The Safety of Anesthesia for Oral Surgery

If you have to have your wisdom teeth removed or if a child has many cavities that need fillings, you may worry about the safety of anesthesia used in oral surgery. However, studies show that oral anesthesia administered by dentists and oral surgeons in office settings is safe, and it helps ease patients' anxieties about pain during dental procedures.

More than a third of adults fear going to the dentist. This can prevent them from getting regular checkups and cleanings, hurting their oral and general health.

Read on to learn about the various types of anesthesia used for oral surgery, how they are administered, how safe they are, and how dentists and oral surgeons decide which methods to use.

How Anesthesia is Administered

Anesthesia in dental procedures can be given in various ways. The method dentists and oral surgeons use may depend on factors such as a person's age, overall health, history of allergies, level of anxiety, their preference, and the length and complexity of the dental procedure required.

Local Anesthesia

Dentists give injections of local anesthesia for routine dental procedures like filling cavities. Local anesthesia can take about seven minutes to work, depending on the location of the tooth. Lower back teeth generally take longer to become numb. The dentist may apply a topical numbing agent to ease the sting of an injection so you don't feel pain.

Local anesthesia is considered very safe. The biggest risk is allergies. A patient may be unusually sensitive to a drug and have an adverse reaction such as itching, swelling, or hives. In a worst-case scenario, a patient may suffer breathing problems and require emergency care. This is extremely rare and happens in fewer than 1 % of all cases.

Sometimes vasoconstrictor drugs, such as epinephrine, are used to help the anesthesia work or make it last for a longer. Epinephrine can make your heart feel like it is racing and cause anxiety, headache, and tremors, but this is not an allergic reaction.

Laughing Gas

For patients who have both dental anxiety and a fear of injections, dentists can anesthetize them by having them breathe in a mixture of oxygen and nitrous oxide, or "laughing gas," The mixture takes effect within two to three minutes.

Patients often feel a tingling or floating sensation but are awake, calm, and feel no pain. Adverse effects are extremely rare. Dentists will advise you not to eat before your procedure to reduce the risk of vomiting.

The mixture wears off three to five minutes after the patient takes off the mask. Dentists advise patients to wait at least five minutes before getting up to avoid the risk of falling.

Sedation

Other levels of sedation include deep and IV sedation. Patients might be given pills to swallow, asked to inhale a medication from a mask, be given an injection, or have the anesthesia administered intravenously (IV, in a vein). They can even be given a combination of these methods.

The different levels of sedation range from conscious sedation, where you're able to follow commands, to being unaware of your surroundings at all.

If you're having deep or IV sedation, the dental team will monitor your vital signs such as your breathing and heart rate, temperature, and blood pressure throughout the procedure.

Review studies show that while IV sedation is slightly riskier, sedation is safe for outpatient oral surgery.

General Anesthesia

General anesthesia is what's commonly known as being put to sleep for a procedure. It's generally used for longer, more complicated procedures, such as the removal of impacted wisdom teeth or the placement of dental implants.

It can also be used for very anxious patients, patients with disabilities, and children who can't sit still. General anesthesia is administered through a face mask, or given as an IV.

Patients are unconscious and, like with deep and IV sedation, their heart rate, blood pressure, and breathing are monitored. General anesthesia is riskier than local anesthesia and sedation but still considered very safe.

Side Effects

A multi-year review found that oral anesthesia is very safe. The risk of death from oral anesthesia is estimated at three deaths per every one million cases.

However, there are side several known side effects. That's why you should always plan on having someone accompany you who can either drive or help get you home after your procedure.

The side effects include:

• Headache
• Nausea, vomiting
• Confusion, delirium, amnesia
• Slurred speech
• Sore or parched throat
• Numbness at the injection site
• Fatigue

Risks of Anesthesia

Most patients don't have any trouble with local anesthesia. Sedation and general anesthesia are riskier for people with health conditions such as heart, liver, lung, or kidney problems. People with disabilities, older patients, and young children also have an increased risk of suffering a complication due to anesthesia.

The possible complications include:

• Allergic reaction: Reactions can range from itching or hives to difficulty breathing. Tell the dentist about any allergies you have and if you've had a prior reaction to anesthesia
• Nerve damage: This can occur after a tooth extraction or even getting an injection in the mouth. Patients can have a loss of sensation, or problems with speech or drooling. Some oral anesthesia medications can cause a "pins and needles" sensation. It's usually temporary, but in rare cases it can last up to six months or more.
• Seizure: People with epilepsy and other medical problems can have seizures while under anesthesia. When they do, it's usually at the beginning of the surgery or 20-30 minutes in, when blood concentration levels of the anesthesia are higher. Make sure you tell the doctor or oral surgeon about your seizure disorder and ask whether they are trained in handling one.
• Coma: This frightening complication is very rare, and often due to an underlying metabolic or neurological conditions. However, young children can move from one level of sedation to a deeper one if they are given too much of a drug.
• Breathing difficulties: The muscles of the tongue or soft palate can become too relaxed, narrowing the airway. Patients can also have a form of apnea or shallow breathing. During deep sedation and general anesthesia, a dental team will monitor you closely for this.
• Heart failure or stroke: One study found that oral surgery has been linked to an increased risk of heart attack or stroke within the four weeks after the procedure. If you're worried about having a heart attack or stroke during your surgery, ask if the anesthesia has a vasoconstrictor, like epinephrine, which can stress the heart. Before undergoing treatment, you might also ask the dentist if the office is equipped with emergency oxygen and medicines like nitroglycerin.

Precautions and Interactions

Certain conditions like heart, lung, and thyroid disease can increase the risk of an adverse reaction to anesthesia.

Dentists and oral surgeons need to evaluate and monitor older patients, children, and patients with disabilities carefully during surgery to prevent overdose. One study found that children with cerebral palsy had an increased risk of adverse effects such as a drop in temperature, blood pressure, or difficulty breathing while undergoing general anesthesia.

In recent years, there has been a trend to use sedation or general anesthesia to treat children with cavities. But certain precautions are necessary if these are used.

The American Academy of Pediatrics and the American Academy of Pediatric Dentistry recommend that two people trained in advanced life support need to be present in case of an emergency involving a child. The office should be equipped with appropriate rescue equipment and the sedation or general anesthesia should also be administered by a trained anesthesiologist.

Redheads and Anesthesia

If you're a natural redhead but color your hair, you may want to tell the dentist or oral surgeon. Studies have found that due to a mutation in a gene, redheads are more sensitive to pain and tend to need more painkillers. One study found that redheads may require as much as 20% more anesthesia than blonde and dark-haired people.

Summary

Whether you're a redhead, a child, an older adult, or someone with underlying medical problems, local anesthesia, sedation and general anesthesia can lessen the pain and help you get through the dental cleanings and treatments you need to maintain your oral health.

Oral anesthesia is considered very safe and can calm people's anxieties about going to the dentist. However, people with certain medical conditions or allergies may have an increased risk of an adverse reaction.

That's why it's important to go over medical history with the dentist and oral surgeon before any operations. Tell them about any allergies you have, any medications you're taking, and whether you've had a prior adverse reaction to anesthesia.

A Word From Verywell

Many people hate going to the dentist. The sound of the drill and fear of pain can cause people to avoid going, which hurts their oral and overall health. Studies show that local, sedation, and general anesthesia methods for oral surgery are safe and help put patients at ease.

However, there are some risks, especially if you have certain health problems. To avoid an allergic reaction or and adverse outcome, it's important to provide the dentist or oral surgeon with a detailed medical history that includes whether you've ever had a reaction to anesthesia, if you have any allergies, and any medications or supplements you're currently taking.