The Pros and Cons of IV Sedation For Tooth Extraction

The thought of tooth extraction can scare you. I’m no stranger to patients who’re anxious about tooth extractions. Some to the extent of canceling their dental appointment altogether. So, you’re not alone in feeling this way. 

Tooth extractions are no more tortuous or painful with modern, sophisticated procedures. 

I’ll discuss the options available to make your tooth extraction experience pleasant and comfortable. And also have my thoughts on these procedures so it can help you gain more clarity based on my professional experience.  

Does Tooth Extraction Hurt? 

This is the most common question that I get from my patients when I tell them that their tooth needs to be removed. 

My answer is no. But there will be some minor discomfort as we work with dental tools and equipment in your mouth. If you are prone to stress, you might feel anxious about the procedure. 

We, dentists, take great care when we handle your teeth and do our best to make sure that you don’t experience pain. Removing an infected tooth is essential to relieve pain, prevent the spread of harmful bacteria and damage to the surrounding teeth, and improve oral functions. 

If the thought of tooth extraction scares you and prevents you from undergoing the procedure, it’ll lead to further tooth decay, impacted teeth, and infections. You have some painless options for your tooth extraction that will help you overcome your fears, and enjoy the dental procedure. 

How Do We Make Tooth Extractions A Painless Procedure? 

The two main procedures to manage pain associated with tooth extraction are anesthesia and sedation. 

Anesthesia

There are two kinds: local and general anesthesia.

Local anesthesia refers to the shutdown of your sensory nerves, where you’ll not feel sensations in that area of your body. So, you’ll not feel pain while we remove your infected tooth. You will also be awake and alert during the procedure. 

In a local anesthetic,  we administer medication via an injection close to the affected tooth, making the area go numb. The effect should last for the entire tooth extraction procedure. However, we can give a second dose of the anesthetic if the effect of the first medication wears off, and you feel the pain. With the local anesthetic, your tooth extraction procedure will be comfortable and painless.  

The effect of the local anesthetic can last for a few hours depending on the type of medication and the different reactions of people. There are some patients where the mouth is numb for hours, while some patients experience mild numbness that wears off sooner. 

General anesthesia is not usually recommended for tooth removals except in some complex cases which require lengthy procedures or for special cases such as young children, people with special needs, and older adults. It can be administered orally, intravenously (IV), or with inhaled medications (or a combination of these) to put you in an unconscious state. Avoid drinking alcohol, driving, or signing any legal documents for at least 48 hours following the dental treatment as your mind will be affected.  

Sedation

Dental sedation makes you relaxed and less anxious during the tooth extraction procedure. 

There are three methods of sedation. 

• Nitrous Oxide or Laughing Gas:  This is the most common method of sedation where inhalation is via an oxygen mask. The patient feels lighthearted and free from stress as their tooth extraction procedure becomes comfortable.

• Oral Sedation:  In some cases, we use the oral sedation method. Here, we give the patient a sedative pill at least one hour before the tooth extraction. The common sedative pills are Triazolam or Halcion, Zaleplon, Lorazepam, Halcion, Xanax, Valium, and Klonopin. This is a form of “conscious sedation” where the patient might be asleep but can be awakened with a nudge and can respond if necessary. Because oral sedation affects the patient’s memory and motor skills, we recommend a family member or friend accompany them and drive them home after the tooth extraction procedure.  

• Intravenous (IV) Sedation:  This is the deepest level of sedation that is administered through an IV that goes straight to your bloodstream. There is a rapid onset of sedation where most patients fall asleep and have little to no memory of the proceedings. 

As dentists, we study various factors about the patient before deciding on the sedation method, such as the complexity of the case, length of the procedure, the patient’s pain tolerance level, the patient’s mental health, and current frame of mind among other factors.

According to the American Society of Anesthesiologists (ASA), there are three levels of sedation:

• Minimal sedation:  At this level, you will be relaxed, awake, and alert to follow your dentist’s instructions.

• Moderate sedation:  Here, you will feel drowsy and may even doze off to sleep. You may @remember the dental proceedings or not be able to recall them.

• Deep sedation:  You will not be unconscious but most likely to be asleep throughout the dental procedure with little to no memory of it. 

Benefits of IV Sedation For Tooth Extraction 

There are many benefits of IV sedation that aid your safety and comfort. Some benefits are:

• Safe and effective method. 

• The highest form of conscious sedation puts you in a deeply relaxed and calming state. 

• Since the IV sedation goes directly to the bloodstream, it works quickly. So, you experience the positive side-effects sooner such as relief from anxiety and nervousness.

• Since the dentist is constantly monitoring the IV sedation, they can easily adjust the dosage to keep you comfortable and keep a tab on your breathing.

• Ideal for longer procedures that require time, such as tooth extractions and dental implants. 

• Even though you may sleep, it is easier to get you to be responsive if necessary, compared to general anesthesia. 

• If you’re prone to anxiety around dental treatments, the amnesia-like effects of IV sedation make you unaware of the proceedings during the treatment and make you less afraid of future dental visits. 

• It makes you less fearful of dental treatments, and more inclined to stay on top of your routine dental work and oral hygiene instead of putting them off and causing dental work delays.  

• You can resume normal activities the next day after the IV sedation effects wear off.

Disadvantages of IV Sedation For Tooth Extraction

On the flip side, there are some complications to IV sedation that you need to be aware of.

• While IV sedation is safe, it is not free from potential negative side effects if not taken care of. Some of these side effects are the risk of losing consciousness, respiratory problems, and cardiovascular depression. 

• A potentially serious challenge of IV sedation is the shared, unsecured airway between the dentist and the anesthesiologist. We can overcome this with proper communication and an emergency airway management plan between the dentist and anesthesiologist to ensure a safe airway. 

• IV sedation is not suitable for all groups. If you have a high BMI (>35), high blood pressure with a diastolic pressure over 100, you may not be the right candidate for this type of sedation. 

• If you have certain conditions, you need to discuss them first with your dentist. These conditions include being pregnant, nursing, glaucoma, impaired lung, kidney, and liver, alcohol addiction, psychosis, mental instability, advanced age, sleep apnea, epilepsy, or allergy to benzodiazepines. The dentist, if they decide to go forward, needs to exercise caution while administering IV sedation. 

• IV sedation is expensive compared to the other sedation alternatives. While there is insurance for sedation under certain dental plans, IV sedation may not always be included. It’s best to check with your insurance provider for more clarity on the coverage and expenses for IV sedation. 

We strongly suggest that you discuss all the potential risks and disadvantages possible in advance with your dentist. 

Our Verdict on IV Sedation For Tooth Extraction

IV sedation is not necessary for most basic tooth extractions in Palo Alto. 

For basic tooth extractions, most patients will need only local anesthesia with or without oral conscious sedation before the procedure. In local anesthesia, the patient is fully conscious of what’s happening during the procedure. For someone who is more prone to anxiety might find it an uncomfortable and worrisome experience, we would also provide oral conscious sedation. 

It’s important to note that sedation does not numb pain and is always administered along with an anesthetic. Also, there is more risk involved in general anesthesia and sedation as compared to local anesthesia, even though both are considered safe when performed under the supervision of trained specialists. 

We will recommend IV sedation in cases of extreme anxiety, current mental health state, special health conditions, and complexity of the tooth extraction procedure, but for most of our patients, local anesthesia with or without oral conscious sedation is adequate to keep them comfortable and pain-free.