Major oral surgery can be performed in a hospital or surgical center operating room; however, the majority of more minor surgeries are performed in the office. Several sedation dentistry options are available to ensure that our patients are as comfortable as possible. These include:
Local anesthesia for Oral Surgery
Many simple procedures can be performed using local anesthesia or numbing.
Nitrous oxide for Oral Surgery
Nitrous oxide, or laughing gas, is available for office procedures. This serves to make the patient feel more relaxed and also provides significant analgesia (pain control). Laughing gas is suitable for minor procedures with fairly relaxed patients. It is unreliable and generally inadequate for larger procedures or very anxious patients. Nitrous oxide is very safe, and patients can generally function normally, including driving after a short recovery period.
Intramuscular sedation for Oral Surgery
This anesthetic is most appropriate for young children. It has an exceptionally high safety level and is very reliable. This anesthetic requires a small injection usually into the shoulder muscle, and works within five minutes. It requires some monitoring of the patient throughout the procedure. In our office we utilize advanced monitoring for the greatest level of safety.
IV (intravenous) sedation
Also called conscious sedation, IV sedation utilizes an arm vein for access for the medications. This anesthetic makes the patient more relaxed and allows access for pain medication as well as other medications. By definition, conscious sedation maintains the patient in an awake but more comfortable state. To fall into this category, the patient must be able to converse with the doctor throughout the procedure. Patients must not eat for at least six hours prior to an IV sedation and must have someone to drive them home
Deep sedation or general anesthesia
By far the most popular mode of anesthesia in an oral surgery office, deep sedation or general anesthesia allows the patient to sleep throughout the procedure unaware of the surgery being performed. A small IV is placed into an arm vein, and anesthetics are administered. These anesthetics are fast acting and short lasting which allows for very small, safe, but effective doses. When the procedure is finished, the doses are discontinued, and the patient wakes up quickly. Patients generally find this anesthetic very comfortable and enjoyable. Nausea is uncommon and can usually be avoided in susceptible patients.
How safe is IV anesthesia?
IV anesthesia is considered to be very safe especially in healthy patients. Several studies have been done to look at the level of safety of anesthesia performed by an oral surgeon, and all have demonstrated safety at or above the safety level of any other setting.
Is an oral surgeon qualified to perform anesthesia?
Absolutely. An oral surgeon has at least four years of additional training and experience in anesthesia (the same as a medical anesthesiologist). Dr. Bulloch also did an additional year doing hospital anesthesia, for a total of five years. An oral surgeon’s training includes operating room anesthesia; however, the large majority of the training and experience is in office anesthesia. This is a relatively narrow scope which allows the surgeon to concentrate his abilities on a small range of anesthetics and techniques. This makes oral surgeons very proficient at the type of anesthesia that they do, thus accounting for the extremely high safety rating.
Dr. Bulloch is also a certified instructor for CPR and ACLS (Advanced Cardiac Life Support) and has taught classes in each for over fourteen years.
Is the anesthesia performed by an oral surgeon different than that performed by a dentist?
Yes There are four levels of licensure for dental practitioners.
Level One: This gives the dentist the certification to give local anesthesia (numbing shots) without which no civilized dentist could practice.
Level Two: This certifies the dentist to give nitrous oxide (laughing gas). All dentists have Level One and Level Two certification.
Level Three: With a few additional hours of training, dentists may obtain Level Three certification. This allows them to perform IV conscious sedation. By definition, conscious sedation requires that the patient be awake and able to converse throughout the procedure. You are not asleep with level III anesthesia.
Level Four: Generally only certified oral surgeons obtain the training necessary to receive Level IV certification. This allows them to perform deep sedation or general anesthesia in which the patient is asleep throughout the procedure. This requires specialized training and specialized monitoring, and provides a much more comfortable level of anesthesia for most procedures. An oral surgeon can perform any of the four levels of anesthesia, and can therefore provide the greatest flexibility in anesthesia options.
What is “sleep dentistry” that I have seen some dentists advertise?
Regardless of advertising names, a general dentist does not have the training or the license to put patients to sleep. As a result, any general dentist that is advertising that patients can sleep through the procedure is either misrepresenting the level of anesthesia that they are actually using, or they are practicing outside of their training and licensure. Either way this is a situation best avoided.
Are there other benefits to IV anesthesia?
Yes. The IV access gives the ability to give other medications that are very beneficial to patients. We give long lasting pain medication, medication to decrease swelling, and medication to prevent nausea along with the anesthetics. These help tremendously in the overall comfort of our patients.