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The ability to provide mild sedation, moderation sedation, or even general anesthesia in an outpatient dental office increases access to care for an increasingly diverse patient population. While a majority of the population can still receive routine dental care under local anesthesia, the growing complexity and length of certain dental procedures may warrant the use of a more sophisticated level of anesthesia and analgesia.

 

Historically, the high costs associated with providing dental care in an operating room setting at a hospital precluded the use of advanced techniques in anesthesia for dentistry. Dentist anesthesiologists now bring what is currently an unsurpassed level of safe sedation and general anesthesia directly to a dental office at a lower cost. This eliminates the need to bring a large amount of dental equipment to the hospital and to perform the procedure on an uncomfortable operating room table as opposed to a dental chair in the comfort of one’s own office. With extensive knowledge in both dentistry and anesthesiology, dentist anesthesiologists can specifically tailor the level of anesthesia to meet the needs of both the patient and the dentist. For example, certain steps in dental-surgical procedures require varying degrees of patient cooperation, such as checking occlusion, taking impressions requiring soft tissue border molding, or taking a bite registration. A dentist anesthesiologist can anticipate these needs and adjust the depth of anesthesia accordingly throughout the different stages of treatment, allowing for a seamless operative experience. Improved efficiency translates into the ability to complete a treatment plan that would normally take multiple appointments in fewer or even a single appointment.

TYPES OF ANESTHESIA

Type of anesthesia will depend of various factors including patient’s health history and physical examination, the type of procedures being performed, and the length of procedures.  Our anesthesia services can range from IV moderate sedation to general anesthesia.  A variety of airway techniques may be utilized.

Definitions taken from ADA guidelines:

Moderate/Conscious Sedation

Moderate/Conscious Sedation

A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.

Note: In accord with this particular definition, the drugs and/or techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely. Repeated dosing of an agent before the effects of previous dosing can be fully appreciated may result in a greater alteration of the state of consciousness than is the intent of the dentist. Further, a patient whose only response is reflex withdrawal from a painful stimulus is not considered to be in a state of moderate sedation.

The following definition applies to the administration of moderate or greater sedation: titration – administration of incremental doses of a drug until a desired effect is reached. Knowledge of each drug’s time of onset, peak response and duration of action is essential to avoid over sedation. Although the concept of titration of a drug to effect is critical for patient safety, when the intent is moderate sedation one must know whether the previous dose has taken full effect before administering an additional drug increment.

Deep Sedation

Deep Sedation

A drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.

GENERAL ANESTHESIA

General Anesthesia

A drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug induced depression of neuromuscular function. Cardiovascular function may be impaired. Because sedation and general anesthesia are a continuum, it is not always possible to predict how an individual patient will respond. Hence, practitioners intending to produce a given level of sedation should be able to diagnose and manage the physiologic consequences (rescue) for patients whose level of sedation becomes deeper than initially intended.

WHAT TO EXPECT

Our anesthesiologists will arrive 30 minutes to 1 hour prior to the appointment to set up the operatory with the required equipment. A preoperative assessment and evaluation will be completed to review the medical history, focused physical examination, NPO status, and anesthetic plan. Once the patient is ready for treatment, the anesthesiologist will begin administering medications and the dentist will be able to begin treatment shortly thereafter. Upon completion, the patient will be recovered by the anesthesiologist and subsequently discharged when the patient demonstrates adequate recovery.

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Coordination Of Care

You can begin coordinating patient appointments with any of our dentist anesthesiologists
with one phone call to our office at (972) 536-3972

(972) 536-3972
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