Are you scheduled for a dental treatment and wondering about anesthesia?
Approximately 10 to 30 percent of individuals feel anxious or fearful about pain from dental care. Anxiety can postpone needed treatment and let dental issues get worse.
Anesthetics have been in use for more than 175 years. The first documented anesthetic dental procedure occurred in 1846 using ether.
We’ve made significant advances since then, and anesthetics play a vital role in making patients comfortable during dental work.
With a variety of options available, anesthesia can be confusing. We explain the basics so you’ll feel more prepared before your next dental visit.
Types of dental anesthetics
Anesthesia refers to a loss or absence of sensation, which may occur with or without loss of consciousness.
Today there are multiple choices for dental anesthetics. Medications may be used alone or combined to improve effectiveness. Care is tailored for a safe, successful procedure.
The choice of anesthetic also depends on age, health status, procedure length, and any prior adverse reactions to anesthetics.
Anesthetics act differently depending on the agent used. Some are short-acting when applied directly to an area, while others last longer for more extensive surgeries.
The effectiveness of dental anesthesia depends on:
- the medication
- the area being numbed
- the procedure
- individual patient factors
Other influences on dental anesthesia include timing of the procedure. Research also indicates inflammation can reduce anesthetic effectiveness.
Additionally, for local anesthesia, lower jaw (mandibular) teeth are generally more difficult to numb than upper jaw (maxillary) teeth.
There are three primary categories of anesthesia: local, sedation, and general. Each serves different purposes and can be combined with other drugs.
Local anesthesia
Local anesthesia is used for simpler treatments like filling a cavity, which are shorter and typically less complex.
You remain awake and able to communicate with local anesthesia. The treated area is numb, so you shouldn’t feel pain.
Most local anesthetics begin working quickly (within about 10 minutes) and last 30 to 60 minutes. Sometimes a vasopressor such as epinephrine is added to prolong the effect and limit spread to other areas.
Local anesthetics come as over-the-counter and prescription options in gels, ointments, creams, sprays, patches, liquids, and injectable forms.
They can be applied topically to numb the surface or injected into the treatment area. Occasionally, light sedation is combined with local anesthetics to help patients relax.
Examples of local anesthetics articaine bupivacaine lidocaine mepivacaine prilocaine
Sedation
Sedation exists at several levels and is used to calm patients who are anxious, help control pain, or keep them still during procedures. It may also cause partial memory loss of the event.
You might remain fully awake and responsive, be semi-awake, or be barely conscious. Sedation is classified as mild, moderate, or deep.
Deep sedation is sometimes termed monitored anesthesia care (MAC). Under deep sedation, you are usually unaware of your surroundings and only respond to repeated or painful stimulation.
Sedation drugs can be given orally (tablet or liquid), inhaled, intramuscularly (IM), or intravenously (IV).
IV sedation carries greater risks. Heart rate, blood pressure, and breathing must be closely monitored during moderate or deep sedation.
Medications used for sedation diazepam (Valium) midazolam (Versed) propofol (Diprivan) nitrous oxide
General anesthesia
General anesthesia is used for longer procedures or when severe anxiety could interfere with care.
You will be fully unconscious, free of pain, with relaxed muscles and no memory of the procedure.
Medications are administered through a face mask or IV. The depth of anesthesia depends on the operation and the patient. General anesthesia carries distinct risks.
General anesthesia medications propofol ketamine etomidate midazolam diazepam methohexital nitrous oxide desflurane isoflurane sevoflurane
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Side effects of dental anesthesia
Side effects vary by the type of anesthetic used. General anesthesia involves more potential complications than local anesthesia or sedation. Individual responses differ.
Some reported side effects of sedation and general anesthesia include:
- nausea or vomiting
- headache
- sweating or chills
- hallucinations, delirium, or confusion
- slurred speech
- dry mouth or sore throat
- pain at the injection site
- dizziness
- fatigue
- numbness
- lockjaw (trismus) from surgical trauma, causing temporary limited jaw opening
Vasoconstrictors like epinephrine added to anesthetics can also affect heart rate and blood pressure.
These are some known side effects. Discuss your specific medication and any worries with your dental team.
Precautions when using dental anesthetics
Certain conditions and situations call for discussion with your dentist or doctor about whether dental anesthesia is appropriate.
Consent is an essential part of preprocedure discussions. Ask about risks and safety measures to promote a positive outcome.
Pregnancy
If you are pregnant, your dentist or surgeon will weigh the risks and benefits of anesthetics for you and the fetus.
Special needs
Children and individuals with special needs require careful assessment of the type and depth of anesthesia needed. Children often need dosage adjustments to prevent adverse effects or overdose.
The Food and Drug Administration (FDA) warned that numbing agents used for teething are unsafe in children under 2. Do not use these products without consulting a healthcare professional.
Children and adults with special needs may have other medical issues increasing anesthetic risks. For instance, a study showed children with cerebral palsy had the highest number of airway-related complications under general anesthesia.
Older adults
Seniors with certain health issues may require dose changes and close monitoring during and after procedures to ensure safety.
Some patients may experience postoperative delirium, confusion, or memory difficulties.
Liver, kidney, lung, or heart conditions
People with liver, kidney, lung, or heart disease may need dose modifications because drugs can linger longer in the body and have intensified effects.
Certain neurologic conditions
A history of stroke, Alzheimer’s, Parkinson’s, thyroid disorders, or psychiatric illness may raise the risks associated with general anesthesia.
Other conditions
Tell your dental team if you have hiatal hernia, acid reflux, mouth infections or open sores, allergies, severe nausea or vomiting with anesthetics, or are taking medications that cause drowsiness, such as opioids.
People at higher risk from dental anesthesia Risks are increased for those with: sleep apnea seizure disorder obesity high blood pressure heart disease children with attention or behavior disorders chronic obstructive pulmonary disease (COPD) gastric bypass surgery substance misuse or substance use disorder
Risks of dental anesthesia
Most patients don’t have problems with local anesthesia. Risks increase with sedation and general anesthesia, particularly in older adults and those with other medical issues.
There’s also greater risk for those with bleeding disorders or taking medications that raise bleeding risk, such as aspirin.
If you take pain medications like opioids or gabapentin, or anxiety drugs such as benzodiazepines, inform your dentist or surgeon so anesthetic plans can be adjusted.
Risks of anesthesia The risks include: an allergic reaction — tell your dentist about any allergies, including to dyes or other substances. Reactions may range from mild to severe and include rash, itching, swelling of the tongue, lips, mouth, or throat, and difficulty breathing. anesthetics articaine and prilocaine at 4% concentrations may cause nerve injury (paresthesia) seizures coma respiratory arrest heart failure heart attack stroke low blood pressure malignant hyperthermia — a life-threatening rise in body temperature, muscle stiffness, breathing problems, or increased heart rate
Takeaway
Fear related to dental care is common but can complicate treatment. It’s important to address all concerns and expectations with your dental team beforehand.
Ask about the drugs to be used and what to expect during and after the procedure.
Share your full medical history, including allergies and all medications you take — prescription, over-the-counter, and supplements.
Ask about any special instructions to follow before and after treatment, including guidelines about eating and drinking.
Ask whether you’ll need someone to drive you home and any other practical details.
Your dental provider will give you pre- and postprocedure instructions and a way to contact them if complications or questions arise.
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