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. Dr. Roksar works with board certified anesthesiologist (medical doctor, MD) for any I.V. Sedation or anesthesia.
The following table illustrates the choices of anesthesia, a description of the anesthetic technique, and the usual indications for that technique.
| Method of Anesthesia | Description of Technique | Usual Indications |
| Local Anesthetic | The patient remains totally conscious throughout the procedure. A local anesthetic (e.g. lidocaine) is administered in the area where the procedure is to be performed. Local anesthetic is used in conjunction with the other methods of anesthesia in all oral surgery procedures. | Simple dental and oral surgery procedures such as dental fillings, root canal, gum treatment and minor soft tissue procedures, and basic tooth extractions. Patients may elect to have wisdom teeth removed with local anesthetic. |
| Nitrous Oxide Sedation with Local Anesthetic | 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. | Simple dental procedure and oral surgery procedures to more involved procedures such as removal of wisdom teeth and placement of dental implants. |
| Office Based Intravenous Anesthesia with Local Anesthetic* | 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. | Intravenous anesthesia includes I.V. sedation and general anesthesia for all types of oral surgery. A patient may choose intravenous 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 intravenous anesthesia. General anesthesia and/or I.V. sedation 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. |
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 procedure, please do not hesitate to discuss your concerns with your doctor at the time of your consultation.
Intravenous Sedation or Dental Intravenous Anesthesia or to some it is referred to as “Twilight Sedation” for their dental treatment. Intravenous Sedation or “twilight sleep” helps you to be comfortable and calm when undergoing dental procedures. Your treatment can be completed under intravenous sedation. Intravenous sedation or “IV sedation” (twilight 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. 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 option of intravenous sedation, your IV sedation/anesthesia is administered and monitored by the anesthesiologist, therefore eliminating the costly expense of having your treatment carried out in an operating room or same day surgical facility. Please make sure that you have someone to drive you back home after an IV Sedation procedure.
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. Once again, some patients may be asleep while others will slip in and out of sleep. Some patients with medical conditions and/or on specific drug regimens may only be lightly sedated and may not sleep at all.
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. Along with IV sedation, there are also other different “levels” of sedation available to you in our office. There is nitrous oxide analgesia.
As we age, our oral health becomes more important than ever. Periodontal disease can lead to bone and tooth loss, which affects nearly every part of our daily lives. To lead full and active lives, we need our teeth and gums. They allow us to enjoy food, support speech and good conversation, and facilitate digestion. Your Oral Surgeon is dedicated to treating elderly patients with care and commitment to comfort and health.
Elderly patients as a group tend to avoid dental visits for a variety of reasons, including: more pressing medical concerns, anxiety about treatment, the hardship of transportation, or fixed incomes. Once their oral health has reached an unmanageable point, fear and embarrassment further keep these patients away from the dentist.
For elderly patients embarrassed or fearful of their current oral state, sedation dentistry provides the opportunity for your Oral Surgeon to treat these conditions while the patient remains relaxed and unaware until “awaking” to an improved oral state!
Dental phobia is a real, often overwhelming reality for millions of people. Negative previous dental experiences, fear of needles or drills, and severe gag refluxes are just some of the reasons people feel extreme anxiety when thinking about visiting the dentist.
If you suffer from dental phobia, speak to Dr. Roksar. He is committed to understanding the very real nature of your fears. Not only will our staff treat you with delicacy and care, but IV sedation will allow you to experience dentistry in a whole new way. While engaging in a pleasant sleeplike experience.
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. 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
Reasons to not use Nitrous Oxide
Though there are no major contraindications to using nitrous oxide, you may not want to use it if you are pregnant or have emphysema, exotic chest problems, M.S., a cold, or other difficulties with breathing.
Sedation dentistry offers patients with general anxiety or fears about a dental procedure the opportunity to have a more comfortable and stress-free experience. By utilizing safe and controlled sedation techniques, the patient is eased into a state of complete relaxation before the procedure. This approach eliminates discomfort, pain, and preoperative anxiety, and typically makes patients feel more at ease post-operatively, as they have little or no memory of the actual moment-to-moment procedure.
Local anesthesia involves an injection directly into or close to the area where a procedure is being performed. While it eliminates any sensation of pain in the targeted area, it does not affect your state of mind or level of anxiety. When a patient receives sedation, additional medications to ease anxiety and promote relaxation are employed in advance of local anesthesia. In this way, both the stress and discomfort associated with a procedure are eliminated. Sedation can be administered in a variety of forms based upon patient needs and the recommendations of the dentist or dental anesthesiologist.
Choosing the most appropriate method of sedation for a procedure depends on a variety of factors such as a patient's medical history and their level of anxiety. Dental sedation can come in the form of nitrous oxide sedation, oral conscious sedation, and IV sedation. Certain patients receiving comprehensive treatment or undergoing a complex surgical procedure may require general anesthesia in a hospital setting.
Nitrous oxide, or "laughing gas," is a mild sedative, which is inhaled through a small mask over the nose. A standard in dental sedation for decades, the effects of nitrous oxide are almost immediate and wear off quickly once your procedure is completed.
Oral sedation involves the prescription of an oral medication prior to your appointment. Taken at the recommended time before your visit, oral sedation allows you to feel fully relaxed by the time you're ready for your procedure. With oral sedation, it's necessary to plan on having an escort to and from your dentist's office.
IV Sedation is administered intravenously, or directly into a vein. It is typically indicated when a deeper state of sedation is required. Your dentist will provide you with specific instructions before your visit, and require that you have an escort for the trip home from your appointment.
