Several methods of anesthesia are available. The method of anesthesia depends upon the nature of the surgical procedure and the patient’s level of apprehension. Oral and Maxillofacial Surgeons are the only dental specialty to obtain extensive, focused anesthesia training during residency in addition to clinical training. As board certified Oral and Maxillofacial Surgeons, Drs. Cudney and Ewig have significant inpatient and outpatient based medical and anesthesia training for managing pediatrics and adults. The knowledge and hands-on experience were learned during their residency, used in daily practice, and kept up-to-date with continuing education and office-based medical emergency and mock code simulations. Dr. Cudney is an examiner for the Ohio State Dental Board of Anesthesia and performs office evaluations of other dentists and specialists attempting to obtain an anesthesia permit.
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. The relaxing effects of nitrous oxide vary significantly from one-person to the next. Patients who receive nitrous oxide during routine dental appointments may not feel the same effect of the nitrous during surgery due to increased anxiety. In our office, nitrous oxide is not used in conjunction with oral medications as this is considered moderate sedation. Moderate sedation may be administered more safely and in a titratable manner with IV sedation.Usual IndicationsPatients with very mild anxiety that are undergoing simple oral surgery procedures.
Method Office Based IV Anesthesia with Local Anesthetic*Description of Technique Medications are administered through an intravenous line (I.V.). The level of sedation depends on the type and quantity of medication given. This spectrum varies from awake and relaxed to completely asleep and requiring assistance to breathe. Medications most commonly used are Fentanyl (opiate), Versed (benzodiazepine), Ketamine, and Propofol. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored.Usual Indications IV anesthesia is available for all types of oral surgery. Patients with a compromised medical status, may have IV antibiotics and/or very light sedation for anxiety reduction while healthy patients may choose general anesthesia for simple procedures depending on their level of anxiety. Most people having their wisdom teeth removed or extensive dental implant procedures 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.
Method Hospital or Surgery Center Based General AnesthesiaDescription of Technique A patient is admitted to a hospital or surgery center where anesthesia is administered by an anesthesiologist.Usual Indications 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 five months of hospital based anesthesia training including dedicated pediatric anesthesia. 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. Dr. Cudney is an examiner for the Ohio State Dental Board of Anesthesia.
Again, when it comes to anesthesia, our first priority is the patient’s safety and comfort. 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.
Intravenous Sedation (“Twilight Sedation”)
Our office offers our patients the option of Intravenous Sedation 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 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.
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 still receives 30-70% 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 is very effective in minimizing gagging.
- It works rapidly as it reaches the brain within 20 seconds. In as few as 2-3 minutes its relaxation and pain killing properties develop.
Reasons to Not use Nitrous Oxide
The effects of nitrous oxide are variable form person-to-person. If you are very anxious regarding your upcoming appointment, nitrous oxide is unlikely to provide the level of anxiety reduction you desire and IV sedation may be better. Medical contraindications include emphysema, pulmonary hypertension, M.S., a cold or other difficulties with breathing, certain recent abdominal or eye procedures, and more. Patients who are receiving nitrous oxide will require a consultation appointment prior to the procedure.