sedation or general surgery, and certain oral or
periodontal surgery procedures. Most routine
informed consent can be easily accomplished during
the verbal verification of diagnosis and treatment
PAIN AND ANXIETY CONTROL
When dental surgery is indicated, whether oral or
periodontal, there are several pain and anxiety control
methods available to make the surgery as smooth as
possible and put the patient at ease. The three basic
levels of anesthesia are local, conscious sedation, and
general. You should review Dental Technician,
Volume 1, Chapter 7, "Oral Pharmacology," to help
you better understand the following information
The primary effect of local anesthetic agents is to
penetrate the nerve cell membrane and block the
conduction of nerve impulses from the point where the
local anesthetic is active. This produces anesthesia in
the local area. Local anesthesia, using infiltration,
nerve block, or a combination of both techniques, is
used in surgery cases to numb the surgery area.
Most dental surgery procedures require two or
more injections of a local anesthetic. For this reason, it
is a good practice to include two aspirating syringes
with each instrument setup. This will let you supply
the dentist with a loaded anesthetic syringe for as long
as needed with minimum loss of time. Since anesthetic
solutions are bitter and there is leakage from the
injection sites, you will need to irrigate and aspirate the
fluids from the patient's mouth after injection.
Conscious sedation is a minimally depressed level
of consciousness that retains the patient's ability to
independently and continuously maintain an airway,
and respond appropriately to verbal commands.
Conscious sedation involves using various drugs or a
combination of drugs to achieve pain and anxiety
control while maintaining the patient in a conscious
state at all times. The common routes of administration
of conscious sedation are oral premeditation,
inhalation, and intravenous. Local anesthesia is
administrated with all types of conscious sedation.
General anesthesia is a controlled state of
unconsciousness accompanied by a partial or complete
loss of protective reflexes, including the ability to
maintain an airway independently and respond to
verbal commands. General anesthesia renders the
patient unconscious through depression of the central
nervous system, thus eliminating patient cooperation
as a factor. The administration of general anesthesia is
performed by an anesthesiologist in the hospital
operating room. Local anesthesia is also administered
at the treatment site.
ORAL SURGERY PROCEDURES
While there are many oral surgery procedures,
some are more commonly performed than others. You
should be knowledgeable of those that are commonly
performed. In the following paragraphs, we discuss
surgical procedures you will need to know.
Tooth extraction is an oral surgery procedure
classified into three types: simple, complicated, and
impacted extractions. These are explained briefly in
the following paragraphs.
Simple extractions involve removal of a tooth or
root that does not require bone removal or sectioning.
The deciduous (nonpermanent) or permanent tooth
extracted is erupted and usually diseased or malposed.
Retained roots may be buried in the tissue and not
visible in the oral cavity. Retained root tips may be
present because of fractured teeth, advanced decay, or
any incomplete post-surgical procedure. They can be
identified on radiographs.
Complicated extractions involve removal of a
tooth or root that requires surgical sectioning and/or
Impacted extractions involve removal of a tooth
that is partially or completely covered by bone and or
This extraction may involve tissue
incision, excision, or bone removal. Two types of
impactions are associated with oral surgery: soft tissue
and bony impaction.
Soft tissueoccurs when the tooth is blocked
from eruption due to the gingival tissue. It may be
partially erupted with a portion of the tooth visible in the