Dear Dr. Velez: Recently I caught bits and pieces of news about a dentist using anesthesia during a dental procedure to produce conscious sedation. Could you explain this procedure? - W.K., Wheeling
Dear W.K.: The term anesthesia generally means the absence of sensation, especially the sensitivity to pain. The point to remember is that anesthesia can be induced by several medications, singularly or in combination, to help create a more relaxed experience. Some medications control pain, some help you to relax, while others can be combined to place you in a deep relaxed state.
In dentistry, anesthesia can be accomplished by several methods: by local anesthesia, by conscious sedation or by general anesthesia.
What is local anesthesia? We have all experienced at one time or another local anesthesia when getting a cavity restored, a crown prepared, gingival surgery or a tooth extraction. This is the injectable method affectionately known as "the shot," immortalized by late night TV hosts and Grandpa as novocaine.
Injectable local anesthetics (lidocaine or equivalent) prevent pain in a specific area of your mouth during treatment by blocking the nerves that sense or transmit pain sensation to the brain. They cause the temporary numbness often referred to as a "fat lip" feeling.
To recreate this "fat lip " feeling, especially at a party, do this: With palms straight up, place your right hand up against the left hand of another person. Then have the other person place their thumb and middle finger of the right hand over the forefingers of the the two joined hands. Have them rub up and down and then watch for their response. This is the technique I have been using for years to explain to a patient the feeling of numbness. It works! Try it.
What is conscious sedation? Well, it's like being in "Margaritaville," without the margaritas. This type of anesthesia is accomplished by various combinations of analgesics, sedatives, tranquilizers and low concentrations of anesthetic gases. For example, narcotics such as morphine and Demerol are used with sedatives like Valium and nitrous oxide to create relaxation and pain relief. Most often this type of anesthesia is used for extraction of wisdom teeth, periodontal surgery or complex root canal treatment. Because the patient is in a state of mild to moderate relaxation, he or she can breathe on their own and can respond to verbal directions.
What is general anesthesia? It is a type of anesthesia in which pain relief is accomplished by a temporary loss of consciousness with loss of breathing. All the medications used in conscious sedation can be used in larger doses for general anesthsia, in addition to other agents. The hospital operating room provides the optimum setting because of the availability of monitors for vital signs, resuscitative equipment and trained anesthesia personnel. This type of anesthesia is used frequently for complex maxillofacial and oral surgical procedures such as impacted wisdom teeth, which are well embedded in the jaw bone, fractured facial bones and jaw reconstruction.
Understanding the range of choices that are available to relieve anxiety and discomfort makes you a well-informed dental consumer. If you have questions or concerns about your oral health care, don't hesitate to talk to your dentist. If you still have concerns, consider getting a second opinion. Working together, you and your dentist can choose the appropriate steps to make your dental visit as safe and comfortable as possible.
Manny Velez received a Doctor of Dental Surgery degree from West Virginia University School of Dentistry in 1983 and is in private practice in Wheeling. He was also professor of oral medicine for 15 years in the Department of Health Sciences, West Liberty State College.