Introduction
This section will attempt to answer some of the questions that you might have concerning sedation and general anesthesia. Of course, I would be happy to answer further questions that you might have regarding anesthesia either by phone or email. Your dentist/surgeon has determined that sedation or general anesthesia will benefit you for your dental treatment and we will do what we can to make this as comfortable an experience for you as we can.
Sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Memory recall of the procedure is usually minimal and time passes quickly.
General anesthesia, in simple terms is a state of unconsciousness, where the patient is unaware of the dental surgical procedure that they are undergoing and are not arousable. The unconscious state requires close and continuous monitoring of the patient’s blood pressure, heart electrical activity, breathing, oxygen levels, and temperature. Dentist anesthesiologists are trained to vigilantly monitor these parameters as well as to administer medications which keep patients at a safe level of anesthesia.
In the very unlikely event of an emergency such as cardiac arrest, dentist anesthesiologists are trained and prepared to manage these situations that may arise. General anesthesia is tightly controlled by the California Dental Board and only issues permits to those individuals who meet the qualifications set forth by the Board (E.g., completed residencies). Therefore, general anesthesia is safe as long as the individual providing the anesthesia is knowledgeable, the medical health history is accurate, and preoperative instructions are followed exactly as prescribed.
If sedation or general anesthesia is suggested for you, you will be asked to fill out a medical history form and read an informed consent document which details the risks, benefits, as well as alternatives to sedation or general anesthesia. The medical history form will be sent to Dr Krall who will review the information and determine if you are a candidate for office-based sedation or general anesthesia. Dr Krall will call you several days before the appointment and review the history with you and answer any questions that you might have concerning the appointment. In some situations where there is uncertainty on the medical diagnosis, Dr Krall may request consultation by your primary care physician (or other specialist) before the surgery appointment.
Pre-Operative Instructions
Eating and drinking:
It is extremely important that patients undergoing sedation or general anesthesia have an empty stomach on the day of treatment. Vomiting and subsequent aspiration of stomach content during anesthesia may be life threatening. In most cases, violation of fasting guidelines necessitates rescheduling the dental surgery for another day.
- Solids- no food up to 8 hours before appointment
- Liquids- clear liquids (no pulp) such as water, apple juice and gatorade are allowed up to 2 hours before appointment
Illness:
If you develop a cold, flu, or cough, please call the office. In most cases we will cancel the appointment and reschedule in 2-4 weeks.
Medications:
If you take any prescription medications, Dr Krall will discuss with you whether or not this medication should be continued. Most medications should be taken on the day of surgery. Oral medications should be taken with a couple teaspoons of water.
Clothing:
A loose fitting, short sleeved shirt is appropriate for the appointment. If the weather is cold, please dress warmly in layers to keep the extremities warm. Cold extremities result in small veins which make it difficult to start an intravenous line. Please bring an older blanket which will be used to keep you warm during the procedure. Please remove any cosmetic makeup on the day of surgery, including nail polish as this affects the reliability of certain monitors.
Adult Escort:
A responsible adult must accompany you to the office and remain there during the procedure and escort you home after you have met discharge criteria. Also, a responsible adult must stay with you throughout the remainder of the day.
Day of Appointment
On the day of appointment, please arrive 15-30 minutes early. Dr Krall will review the medical history, confirm that the fasting guidelines have been adhered to, and review the risks, benefits, and alternatives to sedation or general anesthesia. After answering all questions, completion of a pre-procedural physical exam (heart, lung, and airway assessment), standard monitors will be placed, baseline vitals taken and supplemental oxygen given. An intravenous line will be placed, usually in the back of the hand or upper arm and at this point, medications will be titrated according to your response.
Your cardiovascular/pulmonary function and depth of anesthesia will be continually monitored closely throughout the procedure. When the treatment is complete, you will remain in the treatment area for recovery. You will be able to go home when all post-op instructions are understood, your vital signs are stable and you are alert and oriented.
Post-Operative instructions
Eating, Drinking, and Smoking
Limit oral intake to liquids for the first few hours. Begin with water and follow with sweet liquids such as sports drinks, clear juice and soda as tolerated. If teeth were extracted, do not use a straw. Food can be consumed once liquids are tolerated. Suggestions include scrambled eggs, applesauce, yogurt, mashed potatoes, and soups. If you are not hungry, do not eat, but try to take liquid as tolerated. Absolutely no alcoholic beverages and/or smoking for 24 hours following anesthesia.
Activities
Do not drive and/or engage in moderate to high level physical activity for 24 hours or until the effects of the anesthetic have completely subsided. Judgment may also be impaired during this time, so please avoid making any major life decisions.
Pain or Fever
Muscle aches and a sore throat may occur similar to the flu following anesthesia. These symptoms are very common and will usually disappear within 24 to 36 hours. Medications such as Tylenol and Advil are usually very effective and should be taken at the first sign of pain.
Seek Advice
If vomiting occurs and persists beyond 8 hours, if temperature remains elevated beyond 24 hours, or if you have other serious concerns following anesthesia, please contact: Dr. Krall at (909) 835-7940 or (909) 824-3464. In the event of a serious medical emergency, please call 911.
Financial Information
Insurance coverage for dental procedures under anesthesia is quite variable. Most dental and medical insurance plans do not cover anesthesia services for dental procedures. However, some medical plans cover dental procedures in certain patient populations (age < 7, special needs etc). Therefore, it is important to check with your insurance representative to see if anesthesia is a covered expense. If dental insurance covers anesthesia services, the cost of the treatment often exceeds the yearly plan maximum and therefore, the patient would be responsible for the balance. The estimated anesthesia fee is based upon the dentist/surgeon’s estimated procedure time, plus the time for induction and recovery from anesthesia. Depending on how much time the dentist/surgeon actually takes to complete the procedure, the actual charge may be greater than or less than the estimate. Your treating dentist/surgeon will give you his/her best estimate on the time necessary for treatment. If the fee is less than the estimate, you will be promptly refunded the balance. If the treatment time goes over the estimate, the balance will be collected at the end of the procedure. Because insurance usually does not pay for anesthesia services, Dr Krall does not directly bill medical or dental insurance. Dr Krall will generate a detailed Anesthesia Services Billing Statement at the conclusion of the procedure, if requested. This form has the necessary coding to submit to your insurance for reimbursement and Dr Krall will be happy to help you complete the insurance form if necessary. [/tab] [tab title="Scheduling"]
Scheduling Information
Dr Krall does not provide dental treatment and therefore coordinates with dental colleagues to provide the dental care. After contacting your dentist/surgeon and scheduling an appointment in their office, the office will contact Dr Krall directly to schedule a date and time that works for all.
Patient Related Forms
Please use the following links to download patient forms.
