Oral and Maxillofacial Surgery
Sedation and anesthesia, compared
Dental anesthesia is chosen by depth, not by preference alone. Local anaesthetic numbs the site and leaves you fully aware. Nitrous oxide adds light calm and clears in minutes. IV sedation drops awareness sharply while you keep breathing on your own. General anesthesia goes deeper still. Fasting and an escort are required from IV sedation upward.
The four options, compared
Local anaesthetic alone numbs the site and nothing else. You are fully aware, you can drive yourself home, and there are no fasting rules. It suits straightforward extractions and patients who are not anxious.
Nitrous oxide adds a light, floating calm on top of the local. It clears within minutes of the mask coming off, so you can usually drive home. It takes the edge off mild anxiety, and it does not produce the loss of time that patients often expect.
IV moderate sedation is a different level. Drugs are titrated through a line, and awareness drops sharply. Most patients describe losing track of time rather than being unconscious. It suits longer surgery, multiple impacted teeth, and genuine dental anxiety.
General anesthesia goes deeper again. It is given through the same line, and at this depth you are not rousable and your breathing is supported and monitored throughout by a team whose composition Florida sets by rule. It is used for the longest and most complex cases, for patients whose medical or behavioural history makes lighter levels unworkable, and it is a decision made against your history rather than requested from a menu.
Florida issues these permits by depth, and a practice may only work at the depth it holds. Which level is appropriate for you is settled at the consultation, in writing, before the day.
What it actually feels like
The line goes in with a small pinch on the back of the hand or the inside of the elbow. Within a minute or two the room feels distant and unhurried.
You will be asked to open, turn your head, and bite on gauze, and you will do all of it. You simply will not retain much of it. Patients often say the procedure "did not happen" from their point of view.
Afterwards you will be drowsy for the rest of the day. Judgement and coordination are affected for longer than you will feel they are, which is why the rules below are not negotiable.
The rules, and why they exist
Nothing to eat or drink for the period stated in your pre-operative instructions. Sedation reduces the reflexes that keep stomach contents out of the airway. This is the one instruction where an exception is not possible and your appointment will be rescheduled.
An adult must drive you home and stay with you for the first few hours. Taxis and rideshares are not acceptable on their own, because the requirement is a responsible person rather than transport.
No driving, no operating machinery, no signing anything of consequence and no alcohol for 24 hours.
Tell us every medication and supplement you take, including anticoagulants, bisphosphonates and anything for blood pressure or diabetes. Some of these change the plan, and finding out on the day means rescheduling.
Who is in the room
At the deeper levels Florida sets the team by rule: three trained individuals, present throughout. The surgeon operates. A second person monitors you and does nothing else — that is their whole job for the length of the case. A third assists at the chair.
Monitoring is continuous rather than periodic, and it covers oxygen levels, heart rhythm, blood pressure and breathing. The surgeon stays with you from the start of the anaesthetic until you are discharged, which is also a requirement rather than a courtesy.
You are not discharged to a taxi or to your own judgement. An adult takes you home, and the handover happens with someone from the practice, in person.
Who should not have IV sedation here
Sedation in an office setting suits patients who are otherwise well. Significant cardiac or respiratory disease, obstructive sleep apnoea, a high body mass index, pregnancy, or a previous complication under sedation may all mean the procedure is safer in a hospital setting.
That assessment happens at the consultation, and being referred onward is a judgement about the setting rather than about you.
Risks, stated plainly
Every one of these is discussed before you consent.
- Nausea afterwards, which is the most common effect and usually settles within a few hours.
- Bruising or soreness at the cannula site.
- Prolonged drowsiness, more likely in older patients and with certain regular medications.
- Airway or breathing depression, which is why monitoring is continuous and why the fasting rule exists.
- Rarely, an unexpected reaction to a sedative agent.
Alternatives
Surgery is not always the answer, and we will say so.
- Local anaesthetic alone, for shorter procedures and patients who are comfortable.
- Nitrous oxide with local, for mild anxiety and where driving home matters.
- Treatment in a hospital setting, where a medical history makes an office setting the wrong place.
Questions people ask us
What does IV moderate sedation feel like?
How long do I have to fast?
Can I take my regular medication that morning?
Will I feel anything during the procedure?
What does the permit tier mean?
Written and reviewed by Peter K. Cudjoe, D.D.S., Oral and Maxillofacial Surgery. Last reviewed .