by Gabriella Choi
10%-30% of people have anxiety and concerns about pain with dental procedures. Dental anxiety can delay getting treatment and that can make the problem worse without routine check ups. Did you know that anesthetics have been around for over 175 years? The first recorded procedure with an anesthetic was done in 1846 using ether. Anesthetics are an important tool in helping patients feel comfortable during dental procedures. With lots of different options available, anesthesia can be confusing and full of mystery. This article will explain the most common types of dental anesthesia, how it is used, side effects and risks associated with it, and the recovery process.
There are three main types of anesthesia: local, sedation, and general. Each has specific uses and 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 (drugs used to raise blood pressure in people whose blood pressure is very low) 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. Some examples of local anesthetic medications include articaine, bupivacaine, lidocaine, mepivacaine, and prilocaine.
Dentists often recommend sedation dentistry for those with dental anxiety or dentophobia (fear of the dentist), a sensitive gag reflex or extreme teeth sensitivity, aichmophobia (fear of needles), claustrophobia (fear of enclosed spaces), decreased sensitivity to local anesthesia, difficulty controlling movements (because of tics, twitches, or physical reactions), or special needs and disabilities.
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 include diazepam (Valium), midazolam (Versed), propofol (Diprivan), and nitrous oxide.
Finally, 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. General anesthesia medications include propofol, ketamine, etomidate, midazolam, diazepam, methohexital, nitrous oxide, desflurane, isoflurane, sevoflurane.
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, headache, sweating or shivering, hallucinations, delirium, or confusion, slurred speech, dry mouth or sore throat, pain at the site of injection, dizziness, tiredness, numbness, and lockjaw. 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. 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. 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. 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 such as opioids.
Other people at risk are those with sleep apnea, seizure disorder, obesity, 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.
Dental anesthetics are essential for making dental procedures less intimidating and more comfortable for the patient. Talk to your dentist for more information about the benefits and risks of using dental anesthesia!
Sources:
https://my.clevelandclinic.org/health/treatments/22275-sedation-dentistry Assessed and Endorsed by the MedReport Medical Review Board