Dental Sedation & Anesthesia

Treating Dental Anxiety

Dental anxiety, dental fear, or dental phobia should not prevent you from getting the treatment that you need.

patient being sedated

The first step is to make an appointment for a consultation. Not only will Dr. Gallez, Dr. Sanz Miralles and Dr. Ha assess your dental need, but they will also discuss with you the different sedation modalities available that fit your need and your medical status.

We offer:

  • Nitrous Oxide sedation (laughing gas): You breathe a mixture of Nitrous Oxide and Oxygen through a nasal hood during the procedure.
  • Oral sedation: You arrive at the office 1 hour before the procedure, we check your vital signs and give you an oral sedative (a pill). It usually takes 30 to 45 min before you feel the effect. You need someone driving you back home after.
  • IV conscious sedation: We start an IV and titrate (add) some medicine that will create drowsiness, amnesia, euphoria and pain control. You will still be conscious, yet will likely not remember the procedure and have a “positive experience”. You need someone to drive you back home after.
  • General anesthesia: We work with experienced Anesthesiologists who come to our office and “put the patient to sleep”. Typically, you will be intubated, meaning that they will put a breathing tube to secure your airway and connect you to their anesthesia cart.

Dr Gallez is trained and licensed to provide Nitrous Oxide, oral sedation and IV sedation. He is a member of the American Dental Society of Anesthesiology.

Dr Gallez is certified in CPR (CardioPulmonary Resuscitation) and ACLS (Advanced Cardiac Life Support).

Dr Gallez uses the following monitoring during moderate sedation:

  • Automatic Blood Pressure
  • Pulse oximeter SpO2 (to monitor your hemoglobin O2 saturation)
  • Pre-tracheal stethoscope (to monitor your ventilation)
  • Side-stream sampling capnography (to monitor your ventilation and CO2 level)
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Anesthesia Options

The following table illustrates the choices of anesthesia, a description of the anesthetic technique, and the usual indications for that technique.

  • Types of Anesthesia
  • Method Local Anesthetic
    Description of Technique 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.
    Usual Indications Simple oral surgery procedures such as minor soft tissue procedures and simple tooth extractions.
  • Method Nitrous Oxide Sedation with Local Anesthetic
    Description of Technique 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.
    Usual Indications Simple oral surgery procedures to more involved procedures such as removal of wisdom teeth and placement of dental implants.
  • Method Office-Based General Anesthesia with Local Anesthetic*
    Description of Technique Medications are administered through an intravenous line (I.V.). The patient falls asleep and is completely unaware of the procedure being performed. Medications most commonly used are Fentanyl (opiate), Versed (benzodiazepine), Ketamine, and Diprivan. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored.
    Usual Indications General anesthesia is available for all types of oral surgery. A patient may choose general 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.
  • Method Hospital or Surgery Center-Based General Anesthesia
    Description of Technique A patient is admitted to a hospital or surgery center where anesthesia is administered by an anesthesiologist.
    Usual Indications 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 general anesthesia in the office, a periodontist must have completed at least three months 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 general 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.

How is the IV sedation administered?

A thin needle will be introduced into a vein in your arm or hand. The needle will be attached to an intravenous tube through which medication will be given to help you relax and feel comfortable. At times a patient’s vein may not be maintainable, in these situations, the medications will be administered and the needle retrieved – both scenarios will achieve the same desired level of conscious sedation. Once again some patients may be asleep while others will slip in and out of sleep. Some patients with medical conditions and/or on specific drug regimens may only be lightly sedated and may not sleep at all.

The goal of IV sedation is to use as little medication as possible to get the treatment completed. It is very safe and 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.