Patients come to see me with differing levels of anxiety and we figure out what level of sedation is best for them. As an Oral and Maxillofacial Surgeon, I have been trained to provide all levels of in-office sedation. During my residency training, I spent 6 months working with the General Anesthesia department at UT Health – San Antonio. The Anesthesia faculty trained me to provide a high level of anesthetic care for hundreds of oral and general surgeries as well as train me to handle any medical emergencies that may arise. As a lifelong learner, I continue to regularly attend continuing education course in sedation and anesthesia to better care for my patients. If we decide to proceed with sedation, the options I can provide are below.
Moderate and Deep IV Sedation
Intravenous sedation (IV) is the most reliable way to treat our anxious patients. Since medication is given intravenously, effects are seen within minutes and dosing can be adjusted accordingly. The level of sedation that can be offered with IV sedation can range from moderate to deep. With moderate sedation, you will be awake and be able respond to questions asked by your provider. However, it is unlikely you will remember your procedure as one of the medications used causes intraoperative amnesia. A disadvantage of moderate sedation is the types of medications used are limited and high doses of one or two medication must be administered to achieve higher levels of sedation. Not all patients desire to be deeply sedated, so moderate sedation may be a good choice for you.
With deep sedation, your level of consciousness is depressed but you will respond to stimulation and continue to breathe on your own. Often smaller doses of a combination of medications can be used to achieve deep sedation. Since smaller doses are used, the side effects of the medications can be minimized and recovery time from anesthesia is often quicker. Similar to moderate sedation, it is unlikely you will remember your surgery. Only Oral Surgeons and Dental Anesthesiologists are able to provide deep sedation in the dental setting.
Your safety during IV sedation, is very important to us. Your medical history will reviewed with you to ensure you are a good candidate for IV sedation. During your surgery, your vital signs (heart rate, blood pressure, respiration) will be continuously monitored by myself and my assistants. On the day of your surgery, you will need to keep an empty stomach – nothing to eat for 8 hours before your surgery and clear liquids (i.e. water, Gatorade) are okay to drink up to 3 hours before your surgery. You should take any medications your normally take as well as any prescribed premedications at the requested times with 2 ounces of water. You will be required to have a family member or friend accompany you to and from your procedure since you will be ill-equipped to drive for some time afterward. It is also suggested that you have your schedule free for the day and not to engage in any important activities following your procedure. Make sure to get home as soon as possible and rest for the remainder of the day!
Oral Conscious Sedation
Oral conscious sedation is a mild to moderate level of sedation where an IV is not required. A sedative medication is taken by mouth approximately one hour before your treatment. By the time your treatment starts, you will feel much more relaxed and competent to get the dental care that you require. You are generally awake, but relaxed, for the entire procedure. Oral conscious sedation is a great option for anxious patients that want to avoid being intravenously sedated. I may also recommend this if I believe we will have difficulty starting in IV for you. The sedatives will continue to have mild effects for a few hours after your surgery. You will need a family member or friend bring you to and from your oral surgery appointment. You should also avoid any opioid pain medication in the immediate post-operative period.
Local anesthetic is required for all surgical procedures, regardless of whether sedation is provided. Local anesthetic “numbs” the area that we are working on. You will feel pressure at the surgical site, but should not feel sharp pain. While pain medication is provided intravenously during IV sedation, it does not adequately provide enough pain control by itself. However sedation is an excellent adjunct to local anesthesia and makes the surgical experience more comfortable. If you decide to have local anesthesia without sedation, please keep in my mind that you will be awake and aware during your entire procedure.
Regardless of which option you decide for your treatment, we strive to take excellent care of you. Visits to the dentist’s office can be anxious for anyone at any age. For you to have a successful and pleasant sedation experience you need to have a compassionate and caring dentist. My goal is to make all your visits enjoyable and equally effective and I am proud to say that hundreds of my patients have testified to that.