The options of local anaesthetic only, local anaesthetic and intravenous sedation and treatment under general anaesthetic will be discussed with you. Each has its own merits.
Modern day intravenous sedation provides a wonderful environment for minor oral surgery procedures to be carried out. Essentially, a small cannula is placed into a vein and a sedative agent is administered which causes the patient to ‘drift off’, although spontaneous breathing and a degree of communication are maintained. The sedative agent removes all anxiety and is powerfully amnesic so that the procedure seems to happen in an instant! Local anaesthetic is always used so that there is no discomfort afterwards. Effective painkillers are prescribed and most patients have a very smooth recovery with minimal discomfort.
Local anaesthetic provides pain control but not anxiety control. It is my opinion that local anaesthetic by itself does not provide an optimal environment for many oral surgical procedures.
A general anaesthetic on the other hand, is more invasive and has to be carried out at a day care hospital. It should therefore be used for more difficult surgeries or when the medical status of the patient requires a hospital environment. For the uninsured patient, a general anaesthetic may also be very expensive.
By contrast, in-surgery sedation is a safe, cost effective way of providing pain free treatment and eliminates all the anxiety normally associated with surgical procedures.
Sedation in dentistry in Australia is currently very well regulated. The recently formed Dental Board of Australia requires that all dental sedationists are Board registered (endorsed) and appropriately qualified (Grad Dip Clin Dent). Sedationists are required to attend an annual, one day training program in dental emergencies as well as fulfil continuing professional development (CPD) requirements to remain endorsed. In addition, the ACT Department of Health requires the licensing of all premises (Licensed Health Care Facilities) that provide sedation services, be they medical or dental. The Department carries out an annual audit of sedation premises, which includes examination of records, emergency drugs and equipment, monitors, cross infection control protocols, staffing requirements and annual currency in CPR training. We fully comply with all of these requirements.