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Anesthesia used in Dentistry– Part 2: Advanced Anesthesia

Previously we discussed some basic forms of anesthesia used daily in the field of dentistry that can be safely administered by most dental professionals.  This blog will discuss some more advanced forms of anesthesia that should only be performed by professionals who have undergone advanced training in these techniques, such as an oral and maxillofacial surgeon.  Oral surgeons are among “the recognized leaders among the nation’s dental and medical professionals for the delivery of safe and effective outpatient anesthesia”.  In addition, the American Association of Oral and Maxillofacial Surgeons, continues to be consulted by other medical and dental specialties, accrediting agencies and regulatory bodies regarding standards in anesthetic safety1.

Whether these advanced techniques are performed in an office setting or in a hospital, advanced patient monitoring beyond what is found with basic anesthesia techniques is performed to further ensure patient safety.

IV or Deep Sedation:  This is an advanced technique done to control moderate to severe anxiety.  As the name implies, an intravenous catheter (IV) is needed to perform this technique. The IV is usually placed in the arm or hand, after some form of topical anesthesia  is applied to make the placement easier with usually little to no discomfort to the patient.    Once the IV has been placed, the doctor can give the drugs in small quantities until just the right level of sedation is achieved.  This process is called titration, and the ability to titrate medication helps to make this form of anesthesia very safe.    In combination with local anesthesia, IV sedation can be appropriate for a variety of procedures from the super simple to very complex.  This includes tooth extraction, wisdom teeth removal, dental implants and minor surgery of the bones and soft tissues of the face.   The goal of the IV sedation is provide a level of sedation to control all anxiety in a safe manner appropriate for an outpatient or non-operating room setting.

General Anesthesia:  This is done when IV sedation and local anesthesia are not adequate to control a patient’s pain and anxiety.  A general anesthesia gets it’s named, because it provides a level of anesthesia to block pain anywhere in the body, at any level of complexity.  In order to provide this level of anesthesia, a patient often requires help in maintaining basic functions of the body such as breathing or maintaining basic protective reflexes (coughing).  A breathing tube (endotracheal tube) is often necessary to accomplish this, although the breathing tube is typically removed once the patient no longer requires this level of anesthesia.  General Anesthesia (GA) is typically reserved for major surgery, such as open TMJ surgery, corrective jaw surgery as well as cases that involve extensive pathology or require significant hard and soft tissue grafting.

The next blog in this series will discuss what a patient will need to prepare for the level of anesthesia planned to be used for their procedure.