Sedation/ General Anesthesia

What is Oral Sedation?
What is Intravenous Moderate (Conscious) Sedation?
What is General Anesthesia?
Which technique or medication will be administered to my child?
How will my child or I be monitored during sedation or general anesthesia?
Who may benefit from these techniques?
Do dental specialists provide specialty dental services in this office?
Why choose to have treatment with general anesthesia in our office rather than the hospital?
When will a patient be discharged after receiving sedation or general anesthesia?
Who administers the sedation or general anesthesia?

What is Oral Sedation?

Oral sedation is a management technique that utilizes oral medications and sometimes nitrous oxide (laughing gas) to create a state of conscious sedation (relaxation and at times unawareness). This technique is advantageous for patients that have mild anxiety and fear. This technique may be used for children and adults depending upon the behavior of the child and level of anxiety of the adult patient. Oral sedation is not recommended for very young children.

What is Intravenous Moderate (Conscious) Sedation?

Intravenous moderate (conscious) sedation is a technique that utilizes intravenous agents and sometimes nitrous oxide to help relax a patient that is anxious. This is a good technique for patients that have mild to moderate anxiety or fear of dental procedures. This technique is also advisable for adult patients who require a great deal of dental treatment and wish to have more treatment completed in fewer visits. Patients treated with moderate (conscious) sedation usually have little to no memory of the dental procedure being performed.

What is General Anesthesia?

General Anesthesia is an anesthetic management technique, which uses intravenous and/or inhalation agents to render a patient completely unconscious (asleep) for the dental procedure. This technique is recommended for very young children, the very resistant child, severe dental phobics, special needs patients who are unable to cooperate for dental treatment and patients who require a great deal of dental care with and without surgical procedures.

Which technique or medication will be administered to my child?

The pediatric dentist treating your child will discuss with you which of the techniques and medications are most advisable for your child. If Dr. Epstein, a dentist anesthesiologist, will be administering the anesthesia he will also discuss the anesthetic technique, pre-anesthesia instructions and medical evaluation if necessary. All of your questions will be answered during this consultation.

How will my child or I be monitored during sedation or general anesthesia?

During sedation or general anesthesia, the doctors providing the care monitor as required by the New York State Education Department and adhere to the guidelines of the American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA). Dr. Mary George has been Chairperson of the AAPD Subcommittee on Sedation and a member of the Committee on Anesthesia for the ADA. Dr. Ralph Epstein has also been a member of the Committee on Anesthesia for the ADA and a member of the New York State Board for Dentistry of the New York State Education Department. Specific types of monitoring that may be utilized, depending upon the level of sedation and the agents administered are: pretracheal stethoscope, end-tidal gas analysis, pulse oximetry, EKG, blood pressure, temperature, agent analysis and BIS. BIS, which monitors the level of consciousness, is one of the newest types of monitoring. Although many hospitals are still not utilizing this technology, BIS monitoring more accurately identifies the point at which the patient has no recall and therefore allows the correct amount of anesthesia to be administered. Patients wake up faster with fewer side effects because of this determination.

Who may benefit from these techniques?

Very young uncooperative children who require multiple fillings may be unable to sit for treatment. By providing dental care with general anesthesia, all of the child's treatment can usually be completed in one visit. This allows the child to experience minimal discomfort and to return in six months as a good dental patient.

Fear, Anxiety and Phobia:
One of the major reasons why patients don't go, or delay going to the dentist is severe fear and anxiety. In some cases, patients have a dental phobia and refuse to go to the dentist until they are in so much pain that they have no other choice. Their treatment by this time is usually irreversible, such as extractions. Patients that have these problems are well treated with conscious sedation or general anesthesia. We also have great success working with psychologists who have a special interest in treating patients with dental fears and phobias.

Low Pain Threshold & Inability to Get Numb:
There are many patients who have a low pain threshold and others who are unable to get numb with local anesthesia injections. These patients are good candidates for intravenous moderate (conscious) sedation. In some situations, general anesthesia may be recommended.

Extensive Treatment:
Child and adult patients who require a great amount of dental care can have that care provided in a shorter amount of time under moderate (conscious) sedation or general anesthesia. For example, if a patient has several teeth that require root canal treatment, all these teeth can usually be treated in one visit while the patient is treated with moderate (conscious) sedation or general anesthesia. This enables the patient to combine multiple visits into one.

Special Needs Patients (Physically and Mentally Challenged):
It is not unusual for special needs patients: (i.e., Autistic, PDD) to require general anesthesia for their treatment. Many of these patients are treated without moderate (conscious) sedation or general anesthesia because the dentists of Distinctive Dental Services of New York, P.C. are well trained and experienced in treating special needs patients. When general anesthesia is required, one of the pediatric dentists can provide the dental care while Dr. Epstein, a dentist anesthesiologist, administers the general anesthesia. When adult patients require general anesthesia, Dr. Zimbardi and Dr. David, our general dentists, will provide the dental care.

Medically Compromised:
There are many people who have medical problems that include for example, a neurologic or cardiac diagnosis. Patients with assorted neurological diagnosis have uncontrolled movements which make dental treatment without sedation or general anesthesia impossible. Patients with some cardiac problems are better treated with sedation, which can reduce cardiac stress during treatment. Due to some cardiac problems patients may require intravenous antibiotics. Dr. Epstein can administer these intravenous antibiotics for dental treatment provided in this office.

Do dental specialists provide specialty dental services in this office?

Dr's. Mary George, Paul Elkin, and Gina Sajnani are pediatric dentists who provide pediatric dental care for patients administered oral moderate (conscious) sedation, intravenous moderate (conscious) sedation and general anesthesia. When other dental specialists are required to provide dental services under sedation or general anesthesia, we can arrange to have those specialists provide care during the scheduled anesthetic. These specialists include endodontists, oral surgeons and periodontists.

Why choose to have treatment with general anesthesia in our office rather than the hospital?

Your dental treatment is a priority in our office. Treatment with general anesthesia is easier to schedule in our office and can be scheduled early in the morning. Unfortunately, dentistry in the hospital operating room is not a priority and therefore treatment may not occur until the afternoon. The dental materials used in our office are of the highest quality. When the dentists are providing dental care with general anesthesia in our office, they are sitting down as they typically provide care; in the hospital they are standing around an operating room table, which makes treatment more difficult to perform. Most radiographs taken in our office are digital, which means less radiation and an increased ability to diagnose problems. If your child is being treated with general anesthesia in our office, you can be with him or her until they fall asleep. When the treatment plan is fully developed you will be informed of the treatment required. Our staff will keep you informed of the progression of treatment and when the treatment will be completed. When your child awakens from the general anesthesia you can be with him in our recovery room.

When will a patient be discharged after receiving sedation or general anesthesia?

Patients that have received sedation or general anesthesia in our office are discharged only when they have met strict discharge criteria. The dentists providing care to the sedated or anesthetized patient will be in contact with you following the procedure. They can also be contacted in the office or through the answering service.

Who administers the sedation or general anesthesia?

Oral Sedation:
All of the dentists in our office have postgraduate training and many years of experience in administering oral sedation

Intravenous Sedation and General Anesthesia:
Dr. Ralph H. Epstein, a dentist anesthesiologist, will provide this service. Dr. Epstein received two years of general anesthesia training and has been providing this type of service in private practice since 1981. He is licensed by the New York State Education Department to administer intravenous sedation and general anesthesia. Please click on Our Dentists to read more about Dr. Epstein's professional background as a dentist anesthesiologist.