Most people associate anesthesia for pain control with dentistry, that’s because most of us would not be able to tolerate having a simple filling without some form of anesthesia. But what does that exactly mean? Anesthesia comes in different forms, but all of them make it possible to have even the most complex procedures done free of pain and anxiety. Part 1 of this series pertains to basic types of anesthesia that most dentists have training to safely offer their patients in an office setting.
Local Anesthesia: Local (as it’s known in the biz) is an agent that is used that blocks nerve conduction. Specifically, local is used to keep your brain from receiving pain signals. Humans experience pain for a very good reason. Pain protects us from something that may be harmful to us. In certain situations though (at the dentist) we may want to stop the feeling of pain. Local anesthesia does that for us. Local can be administered topically without a needle, but in most cases in order to be effective, local must be administered around the nerve responsible for sending the pain signal, and to do that an injection is needed. Topical is often used as a precursor to make the injection more tolerable and with the right technique, many patients do not even feel the administration of the local anesthesia. Local administration is generally considered to be safe, but make sure you and your dentist thoroughly review any significant medical history to help keep it that way. Local anesthesia is almost always used, either alone or in conjunction with another form of anesthesia/sedation.
Nitrous Oxide: Nitrous is an inhalational gas that helps to alleviate mild anxiety. For a simple, quick procedure, nitrous is a great option. Nitrous is intended to relax you, not to make you realize that a procedure is going on. As I tell my patients, you are still going to know what’s happening, you just won’t care as much. Nitrous oxide is commonly used in the pediatric population and typically works great. With the adult population, sometimes nitrous is not sufficient and a different form of anxiolytic therapy (something done to stop anxiety) is needed.
Conscious or Oral Sedation: Oral sedation is a therapy used to treat mild to moderate anxiety. Oral sedation typically involves a pill taken by mouth about 1 hour before a planned procedure. Advantages of oral sedation to the patient are that the pill can be taken at home and can be administered at a lower cost than other forms of anesthesia. A major disadvantage of oral sedation is that the pill(s) must be absorbed through the GI tract, and then later processed by other organs such as your liver. This process takes time and there is no way to ensure that you are taking the correct amount. If given too little, then you may not have enough relaxation, but it could take up to an hour to increase the dosage. While it is possible to take too much, fortunately this is a rare occurrence (unless you are taking other medications that may interact with your pill) and if it does occur, the prescribing doctor should have training to administer reversal agents. The goal of this technique is relaxation, not necessarily to have you sleep during your procedure.
In our next blog, I’m going to discuss some deeper forms of anesthesia. These deeper forms of anesthesia are typically offered by oral surgeons who receive a significant amount of advanced training in anesthetic techniques, advanced patient monitoring and advanced medical knowledge.