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. 

Anesthesia Options

The following table illustrates the choices of anesthesia, 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 to more involved procedures such as removal of wisdom teeth and placement of dental implants.
  • Method Office Based General Anesthesia with Local Anesthetic*
    Description of Technique 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 Diprivan. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored.
    Usual Indications General anesthesia is available for all types of oral surgery. A patient may choose general anesthesia for simple procedures depending on their level of anxiety. Most people having their wisdom teeth removed or having a dental implant placed 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 Anesthesia
    Description 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.

The American Board of Oral and Maxillofacial Surgery and the Commission on Dental Accreditation (CODA), which sets the training standards for oral surgery residency programs, considers the safe administration of anesthesia a top priority for oral surgeons, and ensures that very strict standards are followed. To administer general anesthesia in the office, an oral surgeon must have completed at least six months of hospital-based anesthesia training, including at least one month of pediatric anesthesia. This training is conducted by the Anesthesia Department at teaching hospitals around the country, and oral surgeons function as anesthesia residents during this training. After meeting their training requirements, qualified applicants will then undergo an in-office evaluation by a state anesthesia examiner. The examiner observes an actual surgical procedure during which general anesthesia is administered to the patient by the oral surgeon. The examiner also inspects all monitoring devices and emergency equipment, and tests the doctor and the surgical staff on anesthesia-related emergencies and knowledge. 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 must be renewed every two years, and oral surgeons must maintain qualifications in CPR, BLS, and ACLS (Advanced Cardiac Life Support).

These strict standards make Oral and Maxillofacial Surgeons uniquely qualified to administer general anesthesia in the office, and the field of oral surgery has a long and proud history of the safe and comfortable treatment of patients in an office setting.

Again, when it comes to anesthesia, our first priority is the patient’s comfort and safety. Not every patient is a good candidate for all types of in-office sedation, and we will discuss your options with you at your consultation. 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 us.

Intravenous Sedation

We offer the option of intravenous sedation, or general anesthesia, to help keep patients comfortable and calm when undergoing certain procedures. IV anesthesia will help alleviate the anxiety associated with your treatment. If you will be undergoing general anesthesia for your procedure, it is very important that you have nothing to eat or drink for at least 6 hours before surgery. You will also need a responsible adult to come with you and drive you home afterwards.

If you and your doctor choose the option of intravenous anesthesia, your 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 used to introduce a flexible tube into a vein in your arm or hand. This will be attached to an intravenous tube, through which medication will be given to help you relax and feel comfortable, and achieve the desired level of sedation. Some patients with medical conditions and/or on specific drug regimens may only be lightly sedated and may not be completely asleep. The medications used for general anesthesia are short-acting, allowing you to wake up quickly when your procedure is completed, and generally be ready to go home in 20-30 minutes.

Nitrous Oxide (Laughing Gas)

Nitrous Oxide is an odorless, non-irritating, colorless gas which you breathe in. Nitrous Oxide has been the primary means of sedation in dentistry for over 100 years. Nitrous oxide is safe, and 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 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.
  • There is no need to have an empty stomach before your procedure, and you can drive yourself home afterwards

Reasons to Not use Nitrous Oxide

Nitrous oxide is contraindicated during pregnancy and in patients with emphysema or other difficulties with breathing. If you have any questions regarding the use of nitrous oxide, please let us know.