There are various reasons for your dentist to advise removal of your wisdom teeth such as infection, less jaw space, decay, etc. Nowadays wisdom tooth extraction has become a very painless and simple procedure.
Let us understand the various types of anesthesia options available such as sedation anesthesia, local anesthesia, general anesthesia, etc.
To ensure that you don’t feel anxious while undergoing extraction, your dentist will tell you about the anesthesia options available. Later, you can decide the convenient option that could benefit you.
Different anesthesia options
The anesthesia options during extractions include
Local anesthesia (LA)
Local anesthesia numbs the area of the body using a local anesthetic (lignocaine). Local anesthesia is the most commonly used mean of anesthesia while extraction of teeth.
Unlike general anesthesia, local anesthesia doesn’t require any special preparation before surgery, and also a person recovers with almost zero side effects after the effect of anesthesia wears off. Also, you don’t lose your consciousness.
After administration of local anesthesia, while extraction you will not feel pain but you may feel the pressure on your jaw bone while the dentist is pulling out your tooth.
During wisdom tooth extraction, the dentist gives a nerve block to numb the nerves which supply the particular tooth. Local anesthesia takes about 5 minutes to be effective.
There usually aren’t any major side effects, but LA also numbs the tongue and lips (in the case of lower wisdom teeth). In such cases, patients may end up biting their tongue or lips which can cause an ulcer. Allergic reaction to any constituent of LA is rare.
Terms like twilight sedation and moderate sedation are also used to describe conscious sedation. In this procedure, the patient remains conscious, and medication aims to reduce the anxiety level of patient and calm him. (2)
Ways to administer medication are oral, inhaled and intravenous. When the patient is very anxious and also when the procedure may require more time than usual, it is better to use a combination of LA and conscious sedation.
In either of these cases, conscious sedation can help calm the patient. Let us discuss the various conscious sedation techniques –
In this method, the patient breathes in a mixture of nitrous oxide (aka laughing gas) and oxygen via a mask. The oxygen concentration is usually between 25-40%.
The onset of nitrous oxide is quick and takes about 2-5 minutes while disappears once the patient stops inhaling the gas.
In this method, the dentist can adjust the level of sedation by altering the rate of flow of gas. Oral inhalation is the only technique in which the level of sedation can be changed by merely twisting the knob.
- The dentist cannot administer nitrous oxide to anybody who has just had a meal, and you will be made aware of any other specific precaution by your dentist before the procedure.
- The only difficulty of this procedure is patient has to inhale through his nose the entire time since if the gas reaches the lungs through the mouth, its concentration is diluted thus reducing sedation level.
2. Oral sedation
When you swallow sedative medicines (pill or liquids) orally, then the method is called oral sedation. Valium is a commonly used drug for oral sedation during wisdom tooth extraction.
All sedative medicines are prescription medicines and not available as over the counter drugs.
- You need to take the first dose before going to bed the previous night to help get a good night’s sleep.
- You need to take the second dose an hour before your appointment and onset of the drug take half an hour to sixty minutes. So make sure somebody accompanies you to the clinic and back home.
- Cost of oral sedation medication is very less, and a person doesn’t need any special equipment either.
- The dosage of medication depends on body weight hence it is not possible for the dentist to know if the effect will meet the optimum requirement. The dentist uses a combination of inhalation sedation and oral sedation if oral sedation alone fails to work. Unlike inhalation sedation, the dosage in case of oral sedation can’t be adjusted.
- The withdrawal takes a longer time, so you should make sure that someone stays by your side during the recovery period.
3. Intravenous (IV) sedation
IV sedation induces a state of relaxation and shouldn’t be confused with general anesthesia. In IV sedation the muscle function normally and you do not need a machine to perform respiration on your behalf.
Along with sedation medicines, dentists can also administer anti-swelling, anti-nausea medication and antibiotics using the IV channel.
When compared with patients who have their extraction performed under LA, these patients experience less pain and less swelling.
- Excess weight, heart problems, diabetes can increase risk, but otherwise, IV sedation is very safe and adverse events are rare. Make sure you do not hide any health complication you have to avoid complications (even if it is something as common as fever or cold).
- You will need someone to take you to the clinic and bring you back. Also, do not eat or drink anything 6 hours before surgery.
- Do not drive a car or operate any machinery for 24 hours after the wisdom tooth extraction.
- The drugs used for IV sedation are usually lorazepam, diazepam, propofol, midazolam, etc. the choice of medication depends on what the dentist deems to be fit for the patient. All the drugs vary in their duration of anesthetic effect.
Over to you
Discuss all the anesthesia options in detail with your dentist and keep in minds that even if you opt for sedation anesthesia, you will still need a dose of local anesthesia to numb the extraction site.