A significant number of Americans do not visit the dentist or oral surgeon even when in pain because they are too fearful or suffer from anxiety. Sedation offers an excellent way to provide a safe, anxiety-free, experience to those who are afraid of oral surgery.
Sedation offered by Dr. Gray comes in many forms they include:
Nitrous Oxide
Nitrous oxide, or “laughing gas,” is used as a mild sedative. It is delivered through a nose hood, and is administered throughout the entire procedure. Nitrous oxide elevates the general mood and can evoke a general sense of well-being. Most importantly, it relieves anxiety and reduces pain during the procedure. In addition, some tingling and numbness may be felt. There are few side effects associated with nitrous oxide, and it has been safely used in dentistry for centuries. The effects are felt in as little as 5 mins and leave in around 10 mins. Consequently patients can drive themselves to and from their appointment and resume their normal activities almost immediately after their visit.
Mild Conscious Sedation (IV)
Intravenous sedation requires establishing access to a vein and maintaining a stream of fluid that drugs can be added to to achieve a desired effect in that patient. Mild Conscious sedation generally involves use of 1 or 2 sedative drugs (generally versed and or fentanyl) that are titrated to the specific needs and desired result for a patient's procedure. This may be a single one time dose. Most patients report feeling very relaxed and and comfortable with a loss of recollection of time passing. 2 hrs might seem like 15 mins. Some report feeling like they slept through the entire procedure. However if you were present during the procedure they would respond purposefully to verbal commands, breathe on their own without assistance. Generally, Conscious sedation is used for procedures less than 3 hrs long. Having IV access does allow administration of drugs to assist in recovery. This might include antibiotics to prevent infection, reduce incidence of dry socket. Drugs for long term pain control, reduction in swelling, reduction in nausea potential. Most patients feel sleepy and must have someone to drive them home. Patients are advised to not drive and to clear their schedule for the rest of the day. Generally this is performed on patients who need more anxiety control than nitrous can provide but are fearful of being put completely to sleep or on severely medically compromised patients.
Moderate Conscious Sedation (IV)
Again this variation of Intravenous sedation requires establishing access to a vein and maintaining a stream of fluid that drugs can be added to to achieve a desired effect in that patient. Moderate Conscious sedation generally involves use of 1-2 sedative drugs (generally versed, fentanyl) that are titrated to the specific needs and desired result for a patient's procedure. This may involve repeated doses throughout the procedure. The Goal with this type of sedation is to render recall of the events during the surgery absent. Most patients report feeling very relaxed and and comfortable with an almost universal loss of recollection of time passing. Patients only remember IV being placed and thereafter it is as thought they blinked their eyes and opened them and the procedure was over. If you were present during the procedure they would appear to be sleeping and require tapping their shoulder to illicit a response from them. Often very Groggy and but will respond purposefully to verbal commands, breathe on their own without assistance. Generally, Conscious this flavor of sedation is also used for procedures less than 3 hrs long. Having IV access does allow administration of drugs to assist in recovery. This might include antibiotics to prevent infection and reduce incidence of dry socket. Drugs for long term pain control, reduction in swelling, and reduction in nausea potential. Most patients feel very sleepy and must have someone drive them home. Patients are advised to not drive and to clear their schedule for the rest of the day. Generally this is performed on patients who need significant anxiety control and are very visibly anxious. Generally this is performed only on relatively healthy patients.
Deep Sedation/General Anesthesia (IV)
Again this variation of Intravenous sedation requires establishing access to a vein and maintaining a stream of fluid that drugs can be added to to achieve a desired effect in that patient. Deep Sedation generally involves use of multiple sedative drugs that are titrated to the specific needs and desired result for a patient's procedure. A concept called balanced anesthesia is generally used to employ the beneficial effects of various sedatives but avoiding the major side effects of those agents by using relatively small amounts of those medications to achieved deep sedation. Often Deep sedation is used for short periods of time for especially stimulating procedures (minutes) but can be used for longer periods of time. Medication re-dosing is often done throughout the procedure as needed. The Goal with this type of sedation is to render no response by patient to surgical stimulation and consequently recall of the events during the surgery absent. Most patients report a total loss of recollection of the time they are sedated. Patients only remember IV being placed and thereafter it is as thought they blinked their eyes and opened them and the procedure was over. If you were present during the procedure this patient would not move in response to surgery, shots or awake with physical stimulation. Generally, Deep Sedation is used to get patients through short or stimulating procedures(Draining an abscess, giving local anesthesia). As in other forms of sedation having IV access does allow administration of drugs to assist in recovery. This might include antibiotics to prevent infection and reduce incidence of dry socket. Drugs for long term pain control, reduction in swelling, and reduction in nausea potential. Most patients are very sleepy and must have someone drive them home. Patients are advised to not drive and to clear their schedule for the rest of the day. Generally this is performed on patients who need significant anxiety control and are very visibly anxious. Generally this is performed only on healthy patients.
What types of drugs are used in sedation? here are just a few.
Midazolam- Benzodiazapene, acts very similar on the brain as does alcohol. Reduces anxiety, induces "sleepiness", key to forgetting procedure. Short acting
Fentanyl-Narcotic, pain reliever, induces feeling of euphoria. Short Acting
Dexmetomidine- a new and promising sedative that allows for very constant levels of sedation with fewer side effects than even some of the best current sedation medications.
Propofol- Hypnotic anesthetic. Literally induces "sleep". aka "Michael's milk (Michael Jackson).Received a bad rap. It is a very useful medication, just not for home use without monitoring equipment and constant oversight by an anesthesia provider.
Ketamine-Dissociative anesthetic. Literally chemically(temporarily) disconnects pain nerves from the brain.
Ampicillin/Clindamycin/Unasyn-antibiotic given perioperatively to reduce risk of infection
Dexamethasone-Steroid given to pre-empt swelling from surgery, also helps with nausea
Ketolorac-a strong long lasting NSAID that helps prevent and manage pain
Ondansetron- a drug that prevents Nausea to help patients tolerate narcotic pain pills when they need to take them
Promethazine-a rescue drug given to patients who are prone to or show overt signs of nausea/vomiting
Is Sedation Safe, Will I wake up after my procedure?
Generally sedation is very safe. Dr. Gray takes your safety and health very seriously. Dr. Gray provides hundreds of sedation annually and has extensive experience and expertise in providing IV sedation in an office based setting. He has provided over 200 general anesthetics in a hospital based setting on adults and pediatric patients for procedures ranging from cleft palate repair on infants to 12 hr breast reconstruction cases. Dr. Gray spent over 5 months performing only general anesthesia as an anesthesia resident in his academic training. That aside Dr. Gray encourages and supports a culture of safety in his office by utilizing capnography and other monitoring equipment that are not mandatory in the state of Texas. He additionally submits to peer-reviewed in office inspections voluntarily. Dr. Gray holds current permits in the State of Texas to deliver All levels of Sedation including General Anesthesia. Dr. Gray is concerned 1st and foremost about your safety and if sedation can be employed to help you through your procedure he stands ready to deliver it if you choose to do so. Please do not hesitate to contact our office if you have further questions about this topic.