A patient does not have to be under anesthesia to have their wisdom teeth removed. General anesthesia s usually reserved for people who are really terrified of the procedure, for children, for patients who are having more than one dental procedure done at a time or who have pre-existing conditions such as heart disease.
Most patients are given enough anesthesia to kill the pain of the operation while keeping them awake and aware enough to follow the dentist’s instructions. Here are some techniques used by oral surgeons:
This anesthetic is given via injection near the tooth that is to be operated on. The gum is painted with a numbing agent first so the patient does not feel the entry of the needle.
Novocaine temporarily blocks pain signals from the nerves and is the only type of non-general anesthesia that completely or mostly kills the pain when it is used by itself. The patient can feel what the dentist is doing, but they are pain free. Novocaine can be used with other pain relief drugs.
This is nitrous oxide, or N2O mixed with oxygen. Dentists administer it by placing a mask over the patient’s nose and encouraging them to breathe it in. Though laughing gas won’t eliminate the pain completely the way novocaine will, it is valued by dentists because it very inexpensive and short acting.
It doesn’t bind with the hemoglobin in the blood and is fat soluble. The body eliminates it very soon after the supply is cut off. Among other things, this means that the patient does not need someone to take them home after their treatment.
Laughing gas is also safe enough to be used by most patients, including pregnant women and young children. The patient can also control how much they take in to some extent.
All they have to do is deepen their breathing to get more of the gas into their system or breathe through their mouth to take in less. Nitrous oxide produces euphoria and can make patients giggle, though scientists don’t really know why.
Types of Sedation
Sometimes a doctor prescribes a sedative for the patient to take even before they come in for their wisdom tooth surgery. These sedatives include Ativan, Halcion and Valium. Like nitrous oxide, these sedates are very inexpensive, but they take a bit of time to clear from the body.
Because of this, the patient will need someone to take them to the office then take them back home after the procedure is over. Another drawback to this type of pre-medication is that the effects differ from one patient to the next.
In some patients, a Valium an hour or so before the operation eases their anxiety. In another patient, the Valium does not substantially ease their anxiety over the coming operation. Some dentists specialize in giving oral sedation to children. The amount given depends on the weight and age of the child.
This is also called “twilight sleep,” though it is not sleep, and the patient remains awake. It can be deep enough to put the patient to sleep, but it is easy to wake them up. Some dentists believe IV sedation is the best way to ease a patient’s anxiety and their awareness during an operation.
It is good for patients who can’t tolerate too much pain or have sensitive teeth. It’s also for people who fidget in the dentist’s chair or who are undergoing more than one procedure at the same time. The dentist administers a sedative through an intravenous line.
Though the patient is awake during the procedure, chances are they won’t remember it after it’s over. They wait in a recovery room after the procedure and will need someone to drive them home when they are ready to leave the dentist’s office or hospital.
About General Anesthesia
General anesthesia can either be given in the doctor’s office or in a hospital. During general anesthesia, the patient is fitted with a mask to breathe in an anesthetic and be given an IV line. They then fall asleep.
This requires a surgical team to monitor the patient’s bodily signs, including their temperature and blood pressure. Medications include fentanyl, ketamine or benzodiazepine, and the patient receives oxygen through a nasal tube.
They do not feel pain and won’t remember the operation at all. As with IV sedation, the patient is removed to a recovery room after the operation so that they can be monitored for a while.
Dr. Marissa Crandall Cruz earned her Doctor of Dental Medicine Degree from Nova Southeastern University, Fort Lauderdale, Florida and received a Master’s degree in oral biology from the Kornberg School of Dentistry at Temple University. She is now an expert in periodontal plastic surgery and a Diplomate of the International Congress of Oral Implantologists.
Dr. Mana Nejadi received her dental degree from the University of Pennsylvania School Of Dental Medicine and specialized in periodontics, implant dentistry and esthetics at the same institution. Between 2013 and 2015 she was the Director of the Predoctoral Periodontics program at the University of Pennsylvania.
Both Dr. Nejadi and Dr. Crandall Cruz now practice at King of Prussia Periodontics & Dental Implants. Read more about both dentists at https://www.kopperio.com/about-us.
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