Does This Surgery Require Sedation?
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I need to have a rear bottom molar extracted. I had a root canal years ago, the tooth cracked, and we tried building it up but it cracked again. My dentist thinks it would be best to extract it now. The dentist's office recommends IV sedation for the extraction rather than having the area numbed. Something was said about a bundle of nerves in that area of the jaw that could be damaged. Is this true? I'd feel more comfortable being numb than being put to sleep.
— Barbara, Pennsylvania
It is extremely common to have a molar, or front tooth, extracted with just topical anesthetic and local anesthesia. I've been in practice as a periodontist for the last 28 years and have personally never administered IV sedation. In a few cases - typically around one or less per year — patients have demanded IV sedation, but this is mostly for psychological reasons. In those rare instances, I bring in a board-certified anesthesiologist to administer the sedation. Generally, I perform surgical extractions, periodontal surgery, and implant therapy using local anesthesia.
A number of dentists use IV sedation for various procedures, including implants, periodontal surgery, and extraction of impacted teeth, and there is nothing wrong with that — for many people it creates a very comfortable environment. We all know the benefits of being sedated — you don't hear, see, smell, or in any way become involved in the procedure you're undergoing. Many dentists are qualified to administer IV sedation, and new medications are both fast-acting and safe. Of course, any systemic anesthesia poses a risk of complications. There are too many to list here, but very few dental offices would be able to handle some of them as well as a hospital or other medical facility.
It is very important that you know that whether you have IV sedation or not, your jaw will must be numbed with local anesthesia. I don't understand or agree with the comment that local anesthesia presents a greater risk of damaging the bundle of nerves near the jaw. This is a very unlikely possibility, but its occurrence would not be precluded by IV sedation. The odds that you would sustain nerve damage from an injection or from the extraction are extremely low.
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