Sedation Options in Oral Surgery: Which One is Right for You?

Dr. Lieblick: You're listening to Oral Surgery Insights. I'm Dr. Russ Lieblick, and it's a pleasure to have Dr. Brandon Rehrer with me again. Brandon, one of the areas where we can make a profound difference in a patient’s experience, and a subject patients are always keen to understand better, is how we manage comfort and anxiety during surgical procedures. The range of sedation options we can offer is quite central to that.

Dr. Rehrer: That’s a key conversation to have, Russ, no doubt about it. The idea of any surgery can understandably make people feel a bit uneasy, and oral surgery is certainly no different. Helping patients understand the different ways we can ensure their comfort and safety not only eases their worries but also helps us do the needed treatments more effectively. The progress in this area has been really big, letting us make the experience just right for each person.

Dr. Lieblick: Exactly. A lot of people have real fears or anxieties about dental or surgical experiences, and just acknowledging those feelings is a good first step. Our main goal, besides doing the surgery successfully, is to make sure each patient feels safe, understood, and as comfortable as possible through their whole time with us. Luckily, modern oral and maxillofacial surgery has a good range of ways to provide sedation to help achieve that.

Dr. Rehrer: It’s very different from what was around decades ago. We now have a good variety of choices, which allows for an approach that’s just right for each patient, looking at their health, the type of procedure, and how worried they might feel personally.

Dr. Lieblick: Maybe we can start by going over the different levels of sedation often used in our practice. At the most basic level, and often used together with other methods, is local anesthesia. This doesn't make the patient sleepy in terms of their awareness, but it’s key for numbing the specific surgical area, stopping any feeling of pain during the procedure.

Dr. Rehrer: Local anesthesia is really the main way to control pain for almost all oral surgical procedures. It means giving an anesthetic directly to the area being treated, basically stopping nerve signals. For very minor procedures on calm patients, it might be all that’s needed. But for most of what we do, it numbs the spot, while other methods help with any worry or general awareness.

Dr. Lieblick: Looking at other options for sedation, we have what’s called minimal sedation, often done with nitrous oxide, which most people know as "laughing gas." This is a gas mixed with oxygen that patients breathe through a comfortable nose mask. Patients stay awake and can respond, but usually feel very relaxed, maybe a bit happy or lightheaded, and not so aware of what’s going on around them or how much time is passing.

Dr. Rehrer: Nitrous oxide starts working quickly and, importantly, wears off very quickly too. Once the gas is stopped, the effects usually go away within minutes. This means patients, in most cases, can drive themselves home. It's a great choice for people with mild to moderate anxiety who are having shorter procedures, and it’s also very effective and safe for children.

Dr. Lieblick: For patients who need a bit more help relaxing than nitrous oxide gives, or maybe for those with a fear of needles that might make putting in an IV a bit tricky at first, oral conscious sedation is another good option. This means we prescribe a sedative pill, usually a type of benzodiazepine, for the patient to take by mouth a little while before their appointment.

Dr. Rehrer: With oral sedation, the patient gets quite sleepy and very relaxed. They are still awake enough to breathe on their own and respond when we talk to them, but their worry is much less. Many patients find they don’t remember much, if anything, about the procedure itself, which can be a big plus for those with a strong fear of dental work. Someone definitely needs to drive them to and from the appointment, as their coordination and thinking won't be clear for several hours.

Dr. Lieblick: Then we move into the area of deeper sedation, usually done by giving sedative and pain-relieving medications through an intravenous line, or IV. This is a very good and flexible method that we use a lot for many different procedures, from wisdom tooth extractions to dental implant placement and more involved surgeries.

Dr. Rehrer: IV sedation lets us have very precise control over the level of sedation. We can give the medications slowly right into the vein, so they work fast to get the right effect, and we can keep it steady throughout the procedure. Patients usually get very relaxed, often described as a twilight sleep. They are technically awake enough to respond if needed, but are extremely comfortable and usually have little or no memory of the surgery. This method also works really well for things like a strong gag reflex.

Dr. Lieblick: And finally, there's general anesthesia, where the patient is completely asleep and unaware, and we manage their breathing for them. In the office setting for oral and maxillofacial surgery, this is typically a form of deep IV sedation that makes the patient completely unconscious, rather than the gas-based general anesthesia one might get in a hospital operating room for major body surgery. It’s usually kept for the biggest procedures, very long appointments, or for patients with extreme anxiety or certain medical reasons that call for this level of care.

Dr. Rehrer: No matter how deep the sedation is with IV techniques or general anesthesia, watching the patient's body signs very carefully all the time by a well-trained team, including the surgeon who is also trained in anesthesia, is something we always do.

Dr. Lieblick: Choosing the best sedation option is a process that’s different for everyone. It’s a decision we make together with the patient, after a careful check-up and a good talk. A few important things help us decide.

Dr. Rehrer: First off, and most importantly, is the patient's overall medical history and current health. We carefully look at their general health conditions, any medications they take, allergies, and any past experiences with anesthesia. Certain medical conditions might make one type of sedation a better fit or perhaps rule out another. We also check their American Society of Anesthesiologists, or ASA score, which helps us understand their overall health risk.

Dr. Lieblick: The type of procedure, how complex it is, and how long we think it will take are also big things to think about. A quick, simple procedure might be fine with just local anesthesia and maybe some nitrous oxide. But multiple extractions, complex implant placements, or bone grafting procedures that take longer and are more involved often turn out better for the patient with the deeper relaxation and not remembering much that you get from IV sedation or general anesthesia.

Dr. Rehrer: And, of course, how anxious the patient feels and their personal preferences are critically important. Some people, even with a relatively simple procedure, have a real fear of dental work and would much rather not be aware of what's happening. Others might be okay with just a little help relaxing. Our job is to understand their concerns and offer choices that fit what makes them comfortable, while always making sure everything is safe.

Dr. Lieblick: Talking openly here is so important. We encourage patients to be open about their fears and past experiences. The goal is to make sure we both understand each other and pick a sedation plan that helps them feel safe and calm, so they can get the care they need without too much stress.

Dr. Rehrer: Behind everything we do with sedation is a strong promise to keep patients safe. This is the most important thing in every procedure we perform at Beacon Oral Surgery, and it involves an approach with many parts.

Dr. Lieblick: It starts well before the day of surgery with that careful check-up we talked about. This includes not just looking over their medical history, but also a physical check-up, focusing on their airway, vital signs, and making sure the patient is a good candidate for the planned sedation in our office. Clear instructions before surgery, especially about not eating or drinking – what we call NPO guidelines – before IV sedation or general anesthesia, are also really important for safety.

Dr. Rehrer: During the procedure itself, when any kind of sedation beyond local anesthesia is used, always watching the patient's body signs very closely is a must. Our surgery rooms have advanced machines that keep track of heart rate and rhythm with an EKG, blood pressure, oxygen levels using a pulse oximeter, breathing rate, and often end-tidal carbon dioxide to check their breathing.

Dr. Lieblick: The surgeon, who is also trained to provide anesthesia, along with a well-trained surgical team, carefully watches the patient and these monitors throughout the whole procedure. This lets us quickly see and handle any possible changes in the patient's condition. Our team members are all certified in Basic Life Support, and we keep up our Advanced Cardiac Life Support certification, and some of us also have Pediatric Advanced Life Support if we treat children.

Dr. Rehrer: Being ready for emergencies is also a key part of safety. Our offices have all the emergency medicines and equipment needed, and our entire team practices regularly to handle any medical emergencies well and as a team. These safety steps are followed for every patient, no matter how simple the procedure might seem.

Dr. Lieblick: After the surgery and sedation, patients are watched carefully in a recovery room by our trained staff until they are stable, awake, and ready to go home based on certain checks. We give detailed instructions after surgery, both by talking and in writing, about what to expect, how to handle any soreness, what to eat, what activities to do, and signs of possible problems. Someone always needs to take them home after oral sedation, IV sedation, or general anesthesia, as they won't be able to drive or do things on their own for a while.

Dr. Rehrer: This complete cycle of care – from checking things before surgery, to monitoring during, and careful management after – makes for a strong safety system that lets us offer these helpful sedation services confidently.

Dr. Lieblick: In the end, why we offer different sedation choices is to make sure every patient can get the oral surgery they need in a way that feels safe, supportive, and as calm as possible. No one should have to avoid needed treatment because of fear or anxiety.

Dr. Rehrer: Being able to adjust the anesthesia and sedation for each person lets us handle many different patient needs and types of surgery. New methods and careful safety rules have made sedation in the office very dependable when done by well-trained oral and maxillofacial surgeons.

Dr. Lieblick: We always encourage people to talk openly with us. If a patient has worries or questions about sedation, we want them to feel comfortable discussing those. Understanding their choices and knowing that their well-being is most important to us can really help them feel better.

Dr. Rehrer: So, to sum up, we have a good range of choices, from local anesthesia for basic numbing, to nitrous oxide for light relaxation, oral sedation for moderate anxiety, and IV sedation or office-based general anesthesia to help patients be more comfortable and relaxed during bigger procedures.

Dr. Lieblick: The choice is always made for each person, based on a thorough medical check-up, the type of surgery, and importantly, the patient's own comfort level and preferences. And through every step, careful attention to safety rules, always watching the patient, and a well-trained team make sure we give the best care. Thank you for joining us on Oral Surgery Insights.

Dr. Rehrer: We appreciate you spending your time with us and hope this conversation has provided some helpful and clear information about sedation.

Dr. Lieblick: We wish you good health.