Dental anesthesia is used to control pain and discomfort during dental procedures, allowing dentists to treat affected areas of the mouth without causing unnecessary pain.
The term covers several different approaches, including local anesthesia, sedation and general anesthesia. The method used depends on the procedure, the patient’s medical history and, in some cases, the level of anxiety involved.
Local anesthesia is commonly used
For many routine dental procedures, dentists use local anesthesia to numb a specific part of the mouth. The medicine temporarily blocks pain signals from nerves in the area being treated, while the patient remains awake.
Local anesthetics may be delivered by injection and can also be used in topical forms such as gels or sprays. The dentist determines the appropriate amount before beginning treatment.
Sedation is different from local anesthesia. A patient may receive sedation to reduce anxiety or help them remain relaxed during treatment, while local anesthesia is still used to numb the treatment area.
For patients who are particularly anxious, dentists may use inhaled nitrous oxide and oxygen or intravenous sedation. With intravenous conscious sedation, a small cannula is placed into a vein, commonly in the hand or arm, and the sedative is administered gradually. Patients generally remain conscious and able to respond to the dental team.
The American Dental Association says nitrous oxide and oxygen can be used to manage pain and anxiety in dentistry when administered appropriately.
General anesthesia is different
General anesthesia produces unconsciousness and is different from conscious sedation. It is used for selected dental procedures and patients when clinically appropriate.
The decision to use deep sedation or general anesthesia requires assessment of the patient’s health and the procedure, as well as appropriate monitoring, trained personnel and emergency equipment. Updated American Dental Association guidance calls for pre-procedure assessment, monitoring and preparation for possible complications when these forms of anesthesia are used.
General anesthesia is therefore not simply a stronger form of routine local anesthesia, and it is not automatically required for lengthy dental procedures.
Medical history is important
Before sedation or anesthesia, the dental team should review the patient’s medical history, current medicines and any previous problems with anesthesia or sedation.
The assessment helps the dental team identify conditions or medicines that could affect the choice or dose of medication and determine what level of monitoring is appropriate.
Anxiety can also affect dental care. Sedation may help some anxious patients tolerate treatment, but anxiety disorders and other medical or mental health conditions do not automatically mean a person cannot receive dental anesthesia.
Instead, the dental team should take those conditions into account when planning treatment.
Reactions to dental anesthetics
Side effects from local anesthesia are generally uncommon and serious complications are rare. Patients should tell their dentist about previous reactions to anesthetics, allergies and other medicines before treatment.
A true allergy to local anesthetic used in dentistry is rare. Some reactions that patients describe as an allergy can instead be related to anxiety, fainting or other effects associated with the injection or the medication.
Possible reactions can include dizziness, sweating or fainting. In the rare case of a serious allergic reaction, symptoms can include swelling of the face, lips or throat and difficulty breathing. Such symptoms require urgent medical attention.
Patients receiving intravenous sedation may experience drowsiness, dizziness, nausea or temporary memory problems. Reduced breathing or oxygen levels can also occur and are monitored during the procedure.
After the procedure
Recovery instructions depend on the type of anesthesia or sedation used and the procedure performed.
Patients who receive sedation or general anesthesia may need monitoring before they are discharged and may require an escort home. The dental team should provide specific instructions on eating, drinking, driving and other activities after treatment.
For patients who have received only local anesthesia, the numbness normally wears off as the medicine leaves the treated area.
Patients who develop significant swelling, difficulty breathing or other signs of a serious reaction after dental treatment should seek urgent medical care rather than simply waiting for the symptoms to resolve.
