Several medications are available to help create more relaxed, comfortable dental visits. Some drugs control pain, some help you relax, and others put you into a deep sleep-like state during dental treatment. There are several types of dental anesthesia, and your dentist will make a recommendation based on your medical history, the procedure you will receive, and your preferences.
Working together, you and your dentist can choose the appropriate steps to make your dental visit as safe and comfortable as possible, and to help you keep a healthy smile. Many dental patients have anxiety around dental procedures, especially when they require anesthesia. Concerns about anesthesia are understandable, but understanding the differences between your options can help assuage your anxiety.
What are the types of dental anesthetics?
Anesthesia means a lack or loss of sensation. This can be with or without consciousness. Today there are many options available for dental anesthetics. Medications can be used alone or combined for better effect. It’s individualized for a safe and successful procedure.
The type of anesthetics used also depends on the age of the person, health condition, length of the procedure, and any negative reactions to anesthetics in the past.
Anesthetics work in different ways depending on what’s used. Anesthetics can be short-acting when applied directly to an area or work for longer times when more involved surgery is required.
The success of dental anesthesia depends on:
- the drug
- the area being anesthetized
- the procedure
- individual factors
Other things that may effect dental anesthesia include the timing of the procedure. Researches also shows that inflammation can have a negative impact on the success of anesthetics.
Also, for local anesthesia, teeth in the lower jaw (mandibular) section of the mouth are harder to anesthetize than the upper jaw (maxillary) teeth.
There are three main types of anesthesia: local, sedation, and general. Each has specific uses. These can also be combined with other medications.
Local anesthesia
Local anesthesia is used for simpler procedures like a cavity filling, which requires a shorter time to complete and is generally less complicated. You will be conscious and able to communicate when you get a local anesthetic. The area will be numb, so you won’t feel pain.
Most local anesthetics take effect quickly (within 10 minutes) and last 30 to 60 minutes. Sometimes a vasopressor such as epinephrine is added to the anesthetic to increase its effect and to keep the anesthetic effect from spreading to other areas of the body.
Local anesthetics are available over the counter and as a prescription in gel, ointment, cream, spray, patch, liquid, and injectable forms.
They can be used topically (applied directly to the affected area to numb) or injected into the area to be treated. Sometimes, light sedation is added to local anesthetics to help relax a person.
Sedation
Many people experience anxiety about undergoing dental work or visiting the dentist at all, a fear known as dental phobia. It can keep them from seeking dental care, and may compromise their dental health. Dental phobia can be helped by sedation dentistry.
Sedation dentistry involves the use of medication to provide a relaxing and anxiety-free experience for people undergoing dental treatment. Although sometimes referred to as “sleep dentistry,” most patients remain awake but feel sleepy. There are several different methods available to achieve varying degrees of sedation. Which method is used depends on the type of procedure and the preference of the patient.
Although sedation produces a relaxed state, it does not have the same effect as anesthesia, which is used for most dental procedures. A patient will still require an injection of local anesthesia to eliminate the pain caused by the procedure. Sedation simply helps relieve the nervousness and anxiety that often accompany a visit to the dentist. A patient is usually sedated prior to getting anesthesia to reduce any anxiety about its injection.
Benefits of Sedation Dentistry
Sedation allows people to feel comfortable about undergoing complex and lengthy procedures. When under sedation, it can seem to patients that lengthy procedures have lasted for only a few minutes. Another benefit of sedation dentistry is that extensive treatment can be performed in only one or two appointments. Sedation dentistry may benefit those who:
- Have a low pain threshold
- Have sensitive teeth
- Cannot sit still in the dentist’s chair
- Gag easily
- Need a large amount of dental work done
Types of Dental Sedation
Sedation can be administered through several different methods, depending on the overall health and level of relaxation required by the patient. Most patients use nitrous oxide, also known as laughing gas, to achieve relaxation. A mask is placed over the nose and the patient breathes in the gas. The sedated feelings begin anywhere from a few seconds to a few minutes after inhaling. Numbness throughout the cheeks and gums also begins quickly. Other methods of sedation can be delivered orally or intravenously.
Depending on a patient’s anxiety level, different degrees of dental sedation may be required. They include:
- Conscious Sedation: Most dentists use conscious sedation, which lets patients feel relaxed but also remain awake and able to respond to commands. The patient will not remember most of the procedure with this sedation.
- Deep Sedation: Patients with higher anxiety levels may feel more comfortable with deep sedation, which provides a state somewhere between consciousness and unconsciousness. In this state, patients cannot respond to commands and may need breathing assistance.
- Unconsciousness: Putting a patient in an unconscious state is occasionally necessary. However, doing so requires general anesthesia, which brings about added risks. Usually only oral sugery requires this level of sedation.
General anesthesia
General anesthesia is used for longer procedures, or if you have a lot of anxiety that might interfere with your treatment.
You’ll be completely unconscious, have no pain, your muscles will be relaxed, and you’ll have amnesia from the procedure.
The medication is given through a face mask or IV. The level of anesthesia depends on the procedure and the individual patient. There are different risks with general anesthesia.
Even though general anesthesia may be ideal for certain dental procedures, it can also have more serious side effects than local anesthesia or sedation. Talk to your dentist if you have any risk factors for general anesthesia, which include high blood pressure, bleeding concerns, pregnancy, COPD, and other conditions that might affect your blood pressure, your breathing, or your nervous system.
Preparation
If a patient is going to have surgery that involves a local anesthetic, the doctor should explain beforehand how to prepare. Patients must inform the doctor if they are using any medications, especially if these are blood thinning agents, such as aspirin or warfarin.
The doctor may give instructions not to eat anything a few hours before surgery. In the doctor’s office, the doctor will apply a local anesthetic agent to the relevant area of the body. It will begin to feel numb. The doctor will not proceed if the patient does not feel the numbing effect. The anesthetic will prevent any pain from being felt, but the patient may still feel pressure during the operation.
Depending on what the procedure is, and how anxious the patient feels, a sedative may also be given at the same time. This will help the patient to feel calm and less anxious.
The physician will monitor the amount of oxygen in the blood using a small device placed on the finger. In rare cases, a plastic nasal tube will be used to provide extra oxygen.
Complications from Dental Anesthesia
Dental anesthesia is a common and safe procedure, but before its administration, the dentist should know a patient’s complete medical history to avoid any possible complications. Side effects are rare and vary depending on the type of anesthesia that is administered. These possible complications may include:
- Dizziness
- Nausea
- Vomiting
- Swelling at the injection site
- Swelling or numbness in the mouth
More serious risks of general anesthesia are extremely rare and are more likely to occur in patients with serious medical conditions, those who are highly allergic or those with a history of alcohol abuse.
It is important for all patients to wait for the effects anesthesia to wear off before leaving a dental appointment. Especially in cases where general anesthesia is administered, patients are advised not to drive themselves home.
The dentist will determine which type of anesthesia is best for each patient based on the type and seriousness of the procedure being performed and on the medical condition and personal preferences of the individual patient.
Special precautions when taking dental anesthetics
There are conditions and situations in which you and your doctor or dentist will discuss if dental anesthesia is the best choice for you.
Treatment consent is an important part of the pretreatment discussion. Ask questions about risks and safety precautions that will be taken to ensure a positive outcome.
Pregnancy
If you’re pregnant, your dentist or surgeon will discuss risks versus benefits of anesthetics for you and your baby.
Special needs
Children and those with special needs require careful evaluation of the type and level of anesthetics they need. Children may need dose adjustments to avoid adverse reactions or overdose.
The Food and Drug Administration (FDA) issued a warning about numbing agents commonly used for teething pain. These products are not safe for use in children under age 2. Do not use these medications without discussing it with a healthcare professional.
Children and adults with special needs may have other medical complications which increase risks with anesthetics. For example, a study found children with cerebral palsy had the highest number of airway-related adverse reactions to general anesthesia.
Older adults
Older adults with certain health problems may need dose adjustments and careful monitoring during and after surgery to ensure their safety.
Some people might experience delirium or confusion and memory problems after surgery.
Liver, kidney, lung, or heart problems
People with liver, kidney, lung, or heart problems might need dose adjustments because the drug might take longer to leave the body and have a more powerful effect.
Certain neurologic conditions
If there’s a history of stroke, Alzheimer’s disease, Parkinson’s disease, thyroid disease, or mental illness, there may be an increased risk with general anesthesia.
Other conditions
Be sure to let your dental team know if you have a hiatal hernia, acid reflux, infections or open sores in the mouth, allergies, severe nausea and vomiting with anesthetics, or are taking any medications that can make you drowsy like opioids.
PEOPLE AT RISK FROM DENTAL ANESTHESIA
Risks are also higher for those with:
- sleep apnea
- seizure disorder
- obesity
- high blood pressure
- heart problems
- children with attention or behavior disorders
- chronic obstructive pulmonary disease (COPD)
- gastric bypass surgery
- substance misuse or substance use disorder
The takeaway
Anxiety related to dental procedures is common but can complicate treatment. It’s important to discuss all your concerns about the procedure and your expectations with your dental care team before. Ask questions about the medications that will be used and what you can expect during and after treatment.
Share your medical history, including any allergies and other medications you’re taking. Be sure this includes over-the-counter drugs, prescriptions, and supplements.
Ask about any special instructions you need to follow before and after the procedure. This includes food and drink before and after treatment.
Ask if you need to arrange for transportation after the procedure and any other information you need to know.
Your dental provider will give you instructions to follow before and after the procedure. They’ll also provide a way for you to contact them in case you have any complications or questions.
