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A nesthesia options:

lthough most oral surgery office procedures can be done under local anesthesia, even if you're comfortable, you'll always remember the procedure.  The anxiety for you may also be more than you want to - or are able to - withstand.  


Oral & maxillofacial surgeons are trained extensively in providing sedation and general anesthesia to patients.  During our residency, we are immersed in and serve as a full Anesthesia Resident for six months.  This profound training allows an oral surgeon - legally and ethically - to provide general anesthetic to patients.  More, this training, as well as Dr. Zechel's medical training means he will be able to review your medical history with a relevant physical examination to determine your appropriateness for anesthesia or sedation.  


Some patients will have physical or mental ailments that preclude safe adminstration of sedation or general anesthesia within the office setting.  For these patients, performing the planned procedure(s) in the hospital setting in the Quinte Healthcare System (e.g. Belleville General Hospital) would likely be a suitable option.


Any of the below are anesthesia options are possible:

General anesthesia:


General anesthesia is the complete loss of consciousness and renders the patient insensitive to any stimulus including pain.


General anesthesia is typically the best choice for young children (2 to 6 years old) to undergo an oral surgical procedure.  We will induce (begin) anesthesia on your child by allowing them to breathe a pleasant-smelling gas from a mask.  They will not have to undergo an I.V. line while awake adding to their comfort.  


General anesthesia is delivered through an I.V. for adults and most adolescents.  Once anesthesia is induced, the patient is maintained in this state through medicines administered through the I.V. line. We find patients receiving anesthesia through a total intravenous route experience less post-operative: nausea/vomiting and 'hangover' effect.


Advantages:  No awareness/recall of procedure, less risk of patient movement during the procedure.


Disadvantages:  Fasting time required, post-operative grogginess, patient requires an escort/ride, not the best option for patients who aren't of reasonable health and fitness.

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Intravenous sedation:

Intravenous sedation is fast-becoming the preferred choice for outpatient office-based procedures in oral & maxillofacial surgery, plastics and dental surgery.  Patients should understand that the term "sedation" doesn't mean you won't be asleep.  There are different depths of sedation that are possible from moderate to deep.  Even in moderate sedation, patients typically have no recollection of the procedure.


Because during sedation some degree of patient cooperation and willingness is important (e.g. to have an IV started) this option is not typically recommended for the very young.  


Advantages:  Little or no awareness/recall of procedure, likely less post-operative nausea, less post-operative grogginess, may be a reasonable choice for some patients who aren't fit enough to undergo general anesthesia.


Disadvantages:  Fasting time required, some post-operative grogginess, patient requires an escort/ride, not the best option for patients who either aren't aware of what's going to happen or aren't capable of understanding (i.e. very young).

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Nitrous oxide ("laughing gas"):

Nitrous oxide or laughing gas was the first effective approach at accomodating patient comfort for dental extractions.  Historically, the story goes something like this: a medical school dropout (Gardner Colton) synthesized laughing gas and went around the area setting up "laughing gas parties" along with circus entertainment.  In 1844 a caring dentist (Dr. Horace Wells) was in the audience and noticed a participant of Colton's laughing gas injure his leg while under the effect of the gas.  The injured person explained he had no pain or discomfort despite the extreme injury he just suffered.  Believing this could be a God-send for his patients requiring a tooth extraction, Dr. Wells volunteered to have a tooth removed while Colton adminstered the laughing gas.  When regaining his full senses, Dr. Wells was essentially unaware of the fact that he just had a tooth removed (remember there was no local anesthetic at this point in history).   


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Nitrous oxide can be a good option for "willing" children especially in those over 6-7 years old undergoing a relatively straightforward procedure (e.g. baby tooth extraction).  This can also be a good choice for analgesia (pain control) and anxiolysis (removal of anxiety) for other patients.


Typically, at the levels of laughing gas used, patients should expect that they will be aware of their surroundings and what's being done.  Patients also will likely have recollection of the procedure. However, for those who just need something to 'take off the edge', laughing gas may be the answer. In children, occcasionally they will slip into a sort of 'trance' state and become fully aware of their surroundings briefly.  If timed correctly this can allow the planned procedure to be performed without the patient's awareness or recollection.


Advantages: Works quickly, relatively few contraindications, provides overall reduction in pain and anxiety, patient returns to normal within a few minutes of stopping the gas, patient can leave the office on their own, no fasting period required.


Disadvantages:  Patient still typically aware of procedure and will have recollection of it, not effective for non-willing patients (e.g. the very young).

Local anesthesia ("freezing, numbing, novocaine"):


Unless you have a verifiable allergy to local anesthetic, no matter what other options of anesthetic you and the doctor choose, local anesthetic will be used.  This is to: one, provide immediate post-operative pain control and; two, lessen the depth of sedation required - this optimizes patient safety.

Let's address some possible misconceptions reagarding local anesthetic:  


In the '70s I had freezing and developed hives and difficulty breathing.  I don't think I should get freezing again. 

More likely than not the allergic reaction was due to "Novocaine".  The last dental cartridge of this was made in 1996 and likely wasn't used long before that since other better local anesthestics were available.  Novocaine is very different than lidocaine, articaine and other -caines that are currently being used.  The likelihood of having a reaction to the new class of anesthetics is extraordinarily rare and is not related to a reaction in the past to Novocaine.  


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Freezing doesn't work on me.  Ever time I get freezing I can still feel the tooth being taken out.  

Local anesthetic "freezes" or shuts down the nerves (or more correctly, most of them) that give feeling to the teeth and gums around them. The nerve that enables you to feel pressure are not always frozen with local anesthetic.  For this reason, you may sense the tooth is being touched. For example, it is common for a patient to say "I can still feel the tooth is there when I bite down". That part is normal.  However, you shouldn't be uncomfortable when the tooth is being removed and you especially shouldn't feel "pain".  If you do, you have to let us know and we can redo the freezing or use a slightly different technique.


I just got numbed up and my face feels huge.

Actually, your face feels huge and that's because the sensation has left your lip, chin, or cheeks.


My child just got freezing, is there anything I need to watch for?

Yes, children have a tough time understanding that you can really damage a numb lip or tongue with your teeth.  My suggestion is to caution your child to gently bite on gauze while the freezing is still in.  If they want to eat, give them something that doesn't require chewing until the freezing wears off.


Does all freezing last the same length of time?

No.  Local anesthetics with small amounts of epinephrine in them (the majority of local anesthetics) last longer than their equivalent without epinephrine.  The typical local anesthetic (e.g. lidocaine or articaine) typically will keep you numb for 1-2 hours.  However, there are many factors that can influence this.  If you have a long drive or anticipate a long while before being able to dose with pain medicines, you can request an ultra-long lasting local anesthetic (bupivicaine) which can provide up to 8 hours of local anesthesia.


It's the 21st century.  Why are we still using needles to numb?

As of now, there are clinical studies underway to evaluate the effectiveness of an inhaled or "sniffed" local anesthetic solution that may prove effective in freezing many of the upper teeth.  Unfortunately, this won't do much for lower teeth.  Even though nobody likes the pinch of a needle, be thankful we're not living in the 19th century where teeth were routinely removed without any type of anesthetic (inlcuding local).

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