EndoAsleep

Why Sedation or General Anaesthesia?

There is certainly a negative bias in society towards root canal therapy. It has the reputation of being very painful. We recognize that fear of pain is a primary concern for patients. We employ advanced techniques in local anaesthesia (“dental freezing”) to minimize the risk that the root canal treatment will be a painful experience. Because of the dual nature of his training, Dr. Moncarz lectures to other dentists as to how to achieve profound local anaesthesia, even in patients who have difficulty getting frozen, or who have very painful teeth.

Despite this reassurance, there are many reasons why a patient might choose to have root canal therapy under sedation or general anaesthesia. It is well recognized that there are several potentially difficult psychological and physical aspects to receiving dental care. Some of the issues that our patients report include:

a negative dental experience in the past (often as a child)
fear of the sound of the drill
difficulty with receiving injections in their mouth
a history of difficulty in getting, or staying “frozen” during a long procedure
an inability to tolerate the rubber dam over the mouth due to claustrophobia
limited mouth opening
a pronounced gag reflex
difficulty in laying back for an extended period of time
a complicated medical history

Types and levels of sedation and anaesthesia

Most successful sedations and office-based general anaesthetics are dependent on profound local anaesthesia (“the needle” or “the freezing”). Because of the unpleasantness often associated with this part of the procedure, the local anaesthetic is administered once the patient is already sedated. As such, patients have little perception and recollection of the event.

1. Conscious sedation

This level of sedation relaxes patients, allowing them to remain awake, yet to be dissociated sufficiently so as to minimize stress or discomfort during the procedure. This level of sedation is usually accomplished with the use of a small pill given at the office prior to the procedure, or with nitrous oxide (laughing gas).

2. Deep sedation

Deep sedation is sometimes described as “twilight sleep”. An apt analogy is the sensation one experiences near wake-up time in the morning. Although not quite awake, one is somewhat aware of the surroundings. For example, a song playing on the radio might influence one’s dream. This level of sedation is appropriate for patients who have anxiety about root canal procedures, but who also have anxiety about the thought of having a general anaesthetic. It is also a good option for patients who are not candidates for an office-based general anaesthetic but who wish to be heavily dissociated for the procedure. This level of sedation is usually accomplished with medications administered through an IV.

3. General Anaesthesia

General anaesthesia allows patients to be completely unaware during treatment. Unlike a hospital-based general anaesthetic, patients generally do not have a breathing tube placed in their throat in our office. General anaesthesia is the best option for patients who are very anxious or dental phobic. It is accomplished by administering medication through an IV. Since the effects are so rapid by this means of administration, Dr. Moncarz can precisely give the correct amounts of the medications to make you relaxed and comfortable.

Patients who are anxious about receiving an IV may be given a sedative pill in the dental office 45 minutes prior to the appointment. An anaesthetic patch (EMLA) can also be placed on the skin by the patient 1 hour before the appointment. This patch will numb the skin making IV placement more tolerable.

Patient Safety

The use of sedation and anaesthesia in dentistry has a commendable record of safety. This is due to the advanced training Dr. Moncarz has and his commitment to your overall health. It is important to advise us of all medications that you take as well as any changes in your health since your last visit.

Your health history will be taken at the consultation appointment. Additional information may also be needed from your physician prior to your root canal procedure under anaesthesia. Some patients with hypertension, heart disease, asthma, lung disease, obesity, sleep apnea and other medical conditions may not be suitable candidates for sedation in a dental office.

Anaesthesia Fee

The anaesthesia fee is based on the time required for induction, completion of root canal treatment and recovery. The medications that are administered are all short acting, so you will awaken shortly after the dental work is completed. You will then be monitored for an additional 30-60 minutes to ensure that you can be safely discharged. An estimate of the duration of the procedure and the fee will be given to you prior to the sedation appointment. Payment in full is required on the day of the procedure.

Pre-anaesthesia Instructions

Before the Procedure:

Come to your appointment with a responsible adult who can drive you home. The sedation appointment will not start without an escort. You may not take public transportation home.
You must not have anything to eat or drink 8 hours prior to your appointment.
Take any regular medications on the morning of your procedure as directed by Dr. Moncarz with a small sip of water.
Wear loose comfortable clothing. Short sleeves are preferred to allow for monitor and IV placement.
Do not wear jewelry or contact lenses.
Use the bathroom before your appointment.
Apply the anaesthetic patch (EMLA cream) one hour prior to your appointment on the backs of both hands.

Post-anaesthesia instructions

Following the Procedure:

Get plenty of rest.
Drink plenty of fluids.
Avoid strenuous activity.
Avoid alcohol or other sedative medications for 24 hours.
Do not drive or operate heavy machinery for 24 hours.
Do not make important decisions.
Eat light, easily digested foods.

Pain Control

Pain control is very important in the post-operative period. It is better to avoid pain rather than to deal with it once it has presented. Dr. Moncarz may recommend that you take pain medications prior to the freezing wearing off. Various medications are used to control pain. Options for non-prescription pain medications include:

Ibuprofen 600 mg every six hours (three 200 mg Advil or generic equivalent)
Acetaminophen 1000 mg every four to six hours (two extra strength Tylenol)

Please note: Non prescription pain medication may have serious side effects. Take only the pain medication recommended by Dr. Moncarz. If you have concerns about pain control, please call us immediately at 416-223-1771.