The Less You Worry the Easier It Will Be

An upcoming visit to an oral and maxillofacial surgeon is another potential anxiety producer. In this case, the individual typically is most concerned with possible pain --- whether or not the procedure is going to hurt.

Modern technology now makes it possible to perform complex surgery in the office with little or no discomfort. Knowing this should start to bring your anxiety level down to a minimum.

Extensive Schooling and Experience in the Control of Pain and Anxiety

Dr. Hart and Dr. Isdith are not only specialists in dealing with problems of the mouth, teeth and jaws, but are also experienced in dealing with the control of pain and anxiety.

During years of hospital training, oral and maxillofacial surgeons receive extensive schooling in medical and dental aspects of anesthesia. Your oral surgeon is thoroughly knowledgeable in pain and anxiety control and possesses extensive clinical experience in anesthesia techniques, from local anesthesia to sedation to general anesthesia.

Putting Your Mind at Ease

One of the things your oral and maxillofacial surgeon has been taught in terms of reducing anxiety is the importance of making the patient aware of what to expect during surgery. It's usually true; the more you know, the less you have to be anxious about. That's why beforehand, you'll review with your surgeon the type of anesthetic to be used, as well as the way you're likely to feel during the operation. Your oral and maxillofacial surgeon will answer any questions you may have about any facet of the operation.

During the surgery, one or more of the following can be used in controlling pain and anxiety: local anesthesia, nitrous oxide-oxygen,or intravenous anesthesia.

Anesthesia

Anesthesia as an outpatient in our office can vary from local anesthesia to unconscious sedation.  It should be noted that most office-based oral surgery can be done painlessly with local anesthesia (numbing) alone.  To help reduce anxiety during the procedure, a number of options are available.

Oral and maxillofacial surgeons are unique among the surgical specialties with regards to anesthesia training. Every oral and maxillofacial surgeon during their residency receives formal anesthesia training with the department of anesthesia in the hospital. They are taught the skills to safely administer anesthesia to patients. This includes intravenous sedation, general anesthesia, and management of complications. This also includes complete training in Advanced Cardiac Life Support. Most states have very strict guidelines regarding the administration of anesthesia in the office to ensure patient safety. Your doctor, as most oral and maxillofacial surgeons, follow the guidelines and protocols set forth by our state medical and dental regulatory body. By doing so, our office is regularly inspected. All surgical staff at HPOMS are certified in CPR.

The oral and maxillofacial surgeons at HPOMS have advanced training in all aspects of anesthesia and emergency care. We provide our patients with highest standards of care and availability of the latest techniques and medications. It is our utmost goal to make your surgical experience as pleasant and stress free as possible while maintaining the highest levels of safety.

During the initial consultation you and your oral surgeon will discuss the type of procedure involved, your medical history and your level of anxiety. Some procedures due to their nature are easier with  the use of IV Anesthesia, whereas others are best accomplished under local anesthesia. The choice of anesthesia is always a personal decision and should be made only after an informative consultation with the oral and maxillofacial surgeon. In addition, during the initial consultation, you will also be given instructions to prepare for surgery such as: wearing loose warm and comfortable clothing, not having anything to eat or drink for 6 hours prior to IV Anesthesia, taking all of your regular medications, bringing an escort with you and making arrangements for your recovery at home (preoperative instructions).

Although most of the more modern anesthetic medications are kind to the stomach and do not produce nausea, occasionally just the anxiety that one has about having surgery can generate a queasy feeling in one’s stomach. A patient who becomes sick with a full stomach could present a potentially dangerous scenario of choking. Therefore, it is important to follow all pre-operative instructions. The medications used for sedation do persist in the blood stream for up to 24 hours. Therefore it is understood that you MUST NOT operate a vehicle or operate machinery for 24 hours after receiving sedation or general anesthesia.

Our registered staff are also available to answer any specific questions you may have in regards to the anesthetic. The benefits of IV Anesthesia include a decrease in anxiety and awareness during the surgery. This translates into near or total amnesia of the procedure, lack of noise perception and no pain. During the procedure it is important to note that patients are still given local anesthetic to "numb" the area.

After surgery, your oral and maxillofacial surgeon can prescribe a number of medications to make you as comfortable as possible when you get home.

Which Anesthetic is right for you?

Local Only?

Everyone undergoing a surgical procedure will receive a local anesthetic.  Initially a topical paste will be applied to the injection site to help minimize discomfort.  You will feel pinches from the needle which will render the surgical site insensitive to pain.  During the procedure you will still feel pressure, in some cases a significant amount, but should not feel pain.

Local plus Nitrous Oxide (Laughing Gas)?

Nitrous Oxide can be administered prior to the initial injections, and in most cases, dulls the sensation of the needle.  You will likely have a "floaty" tingly feeling.  You will be aware and awake during the procedure.  In some cases, patients become so relaxed that they doze off,  yet in other cases, patients may not feel much relaxation at all.  You will feel pressure during the procedure, but it should be dulled, and like with local anesthetic alone, you should not experience pain.  There are some patients that aren't affected much by nitrous oxide, and a small percentage of patients may actually feel some nausea.

Local plus Nitrous Oxide (Laughing Gas) and Oral Sedation?

You will be given a prescription for a sedative tablet to be taken one hour prior to your scheduled appointment which will make you somewhat drowsy and relaxed.  You will then be administered nitrous oxide prior to the injections and should be in a very comfortable, relaxed state, so that you hardly notice the pinches.  Patients occasionally drift off while waiting for the numbness to take effect, and generally do not mind what takes place during the procedure.   Again, you will experience some pressure from the extraction.  You will be required to have a driver for this appointment.

IV Sedation/General Anesthesia?

In most cases, you will be given a prescription for a tablet of a mild sedative to be taken 45 minutes prior to your appointment, which may make you somewhat drowsy and relaxed.  You doctor will clean an area inside your arm with alcohol, then spray a very cold liquid to dull the pinch of the IV catheter.  You will be given medications through the IV that will put you into a nice "fog" or "twilight sleep."  Local anesthetic will then be administered to numb the area, and in most cases, patients don't even realize that the procedure was done.  You may occasionally hear voices or notice some pressure during the procedure, but most patients don't remember this.  Intravenous sedation affects people differently, and your Doctor will be monitoring your blood pressure, heart rate and respirations.  If he/she feels that at any time the sedation is adversely affecting any of these vital signs, he/she may lighten the sedation for your safety.  The sedation in the office is different than a hospital anesthesia (where a breathing tube is inserted down the throat, you are hooked up to a ventilator and often paralyzed).  When the procedure is completed, you may be moved to a recovery room where you will be monitored until you can walk with minimal assistance; then released to a responsible party.  You will be required to have a driver(over the age of 18) and an empty stomach (NO eating 6 hours prior and no drinking 2 hours prior) to your appointment. To do otherwise may result in rescheduling your appointment.