A tooth removal is one of the most common surgical procedures performed every day in our dental offices. Removal of infected teeth is necessary to prevent the spread of dangerous bacteria. When it comes to extractions, patients often have various options of just how to undergo this procedure.
Anesthesia vs. Sedation
We use the word “anesthesia” broadly, but technically that is not the accurate term for what we are talking about. When people hear “anesthesia”, they think of being put to sleep, which really means sedation. Anesthesia means turning off sensory nerves so that you do not feel sensations in a certain area of the body. We explain this so that you’ll understand the fact that you can have anesthesia and be completely awake and alert throughout a procedure.
The reason most people misunderstand this concept is because of the widespread use of “general anesthesia” which is commonly performed in hospital settings to turn off all the nerves in your body for major surgical procedures. General anesthesia is rarely performed for dental procedures. In general, only certified anesthesiologists (a medical specialist) perform general anesthesia. There are rare cases when a patient’s complex medical problems require coordination with an anesthesiologist and a hospital setting to perform their necessary dental treatment.
Dentists often provide different options for sedation to enable patients to sleep through dental procedures, so these are the options we will discuss in this article. Sedation involves a reduced awareness of sights, sounds and most other sensations during the procedure. Almost all patients fall asleep when sedated. The sedative medications typically produce an amnesia-like effect so that even if you seem to be relatively alert or awake during a procedure, you are unlikely to remember any of it afterward!
Necessity of Local Anesthesia for All Extractions
In a sense, all extraction patients receive anesthesia. Dentists always use local anesthesia to prevent feeling and pain during the removal of a tooth. Local anesthetic is the injection of medication into a small area near the surgical site that provides numbness to a limited or “localized” area. This temporary effect lasts for one to eight hours, depending on the type of medication used.
Different people can metabolize local anesthetic differently, so some people may feel extremely numb for multiple hours while others feel only light numbness for a short period of time. The goal is to eliminate any pain or discomfort during the procedure itself. Your dentist will adjust the local anesthetic dosage as needed to keep you comfortable throughout the extraction process.
Different Types of Sedation
While many patients opt for local anesthetic only for a tooth extraction, others want to experience much less of the procedure by having sedation. In dentistry, there are three common types of sedative options.
- Nitrous Oxide (Laughing Gas)
Nitrous oxide, commonly referred to as laughing gas, is an inhaled gas used to reduce anxiety and produce relaxation in nervous patients. Technically, nitrous oxide is not a sedative. Its classification is “anxiolytic”, meaning it removes anxiety. It earned the term “laughing gas” because people often relax and find everything funny as they breath the gas.
Nitrous oxide is a safe alternative to sedation because it does not have any of the negative side effects of sedation that suppress breathing. The only potential negative side effect of nitrous oxide is nausea and/or vomiting, so we advise our patients to not eat within two hours of their appointment time.
Most patients who breathe laughing gas experience a reduced anxiety level such that, they are still aware of what is going on, but they do not worry about it. Nitrous oxide is safe for children and provides the added benefit of making the patient feel like the appointment is very short in length.
There are very few contraindications to nitrous oxide, so ask your dentist if it is an option to reduce your anxiety about an upcoming tooth extraction.
- Oral Sedation
Oral sedation uses an oral medication (a tablet or pill) at a specific time before your dental appointment to produce sedation. Patients do typically fall asleep after taking these medications and remain asleep throughout their dental procedures. Oral sedation falls under the classification of “conscious sedation” because while the patient is asleep, he or she is still capable of responding to instructions, walking, speaking, etc . . .
Dentists use various medications for oral sedation, and providing your dentist with a thorough medical history will help him or her choose the right medication for your sedation appointment.
Oral sedation has a slightly higher risk than nitrous oxide because all sedative medications depress the body’s natural breathing reflex. This is why dentists who provide oral sedation follow strict protocols on dosing the medication and monitor your vitals throughout the entire procedure.
The effect of oral sedation is less predictable than IV sedation because of the various metabolic processes the drug undergoes in the body. Different people may experience vastly different levels of sleepiness with the same dosage of a medication.
- Intravenous (IV) Sedation
Most people are familiar with the concept of IV sedation when it comes to the removal of all four wisdom teeth. Dentists and oral surgeons also use it as another sedation option for anxious patients with multiple dental procedures.
IV sedation is actually safer than oral sedation because the administrator is able to titrate, or adjust, the level of sedation throughout the procedure to keep patients as comfortable as possible. While IV sedation is typically more expensive that oral sedation, it produces more predictable results, so we often recommend this for our most anxious patients who want to remember nothing from their dental appointment.
Intravenous sedation requires the provider to carry a higher level of certification with more strict requirements for patient monitoring and office equipment. This all ensures your safety!
Interested in Anesthesia for a Tooth Extraction?
Call your nearest Premier Dental of Ohio location today to schedule a consultation. We will assess your specific situation and discuss all of your options for sedation during a dental procedure.