always possible, as is allergy.  No medication is 100% safe; because of this, our office maintains current equipment and training for use.

 

IV sedation and General anesthesia

A combination of medications are administered to the patient through an intravenous line.  Patients may dictate whether they wish to be lightly sedated (responsive to stimuli) or asleep (not responsive to stimuli).  Patients are not intubated (as they are in the operating room setting) and will continue to breathe on their own.  Patients will not feel pain, and it is unlikely that they will remember much of the surgical procedure.  This form of sedation allows for the careful titration of medication to maximize sedation while minimizing the chance for prolonged oversedation.

The administration of sedative medications through an intravenous line might be indicated for the following patients:

  1. Patients who have significant anxiety associated with dental surgery
  2. Patients who present for difficult or extensive surgical procedures
  3. Patients who present with symptomatic or infected teeth
  4. Patients who are unable to open their mouths very wide
  5. Patients who have a history of high blood pressure or heart disease; these patients may tolerate dental procedures better if they are lightly sedated to reduce dangerous fluctuations in blood pressure readings.

 

Limitations of treatment

  1. Patients must not eat for 8 hours prior to their dental appointment; patients may drink clear fluids up to 2 hours prior to their dental appointment.  Unless otherwise directed by the surgeon, the patient should take medications with a small amount of water at their usual time.  Patients may not take food with medication under any circumstance.
  2. Patients must have an escort / driver who will drive the patient from the dental appointment.
  3. Patients may not drive, operate dangerous tools or equipment or make important decisions for 12 hours after taking this medication
  4. Each patient will respond differently to medications.  Adverse reaction to a medication is always possible, as is allergy.  No medication is 100% safe; because of this, our office maintains current equipment and training for use.

 

 

Understanding Dental Anesthesia: 

What Every Patient Should Know
(from the ADA)

 

Providing you with high-quality, appropriate care and making your dental visit as comfortable as possible are top priorities for the 143,000 members of the American Dental Association (ADA). Advances in dental techniques and medications can greatly reduce, even eliminate, discomfort during dental treatment, and your dentist and the ADA want you to know about them. Here are some of the options available to help alleviate anxiety or pain that may be associated with dental care:

 

Local Anesthesia

Injectable local anesthetics, such as Novacaine, prevent pain in a specific area of your mouth during treatment by blocking the nerves that sense or transmit pain and numbing mouth tissues. They cause the temporary numbness often referred to as a "fat lip" feeling. Injectable anesthetics may be used in such procedures as filling cavities, preparing teeth for crowns or treating gum disease.

 

Sedation and General Anesthesia

Anti-anxiety agents, such as nitrous oxide, or sedatives may help you relax during dental visits and often may be used along with local anesthetics. Dentists also can use these agents to induce "conscious sedation," in which the patient achieves a relaxed state during treatment but can respond to speech or touch. Sedatives can be administered before, during or after dental procedures by mouth, inhalation or injection.

More complex treatments may require drugs that can induce "deep sedation," causing a loss of feeling and reducing consciousness in order to relieve both pain and anxiety. On occasion, patients undergo "general anesthesia," in which drugs cause a temporary loss of consciousness. Deep sedation and general anesthesia may be recommended in certain procedures for children or others who have severe anxiety or who have difficulty controlling their movements.

The ADA provides guidelines to help dentists administer pain controllers in the safest manner possible. Dentists use the pain and anxiety control techniques mentioned above to treat tens of millions of patients safely every year. Even so, taking any medication involves a certain amount of risk. That's why the ADA urges you to take an active role in your oral health care. This includes knowing your health status and telling your dentist about any illnesses or health conditions, whether you are taking any medications (prescription or non-prescription), and whether you've ever had any problems such as allergic reactions to any medications. It also includes understanding the risks and benefits involved in dental treatment, so that you and your dentist can make the best decisions about the treatment that is right for you.

Understanding the range of choices that are available to relieve anxiety and discomfort makes you a well-informed dental consumer. If you have questions or concerns about your oral health care, don't hesitate to talk to your dentist. If you still have concerns, consider getting a second opinion. Working together, you and your dentist can choose the appropriate steps to make your dental visit as safe and comfortable as possible, and to help you keep a healthy smile.

 

For more information about this or other oral health topics, visit ADA Online "http://www.ada.org", or contact your local dental society.

Drug reference information can be found by following the links below:

valium

halcion

versed

propofol

fentanyl