Anesthesia options
Managing anxious patients
Pre-surgical instructions
Antibiotic prophylaxis

Anesthesia options
There are three anesthesia options: IV sedation, nitrous oxide, and local anesthesia. IV sedation is the most recommended and best option chosen by most patients. It can be safely administered to patients of all ages, from five to 85. Most patients recover by the following day. Very simple extractions and biopsies may be performed with nitrous oxide or local anesthesia as long as the patient is not very anxious. For children with simple extractions, IV sedation or nitrous oxide are the appropriate options. Some children appear cooperative and calm, but their anxiety can quickly rise at time of the surgery. It is best to always inform parents of the potential IV sedation needs and prepare them accordingly.

Managing anxious patients
Anxiety is not uncommon for patients having oral surgery. Recommend IV sedation anesthesia and let them know about our personable and calming staff and atmosphere. You can further elaborate on our unique techniques (minimally invasive approaches) that speed up recovery and minimize pain and swelling in most patients.

Pre-surgical instructions

  • Take all routine medications as normal (except anticoagulants and bisphosphonates)
  • Do not smoke
  • Avoid food or liquids for 8 hours prior to surgery
  • Have an escort (older than 18)
  • Patients on Coumadin are advised to stop the medication 72 hours before surgery if approved by their physician
  • Patients on oral bisphosphonates are advised to stop three months before surgery if approved by their physician and the procedure is not emergent or urgent; in an emergency, the procedure may be performed with informed consent
  • Antibiotic prophylaxis is recommended for certain heart valve conditions and prosthetic joints (see below)

  • Antibiotic prophylaxis
    Pre-operative antibiotics are indicated only for patients with one of the following conditions (there may be history of heart murmur or not):

    1. Artificial heart valves
    2. History of infective endocarditis
    3. Some congenital heart defects, such as a completely repaired heart defect with prosthetic material or device
    4. Any repaired congenital heart defect or cardiac transplant which has developed a problem in a heart valve

    Antibiotics are NO LONGER NEEDED for the following types of patients (who say they have heart murmur):

    1. Mitral valve prolapse
    2. Rheumatic heart disease
    3. Bicuspid valve disease
    4. Calcified aortic stenosis
    5. Congenital heart conditions such as ventricular septal defect, atrial septal defect, and hypertrophic cardiomyopathy

    ** If any patient is unsure of their condition, get their physician’s telephone number and call to find out!

    Antibiotic regimen for prevention of infective endocarditis:

    • Not penicillin allergic — Amoxicillin 2 g, 60 minutes before surgery
    • Penicillin allergic — Cephalexin 2 g, Clindamycin 600 mg, Azithromycin 500 mg, or Clarithromycin 500 mg,  30-60 minutes before surgery

    Antibiotic regimen for prosthetic joints:

    • Not penicillin allergic — Amoxicillin 2 g, Cephalexin 2 g, or Cephradine 2 g, 60 minutes before surgery
    • Penicillin allergic — Clindamycin 600 mg, 60 minutes before surgery

    Antibiotic regimen for patients taking medications:

    • Insulin — If having IV sedation, the patient should take half of the normal insulin dosage in the morning. AM appointments are recommended.
    • Coumadin — If approved by their physician, stop the Coumadin 72 hours before surgery. The patient may get back on it the day after surgery.
    • Plavix — No changes are necessary, although some physicians may recommend to stop it for five days before surgery.
    • Aspirin — It may be beneficial to stop it 72 hours before surgery, but bleeding is usually not a significant concern, although it may take longer to stop.
    • Steroids — The patient should take double the normal dosage on the morning of the surgery.
    • Blood pressure medications: Continue on medications as prescribed. If having IV sedation, the patient may take them on the day of surgery with a small sip of water.