Oral surgery can make potential patients anxious, and two of the questions we hear most often are how much pain or discomfort to expect during a procedure and whether you will be awake or under anesthesia for the duration. Both questions come back to sedation—medication used to reduce anxiety, discomfort, awareness, or movement during a medical procedure so patients can feel more relaxed or less aware while still being carefully monitored and kept safe.
For patients considering oral surgery and wanting to understand their comfort and safety options, our various sedation options can make treatment easier to manage by reducing fear, easing pain perception, and controlling a strong gag reflex. The level used depends on your comfort needs and the complexity of the procedure, from minimal sedation with local anesthetic or laughing gas to deeper IV sedation, general anesthesia, and, in some cases, hospital-based pediatric sedation, all of which we are proficient with at the Oral and Facial Surgery Institute.
Minor Procedures and Minimal Sedation
Some of the simplest surgical treatments we perform include basic gum treatments and easy, simple tooth extractions, which may be recommended even when a tooth is not currently painful due to decay, infection, or overcrowding; understanding why teeth are sometimes extracted even without pain can make these recommendations less surprising. For these procedures, we generally use only a local anesthetic, which is lidocaine. Lidocaine is actually used in almost all of our sedation options as our local anesthetic, but it will be used on its own for these minor procedures.
Kicking Up a Notch with Laughing Gas and Moderate Sedation
As the procedures get more complex, we add some more sedation options, all delivered by a trusted oral and facial surgeon recognized for excellent patient care. For common procedures like wisdom teeth extraction or implant placements, we will add the use of nitrous oxide (known to most as laughing gas), an inhaled gas used as conscious sedation during minor surgery and some diagnostic tests, along with the lidocaine used as a local, to reduce pain and anxiety; many patients are reassured to learn more about whether dental implants require general anesthesia when planning their treatment. This sedative is given to patients through a small mask that fits comfortably over your nose and acts as a sedative and analgesic within 1 to 2 minutes, usually providing minimal sedation that leaves you relaxed, fully awake, and able to respond. This can make dental care easier for patients with anxiety or difficulty tolerating treatment, especially those who are preparing for a tooth extraction and managing anxiety about the experience. These effects wear off almost immediately after returning to the use of regular oxygen over the nitrous oxide, and a nurse or other team member may also monitor oxygen levels with a pulse oximeter during treatment, which is reassuring for many of our patients traveling from Mesquite, NV, for oral surgery.
IV Sedation or General Anesthesia in Office
As a complete surgery center, we are licensed and proficient in the use of IV sedation as procedural sedation or general anesthesia in our own office. This approach can span different levels of sedation, from minimal to deep sedation, and when given intravenously, it can be adjusted quickly during treatment. Common drugs used for IV sedation include benzodiazepines such as midazolam, lorazepam, and diazepam. As one example, midazolam can produce sedation in less than 5 minutes, with a typical adult total dose of 0.02-0.1 mg/kg. While we generally will only recommend the use of this sedative for complex procedures like a full-mouth reconstruction, moderate sedation still allows response to verbal commands and may cause partial memory loss, while deep sedation makes patients difficult to arouse but still breathing on their own; propofol is a popular agent for deep procedural sedation and has a rapid onset of action in under 1 minute. By contrast, general anesthesia involves complete unconsciousness with airway support and is safe enough to use at your choice for simple procedures like wisdom teeth removal if anxiety might be a problem, and patients considering this procedure can explore more about wisdom teeth removal in St. George, Utah as they weigh their options. Dexmedetomidine is another option because it provides sedation with minimal respiratory depression.
Sedation exists on a continuum, which means a patient can reach a deeper level than intended, and the risks increase as sedation deepens, so it is important to understand when a situation calls for an oral surgeon rather than routine dental care. Benzodiazepines can cause significant respiratory depression, and ketamine may preserve airway reflexes but can also lead to emergence reactions. The American Dental Association emphasizes monitoring and emergency preparedness in sedation practices, which supports in-office safety and important facts about anesthesia safety and benefits.
When you undergo IV sedation in our office, you may feel sleepy and experience partial or complete amnesia, so many patients have little to no memory of the procedure, which can be especially helpful if you are working to overcome your fear of oral surgery. However, most patients don’t remember their procedure at all and may drift in and out while still responding less as the procedure continues. Consciousness gradually returns in recovery while the team continues checking blood pressure and heart rate for safety. Even if you are technically awake, you are still basically under anesthesia and shouldn’t experience any anxiety from the procedure, which also supports comfort during pain management. Most patients can go home within 1 to 2 hours, but the effects of sedative drugs can last up to 24 hours, so arrange for a responsible adult to drive you home after sedation and stay with you afterward rather than driving or making important decisions during that time.
For Certain Instances, Pediatric Sedation Can Occur in the Hospital
For some instances, including reconstructive or TMJ surgery or for patients whose overall health or certain medical conditions warrant it, we may recommend doing the procedure in a hospital setting under the care of an anesthesiologist and doctor, similar to our broader range of oral and maxillofacial surgery procedures. Follow all pre-procedure instructions from your healthcare provider, including when to stop eating, whether small amounts of clear liquids are allowed only if your healthcare provider specifically instructs it, reporting any medications you take, and stopping smoking before the procedure. Some patients may also need diagnostic tests before hospital-based sedation, and in select cases oral and facial surgery can also be part of treating related conditions such as obstructive sleep apnea with corrective surgery. However, these instances are exceptionally rare for patients who visit us for oral surgery in St. George, UT, though certain upper jaw procedures may still call for careful sinus precaution instructions after surgery during recovery.
When you are considering oral surgery, you will have a wide range of sedation options available to you when you select the Oral & Facial Surgery Institute oral surgeon in St. George, Utah, whose role in supporting your overall health and wellness through oral surgery extends well beyond managing discomfort during a single procedure. The medical team monitors breathing and watches for risks and complications, including respiratory depression, to protect your health, backed by the expertise of our board-certified oral surgeon in St. George and Mesquite, who is a highly trained oral and maxillofacial surgeon with advanced surgical and anesthesia experience. Common side effects can include feeling sleepy, dizzy, headache, or nausea, and these usually resolve quickly. After treatment, pain medicine may be recommended as part of pain management, along with a thoughtful post-oral surgery care routine to support healing at home. Contact us today to learn more!