Local Anesthesia

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.

Nitrous Oxide (Laughing Gas) Sedation with Local Anesthesia

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 for relaxation and anxiety relief. Nitrous oxide is safe; the patient receives 50-70% oxygen with no less than 30% nitrous oxide. 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.
• Recovery from nitrous oxide sedation is rapid. 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.

IV Sedation with Local Anesthetic

Our office offers our patients the option of Intravenous Sedation (conscious or deep sedation) for their dental treatment. Intravenous sedation or “IV 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. Depending on the type of IV sedation chosen, 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 one of the varieties of intravenous sedation (conscious or deep sedation) your IV sedation 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. Some patients with medical conditions and/or on specific drug regimens may only be lightly sedated.

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.

There are many advantages to using IV Sedation

• Reduces anxiety and stress associated with dental treatment
• You will remember little or nothing about the procedure
• It enables the clinician to undertake the procedure with greater ease and safety

Deep IV Sedation with Local Anesthetic*

Medications are administered through an intravenous line (I.V.), producing a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain breathing may be impaired and intervention may be required. Patients may require assistance in maintaining an open airway.  Cardiovascular function is usually maintained. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored. Medications most commonly used are Fentanyl (opiate), Midazolam (benzodiazepine), Ketamine, Propofol, Dexamethasone and Dimenhydrinate. The sedation agents used in treatment will affect your coordination, memory and judgement. Recovery from deep sedation  takes approximately 24 hours and during this time you should not drive, cook, operate machinery, perform any strenuous or hazardous activities, drink alcohol or take any sleeping medications. An escort will be required for this type of anesthesia – if you attend without an escort, deep sedation cannot be provided.

Deep sedation is available for all types of oral surgery. Deep sedation may be necessary if local anesthesia fails to anesthetize the surgical site which often occurs in the presence of infection.

Conscious and/or Deep Sedation

To administer conscious and/or deep sedation in the office, an oral surgeon must have completed at least three months of hospital based anesthesia training. Qualified applicants will then undergo an in office evaluation by a provincial 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 provincial 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.

It is not always possible to predict how an individual patient will respond and, at times, it can be difficult to precisely define the end-point of one level of sedation and the starting point of a deeper level of sedation. Therefore, the drugs and techniques used for sedation carry a margin of safety wide enough to render loss of consciousness highly unlikely.

Again, when it comes to anesthesia, our first priority is the patient’s comfort and safety. 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.