Sedation

Several methods of Sedation 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. 

Sedation Options

The following table illustrates the choices of sedation, a description of the anesthetic technique, and the usual indications for that technique.

  • Types of Anesthesia
  • Method Local Anesthetic
    Description 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 Anesthetic
    Description 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 for adults.  Usually given for children and teens undergoing any procedure in our office.
  • Method IV moderate sedation with  Local Anesthetic*
    Description of TechniqueOffered in this office.  Medications are administered through an intravenous line (I.V.). The patient falls asleep and is in a state of deep relaxation but conscious enough to maintain breathing and heart functions. Amnesia (no memory) of the procedure is common.  Medications most 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.
    More involved surgical procedures.  Any procedure, whether simple or complex for patients with dental anxiety or phobia.
  • Office Based General Anesthesia with Local Anesthetic*
    This is administered by an MD Anesthesiologist present in our office.  Medications are administered through an intravenous line (I.V.). The patient falls asleep and is completely unaware of the procedure being performed. 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.
    General anesthesia is available for all types of oral surgery.  If IV moderation conscious sedation is ineffective or not appropriate for the patient’s medical condition, this is the type of sedation that is proposed.  This is also available for children and teens under age 18 years of age where nitrous sedation is not enough.

Intravenous Sedation (“Twilight Sedation”)

Our office offers our patients the option of Intravenous Sedation (IV sedation) or as some refer 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. There is oral sedation and nitrous oxide sedation.  

Nitrous Oxide (Laughing Gas)

Nitrous Oxide has been the primary means of sedation in dentistry for many years. Patients are able to breathe on their own and remain in control of all bodily functions. 

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

Though there are no major contraindications to using nitrous oxide, you may not want to use it if you have emphysema, COPD, M.S., a cold or other difficulties with breathing.