Anesthesia
Several methods of anesthesia are available. The method of anesthesia that is chosen for or by a patient depends upon the nature of the surgical procedure and the patient’s level of apprehension.
During your consultation visit, Dr. Notarnicola will discuss anesthetic options with you and give you his recommendation. The consultation appointment is very important to help determine the safest type of anesthesia for each patient.
The following table states the methods of anesthesia, a description of the anesthetic technique, and the usual indications for that technique.
| Method of Anesthesia | Description of Technique | Usual Indications |
| Local Anesthetic | The patient remains totally conscious throughout the procedure. A local anesthetic (e.g. lidocaine) is administered in the area where the surgery is to be performed. Local anesthetic is used in conjunction with the other methods of anesthesia in all oral surgery procedures. | Simple oral surgery procedures such as minor soft tissue procedures and simple tooth extractions, also dental implant surgery, wisdom tooth removal. |
| Nitrous Oxide Sedation with Local Anesthetic | A mixture of nitrous oxide (laughing gas) and oxygen is administered through a nasal breathing apparatus. The patient remains conscious in a relaxed condition. Nitrous oxide has a sedative and analgesic (pain- controlling) effect. | Simple oral surgery procedures to more involved procedures such as removal of wisdom teeth and placement of dental implants. |
| Office Based Intravenous Sedation with Local Anesthetic* | Medications are administered through an intravenous line (I.V.). The patient experiences amnesia and a very deep level of relaxation and comfort and is very sleepy. This is sometimes referred to as a “twilight” state where you are able to breathe on your own and follow commands but are not aware of your surroundings. It a very safe type of outpatient anesthesia and wears off very quickly. | IV Sedation/anesthesia is available for all types of oral surgery. A patient may choose IV anesthesia for simple procedures depending on their level of anxiety. Most people having their wisdom teeth removed or having a dental implant placed will choose general anesthesia. General anesthesia may be necessary if local anesthesia fails to anesthetize the surgical site which often occurs in the presence of infection. |
| Hospital or Surgery Center Based General Anesthesia | A patient is admitted to a hospital or surgery center where anesthesia is administered by an anesthesiologist. | Indicated for patients undergoing extensive procedures such as face and jaw reconstruction and TMJ surgery. Also indicated for patients with medical conditions such as heart disease or lung disease who require general anesthesia. |
To administer intravenous anesthesia in the office, an oral surgeon must have completed an intensive regimen of hospital based anesthesia training. Qualified applicants will then undergo an in office evaluation by a state dental board appointed examiner. The examiner observes an actual surgical procedure during which intravenous anesthesia is administered to the patient. The examiner also inspects all monitoring devices and emergency equipment and tests the doctor and the surgical staff on anesthesia related emergencies. If the examiner reports successful completion of the evaluation process, the state dental board will issue the doctor a license to perform general anesthesia. The license is renewable every two years if the doctor maintains the required amount of continuing education units related to anesthesia.
Again, when it comes to anesthesia, our first priority is the patient’s comfort and safety. If you have any concerns regarding the type of anesthesia that will be administered during your oral surgery procedure, please do not hesitate to discuss your concerns with your doctor at the time of your consultation.
Intravenous Sedation (“Twilight Sedation”)
Our office offers our patients the option of Intravenous Sedation or Dental Intravenous Anesthesia or to some it is referred to as “Twilight Sedation” for their dental treatment. Intravenous Sedation or “twilight sleep” helps you to be comfortable and calm when undergoing dental procedures. Your treatment can be completed under intravenous sedation. Intravenous sedation or “IV sedation” (twilight sedation) is designed to better enable you to undergo your dental procedures while you are very relaxed; it will enable you to tolerate as well as not remember those procedures that may be very uncomfortable for you. IV sedation will essentially help alleviate the anxiety associated with your treatment. You may not always be asleep but you will be comfortable, calm and relaxed, drifting in and out of sleep – a “twilight sleep”.
If you choose the option of intravenous sedation your IV sedation/anesthesia is administered and monitored by the doctor therefore eliminating the costly expense of having your treatment carried out in an operating room or same day surgical facility.
How is the IV Sedation Administered?
A thin catheter will be introduced into a vein in your arm or hand. The catheter will be attached to an intravenous tube through which medication will be given to help you relax and feel comfortable.
The goal of IV sedation is to use as little medication as possible to get the treatment completed. It is very safe, much safer than oral sedation. With IV sedation a constant “drip” is maintained via the intravenous tube. At any time an antidote can be administered to reverse the effects of the medications if necessary. Along with IV sedation there are also other different “levels” of sedation available to you in our office. There is nitrous oxide analgesia.
Nitrous Oxide (Laughing Gas)
Nitrous Oxide is a sweet smelling, non irritating, colorless gas which you can breathe. Nitrous Oxide has been the primary means of sedation in dentistry for many years. Nitrous oxide is safe; the patient receives 50-70% oxygen with no less than 30% nitrous oxide. Patients are able to breathe on their own and remain in control of all bodily functions. The patient may experience mild amnesia.
There are many advantages to using Nitrous Oxide
- The depth of sedation can be altered at any time to increase or decrease sedation.
- There is no after effect such as a “hangover”.
- Inhalation sedation is safe with no side effects on your heart and lungs, etc.
- Inhalation sedation is very effective in minimizing gagging.
- It works rapidly as it reaches the brain within 20 seconds. In as few as 2-3 minutes its relaxation and pain killing properties develop.
Reasons to not use Nitrous Oxide
Though there are no major contraindications to using nitrous oxide, you may not want to use it if you have emphysema, exotic chest problems, M.S., a cold or other difficulties with breathing. You may want to ask your dentist for a “5 minute trial” to see how you feel with this type of sedation method before proceeding.
Morris Sussex Oral Surgery Associates, the office of Kurt Notarnicola, DDS
Patient Review
I had dreaded this procedure all of my adult life and now I realize that I was wasting my dental health for nothing I am now paying the price but today's experience was exceptional. All that worry for naught.
- Robert N
Patient Review
My experience today was excellent. I felt comfortable and at ease. Everyone was very pleasant.
- Robert N
Patient Review
this was my first time at this office/under the care of dr kurt. while at my regular dentist it was discovered that i needed the services of dr. kurt and got an appointment immediately. dr kurt and his staff were welcoming-kind-professional. the procedure went very well and i am very satisfied with the results and appreciated the follow up call from the office about my care.
- maryellen d
