Dental procedures can be performed using different forms of anesthesia and sedation, depending on the treatment, the patient’s health and the level of pain control or anxiety management required.
The main options include local anesthesia, sedation and, for some complex procedures, general anesthesia. These methods are not interchangeable and affect consciousness and sensation in different ways.
Local anesthesia
Local anesthesia is the most common method of controlling pain during routine dental treatment. It numbs a specific area while the patient remains awake.
The anesthetic is usually injected into the gum or tissues near the tooth being treated. It blocks pain signals in the treated area but does not normally cause the patient to lose consciousness.
Before the injection, a dentist may apply a topical numbing medicine to the gum to make the injection more comfortable.
The numbness can continue for several hours after treatment. Patients should take care not to bite or injure the numb area until normal sensation returns.
Sedation
Sedation is different from local anesthesia. It is used primarily to help patients relax or reduce anxiety and may make them drowsy, depending on its depth.
Sedation can be given in different ways, including through an IV. A patient receiving sedation may still receive local anesthesia to numb the mouth because sedation itself does not necessarily provide the same local pain control. For example, during wisdom tooth removal, IV sedation may be combined with medicine injected into the gums.
One commonly used form of dental sedation is nitrous oxide, sometimes called laughing gas. It is inhaled through a mask or nasal device, usually together with oxygen, and can help reduce anxiety and discomfort. The American Dental Association describes appropriately administered nitrous oxide-oxygen sedation as a safe and effective method of managing pain and anxiety in dentistry.
General anesthesia
General anesthesia produces a sleep-like state in which the patient is unconscious and does not feel pain during the procedure. It is generally reserved for selected procedures and patients rather than routine dental treatment.
The medicines used for general anesthesia can be administered through an IV, inhaled, or through a combination of methods. During general anesthesia, an anesthesia team monitors vital functions, including breathing, blood pressure and heart rate. In some procedures, a breathing tube may be placed after the patient is unconscious to help maintain the airway.
General anesthesia is different from sedation. Sedation can range from minimal to deep, while general anesthesia involves a controlled state of unconsciousness. The American Dental Association’s current guidelines cover minimal, moderate and deep sedation as well as general anesthesia.
Choosing the appropriate option
The type of anesthesia or sedation used depends on the dental procedure and the patient’s circumstances.
For a routine procedure involving a limited area, local anesthesia may be sufficient. More complicated procedures may involve sedation or general anesthesia, depending on factors such as the nature and length of the procedure, the patient’s medical history and the treatment team’s assessment.
Before sedation or general anesthesia, patients should tell their dental and anesthesia team about their medical conditions, previous reactions to anesthesia and any medicines or supplements they take. The treatment team uses this information to assess risks and determine the safest approach.
Anesthesia and sedation are generally safe when appropriately administered and monitored, but complications can occur. The risks depend on the type of anesthesia, the procedure and the patient’s health.
For this reason, patients should discuss the planned anesthesia with their dentist or oral surgeon before treatment and ask what will be administered, why it is recommended and what preparation or recovery requirements apply.
