Anesthesia is used for so many other surgeries, why not at the dentist? Friend of mine just had oral surgery for a broken tooth and obviously got novocaine, but he asked if he could be unconscious and they said they didn’t provide that service at their clinic. While drilling or grinding they hit a nerve, which was incredibly painful. Seems like if he flinched at the wrong moment it could make something go horribly wrong.
I understand there is liability in using anesthesia and they don’t use it on every single other type of surgery, but wouldn’t there also be liability if the patient flinches and you drill into the wrong part of their mouth? Even just nitrous seems like it would make the surgery so much easier, safer, and less traumatic for the patient.
Edit: thanks for the responses, I guess I was conflating anesthesia with sedation. My question should have been “why is sedation not required for oral surgery?” Regardless, I learned a lot!
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It’s unnecessary. Dental surgery is generally less invasive than other surgeries and almost always an outpatient procedure.
Novocaine is technically a local anesthetic and is administered by the dentist. I believe what you’re referring to is general anesthesia (being put under/to sleep) and it needs to be administered by a trained anesthesia provider.
Most dentist do not have this additional training, thus they are unable to provide the service. Some dentist have an anesthesiologist come to the office to provide the service but it often comes with an additional cost that most dental insurances don’t cover.
Depending on the patient and severity of the case, some dentist may recommend treatment under general anesthesia… possibly with an oral surgeon. This also has some concerns, your dentist will have a hard time during the procedure due to the tube down your throat and your tongue being in the way.
Edit: spelling corrections and additional information.
The basic answer would be unnecessary risk. And or lack of equipment.
From my understanding, general anesthesia carry risks. Which are unnecessary risks if local anesthesia will suffice. Also under general anesthesia you can’t breath for yourself so they will need a ventilators to help you breath which not everyone has. Now I don’t know why they did the surgery like that when it involves drilling into the bone. It was probably just a bad dentistry.
When I had my implant I was knocked out fully so idk.
It all comes down to risk vs benefit; Anesthesia falls under the umbrella of sedation which is light (anxiety medicine, nitrous), moderate (anxiety meds + opiates, maybe Ketamine or Propofol), deep (high doses of the above), and anesthesia (general anesthetics). Outside of deep sedation and anesthesia, sedation is more art than science. There is no magic dose of medications to achieve those, we only have guidelines to go by that assume ideal physiology. There is a risk of you stopping breathing during any level of sedation, in addition to risks of heart attack or stroke of your blood pressure bottoms out. It takes years of training in medication management PLUS airway management to become confident with sedation, and the standard of care mandates that the person performing sedation has to be a different person than the one performing the procedure, because if something goes wrong we have to act quickly.
So overall for procedures like dental extractions or cavity filling, 95% of the time a properly placed local anesthetic completely knocks out any sense of pain through the procedure. So why put you at risk of dying *and* make you pay for two professionals to be in the room when one person injecting Bupivocaine will do the trick?
Dentistry also isn’t the only type of surgery where we don’t use general anesthesia (in most cases). I’m not a surgeon myself but I do minor surgical procedures such as toenail removal, abscess I&D, laceration repairs, chest tubes, etc.
Other surgeries and procedures off the top of my head that we might not sedate you for unless your anxiety gets so bad that you can’t cooperate include bone and joint reduction, cesarean sections, some amputations, some vascular surgeries and imaging procedures. Some surgeons will even put hardware into you without knocking you out because regional blocks exist, which is where a properly placed injection knocks out a whole limb.
We don’t use it on every single other type of surgery. Even a C-section is performed while the mother is conscious. Some foot surgery is also only local anaesthesia and your view simply gets blocked by a curtain. Most surgeries at a dermatologist are all local anaesthesia.
Numbing a specific spot on the patient is far less dangerous, time consuming and expensive than being entirely put under.
But does it suck when getting your nerve drilled? Yes. I’ve been there. It was brutal.
The most an oral surgeon is ever going to use is twilight sedation (like they would use for a colonoscopy for example) because you need to need to be able to follow simple commands (like to turn your head, etc).
Twilight sedation is typically a combo of Versed (a benzo, think IV grade really strong Xanax) and a second med (typically Fentanyl or something similar). The point is to knock you down enough that you can’t remember what is happening but not enough that your body forgets to breathe.
General would not be used because you 1) need a trained anesthesiologist; 2) you have to maintain an airway, which will get in the way of what they are doing; 3) needs a proper OR/additional equipment in case of emergency. But even with twilight sedation, you need a trained professional to administer the meds.
Then you have to figure in the insurance and cost. Many insurance plans don’t cover twilight sedation without major exceptions. When I had my wisdom teeth out, I had sedation only because all 4 of my teeth were impacted and they had to dig them out….and it still cost me a pretty penny. 😑
(Source for info on twilight sedation: Crohn’s patient with 30+ surgeries under my belt. I’ve seen it all at this point, from nerve blocks, general, on down. 😄)
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