Anesthesia

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.

Indications for Anesthesia

  • Fear or anxiety associated with dental treatment
  • For patients who have cognitive impairment or motor dysfunction that prevents adequate dental treatment
  • Patients below the age of reason
  • Surgical Procedures that are deemed to be invasive in which anesthesia would make the experience more comfortable for the patient and be completed more smoothly and efficiently.

Anesthesia Options

IV Sedation and general anesthesia are produced along a continuum, ranging from the relief of anxiety with little or no associated drowsiness (i.e. minimal sedation), up to and including a state of unconsciousness (i.e. general anesthesia). 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

    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.

    Simple oral surgery procedures such as minor soft tissue procedures and simple tooth extractions.

  • Conscious IV Sedation with Local Anesthetic*

    Medications are administered through an intravenous line (I.V.), producing a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain an open airway, and independent breathing is adequate. 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 Glycopyrolate. The sedation agents used in treatment will affect your coordination, memory and judgement. Recovery from conscious 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, conscious sedation cannot be provided. 

    Conscious sedation is available for all types of oral surgery. A patient may choose conscious sedation for simple procedures depending on their level of anxiety. Most people having their wisdom teeth removed or having a dental implant placed will choose a method of IV sedation. 

  • 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 Glycopyrolate. 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. A patient may choose deep sedation if they wish to fall asleep and be completely unaware of the procedure being performed. Deep sedation may be necessary if local anesthesia fails to anesthetize the surgical site which often occurs in the presence of infection.

  • Office Based General Anesthesia with Local Anesthetic*

    Medications are administered through an intravenous line (I.V.) producing a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain independent breathing is often impaired and positive pressure ventilation may be required. Patients usually require assistance in maintaining an open airway. Cardiovascular function may be impaired. 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 Glycopyrolate. The sedation agents used in treatment will affect your coordination, memory and judgement. Recovery from general anethesia  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, general anesthesia cannot be provided. 

    General anesthesia is available for all types of oral surgery. A patient may choose general anesthesia if they wish to fall asleep and be completely unaware of the procedure being performed. General anesthesia may be necessary if local anesthesia fails to anesthetize the surgical site which often occurs in the presence of infection.

  • Hospital or Surgery Center Based General Anesthesia

    A patient is admitted to a hospital or surgery center where anesthesia is administered by an anesthesiologist.

    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.

To administer conscious, deep sedation and/or general anesthesia 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.

Intravenous Sedation (IV Sedation)

Our office offers our patients the option of Intravenous Sedation (conscious, deep or general anesthesia) 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, deep or general anesthesia) 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. 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 

Possible Reasons to Not use IV Sedation

  • No fear or anxiety about the procedure 
  • Head or chest cold present 
  • Pregnancy or chance of pregnancy 
  • Alcohol consumption before procedure 
  • Allergy to benzodiazepine medications 
  • Medical conditions such as severe cardiac or respiratory diseases, sleep apnea, malignant hyperthermia, liver or kidney diseases, diabetes, thyroid and adrenal disorders. Patients with these disorders or anything else in origin should consult with their dentist and/or physician for any proposed sedation treatment.
  • Medications such as high dose steroids and recreational drugs.