Are you scheduled for a dental procedure and have questions about anesthesia?
Anesthetics have been around for over 175 years! In fact, the first recorded procedure with an anesthetic was done in 1846 using ether.
We’ve come a long way since then, and anesthetics are an important tool in helping patients feel comfortable during dental procedures.
With lots of different options available, anesthesia can be confusing. We break it down so you’ll feel more confident before your next dental appointment.
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.
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 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.
Examples of local anesthetic
Sedation has several levels and is used to relax a person who may have anxiety, help with pain, or keep them still for the procedure. It can also cause procedure amnesia.
You might be fully conscious and able to respond to commands, semiconscious, or barely conscious. Sedation is categorized as mild, moderate, or deep.
Deep sedation can also be called monitored anesthesia care or MAC. In deep sedation, you’re generally not aware of your surroundings and can only respond to repeated or painful stimulation.
The medication might be given orally (tablet or liquid), inhaled, intramuscularly (IM), or intravenously (IV).
There are more risks with IV sedation. Your heart rate, blood pressure, and breathing must be carefully monitored in moderate or deep sedation.
Medications used for sedation
- diazepam (Valium)
- midazolam (Versed)
- propofol (Diprivan)
- nitrous oxide
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.
general anesthesia medications
- nitrous oxide
Side effects of dental anesthesia depend on the type of anesthetic used. General anesthesia has more risks involved with its use than local anesthesia or sedation. Reactions also vary based on individual factors.
Some reported side effects with sedation and general anesthesia medications include:
- nausea or vomiting
- sweating or shivering
- hallucinations, delirium, or confusion
- slurred speech
- dry mouth or sore throat
- pain at the site of injection
- lockjaw (trismus) caused by trauma from surgery; the jaw opening is temporarily reduced
Vasoconstrictors such as epinephrine added to anesthetics can also cause heart and blood pressure problems.
These are some reported side effects of anesthetics. Ask your dental care team about your specific medication and any concerns you may have about the medication.
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.
If you’re pregnant, your dentist or surgeon will discuss risks versus benefits of anesthetics for you and your baby.
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,
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.
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
- 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
Most people don’t experience adverse reactions with local anesthesia. There are higher risks with sedation and general anesthesia, especially in older adults and people with other health complications.
There’s also an increased risk with a history of bleeding disorders or with medications that increase the risk of bleeding like aspirin.
If you’re taking pain medications such as opioids or gabapentin, or anxiety medications like benzodiazepines, let your dentist or surgeon know so they can adjust your anesthetic accordingly.
Risks of anesthesia
The risks of anesthesia include:
- an allergic reaction. Be sure to let your dentist know about any allergies you have; this includes to dyes or other substances. Reactions might be mild or severe and include rash, itching, swelling of tongue, lips, mouth, or throat, and difficulty breathing.
- anesthetics articaine and prilocaine at 4% concentrations may cause nerve damage, known as paresthesia
- stopping breathing
- heart failure
- heart attack
- low blood pressure
- malignant hyperthermia, a dangerous increase in body temperature, muscle rigidity, breathing problems, or increased heart rate
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.