Understanding Dental Anesthesia: What Every Patient Should Know
Providing you with high-quality, appropriate care and making your dental visit as comfortable as possible are top priorities for the 143,000 members of the American Dental Association (ADA). Advances in dental techniques and medications can greatly reduce – even eliminate – discomfort during dental treatment, and your dentist and the ADA want you to know about them. Here are some of the options available to help alleviate anxiety or pain that may be associated with dental care:

Non-narcotic analgesics are the most commonly used drugs for relief of toothache or pain following dental treatment. This category includes aspirin, acetaminophen and non-steroidal anti-inflammatory drugs such as Ibuprofen.
Narcotic analgesics, such as those containing codeine, act on the central nervous system to relieve pain. They are used for more severe pain.

Local Anesthesia
Topical anesthetics are applied to mouth tissues with a swab to prevent pain on the surface level. Your dentist may use a topical anesthetic to numb an area in preparation for administering an injectable local anesthetic. Topical anesthetics also may be used to soothe painful mouth sores.

Injectable local anesthetics, such as Novocain, prevent pain in a specific area of your mouth during treatment by blocking the nerves that sense or transmit pain and numbing mouth tissues. They cause the temporary numbness often referred to as a fat lip feeling. Injectable anesthetics may be used in such procedures as filling cavities, preparing teeth for crowns or treating gum disease.

Sedation and General Anesthesia
Anti-anxiety agents, such as nitrous oxide, or sedatives may help you relax during dental visits and often may be used along with local anesthetics. Dentists also can use these agents to induce conscious sedation, in which the patient achieves a relaxed state during treatment, but can respond to speech or touch. Sedatives can be administered before, during or after dental procedures by mouth, inhalation or injection.

More complex treatments may require drugs that can induce deep sedation, causing a loss of feeling and reducing consciousness in order to relieve both pain and anxiety. On occasion, patients undergo general anesthesia in which drugs cause a temporary loss of consciousness. Deep sedation and general anesthesia may be recommended in certain procedures for children or others who have sever anxiety or who have difficulty controlling their movements.

The ADA provides guidelines to help dentists administer pain controllers in the safest manner possible. Dentists use the pain and anxiety control techniques mentioned above to treat tens of millions of patients safely every year. Even so, taking any medication involves a certain amount of risk. That's why the ADA urges you to take an active role in your oral health care. This includes knowing your health status and telling your dentist about any illnesses or health conditions, whether you are taking any medication (prescription or non-prescription), and whether you've ever had any problems such as allergic reactions to any medications. It also includes understanding the risks and benefits involved in dental treatment, so that you and your dentist can make the best decisions about the treatment that is right for you.

Understanding the range of choices that are available to relieve anxiety and discomfort makes you a well-informed dental consumer. If you have questions or concerns about your oral health care, don't hesitate to talk to your dentist. If you still have concerns, consider getting a second opinion. Working together, you and your dentist can choose the appropriate steps to make your dental visit as safe and comfortable as possible and to help you keep a healthy smile.

Talking Points: A Note about Sedation
Conscious sedation, deep sedation and general anesthesia in the dental office are safe and indispensable options – especially for children and other people with special needs who could not otherwise receive essential treatment. Without effective pain and anxiety control, it would be virtually impossible for many patients to get the dental care that they need.
One tragic outcome is one too many. We are committed to advancing the art and science of all oral health care services and reducing risk, recognizing that we can never completely eliminate risk in health care.
Patient safety is our bottom line. That means that only properly trained and equipped dentists should provide conscious sedation, deep sedation and general anesthesia.
Information is the key to safety. We provide and continually update information to help dentists provide conscious sedation, deep sedation and general anesthesia as safely as possible. It is equally important that patients understand the benefits and risks of these services.

Dental Anesthesia Questions and Answers

Q: What about the tragic cases?
There is no loss more devastating than the loss of a child or loved one, and nothing anyone can say can ease the pain of that loss. One tragic outcome is one too many. As a profession, we are committed to advancing the art and science of all oral health care services and reducing risk, recognizing that we can never completely eliminate risk in health care.

Q: What are you doing to make sure there are no more deaths?
A: First, we're making sure that dentists have the information that they need to provide anesthesia and pain control in the safest possible manner. We establish tough, science-based guidelines for anesthesia and sedation in dentistry. And our guidelines don't gather dust – as new information becomes available, we update both the profession and the state boards that regulate dental practice. We also provide information to consumers, to help them make informed choices about their oral health care. As a profession, we're committed to advancing the art and science of dentistry and reducing every possible risk, recognizing that we can never completely eliminate it in health care.

Q: How can you defend dentists who don't practice safely?
A: We don't – we condemn unsafe practices in the strongest possible terms. Just this year, the ADA updated its existing policy to reaffirm that, and I'm quoting here, state dental boards have a responsibility to ensure that only dentists who are properly trained, expe4rienced and currently competent are permitted to use (any form of) anesthesia. W e believe that anyone who flaunts safety rules and endangers a patient should not be practicing dentistry.

Q: Don't you feel responsible for these deaths?
A: No. What we feel is a profound sadness. There is no loss more devastating than the loss of a child or loved one. We are committed to advancing the art and science of all oral health care services to minimize the risks, recognizing that we can never completely eliminate them.

Q: Why is the ADA so slow to take away the licenses of dentists?
A: The ADA does not have licensing authority. Licensing is the responsibility of the state boards of dentistry – these are state regulatory bodies and not to be confused with the state dental associations. The ADA and state dental associations are membership organizations. Just as the American Automobile Association can't revoke your driver's license, the dental association can't revoke a license to practice dentistry.

Q: What are you doing to ensure that bad dentists don't continue to practice?
A: That's not our role. By law, we must rely on the state boards of dentistry to revoke a dentist's license. Our role is to promote the safe practices that prevent tragic outcomes. And we believe information is the key to safety. We set guidelines for safe practice and update those guidelines as new information comes to light. And we want patients to have the information that they need to make smart decisions about their health care.

Q: Has a wrist-slap disciplinary action been taken by the state board?
A: That's a question for the state board and perhaps for the lawmakers who appoint the board. We're not privy to all of the evidence that the board had. And no matter how we might feel personally, it's not our role to second-guess the state authorities. What we can do is to promote the safe practices that will help keep tragedies from occurring in the first place. W e do that by providing tough, specific guidelines for anesthesia and pain control and by encouraging state dental boards to make those guidelines the law of the land.

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