Understanding Dental Anesthesia: Types, Side Effects & Risks

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HealthlineSubscribeWhat You Need to Know About Dental Anesthesia

Medically reviewed by Christine Frank, DDS — Written by Malini Ghoshal, RPh, MS on December 13, 2019

Types
Side effects
Special precautions
Risks
Takeaway

Are you scheduled for a dental procedure and have questions about anesthesia?

Around 10 to 30 percent of people have anxiety and concerns about pain with dental procedures. Anxiety can delay getting treatment and that can make the problem worse.

Anesthetics have been around for over 175 years! In fact, the first recorded procedure with an anesthetic was done in 1846 using ether.

We’ve come a long way since then, and anesthetics are an important tool in helping patients feel comfortable during dental procedures.

With lots of different options available, anesthesia can be confusing. We break it down so you’ll feel more confident before your next dental appointment.

What are the types of dental anesthetics?

Anesthesia means a lack or loss of sensation. This can be with or without consciousness.

Today there are many options available for dental anesthetics. Medications can be used alone or combined for better effect. It’s individualized for a safe and successful procedure.

The type of anesthetics used also depends on the age of the person, health condition, length of the procedure, and any negative reactions to anesthetics in the past.

Anesthetics work in different ways depending on what’s used. Anesthetics can be short-acting when applied directly to an area or work for longer times when more involved surgery is required.

The success of dental anesthesia depends on:

the drug
the area being anesthetized
the procedure
individual factors

Other things that may effect dental anesthesia include the timing of the procedure. Research also shows that inflammation can have a negative impact on the success of anesthetics.

Also, for local anesthesia, teeth in the lower jaw (mandibular) section of the mouth are harder to anesthetize than the upper jaw (maxillary) teeth.

There are three main types of anesthesia: local, sedation, and general. Each has specific uses. These can also be combined with other medications.

Local anesthesia

Local anesthesia is used for simpler procedures like a cavity filling, which requires a shorter time to complete and is generally less complicated.

You will be conscious and able to communicate when you get a local anesthetic. The area will be numb, so you won’t feel pain.

Most local anesthetics take effect quickly (within 10 minutes) and last 30 to 60 minutes. Sometimes a vasopressor such as epinephrine is added to the anesthetic to increase its effect and to keep the anesthetic effect from spreading to other areas of the body.

Local anesthetics are available over the counter and as a prescription in gel, ointment, cream, spray, patch, liquid, and injectable forms.

They can be used topically (applied directly to the affected area to numb) or injected into the area to be treated. Sometimes, light sedation is added to local anesthetics to help relax a person.

Examples of local anesthetic
articaine
bupivacaine
lidocaine
mepivacaine
prilocaine

Sedation

Sedation has several levels and is used to relax a person who may have anxiety, help with pain, or keep them still for the procedure. It can also cause procedure amnesia.

You might be fully conscious and able to respond to commands, semiconscious, or barely conscious. Sedation is categorized as mild, moderate, or deep.

Deep sedation can also be called monitored anesthesia care or MAC. In deep sedation, you’re generally not aware of your surroundings and can only respond to repeated or painful stimulation.

The medication might be given orally (tablet or liquid), inhaled, intramuscularly (IM), or intravenously (IV).

There are more risks with IV sedation. Your heart rate, blood pressure, and breathing must be carefully monitored in moderate or deep sedation.

Medications used for sedation
diazepam (Valium)
midazolam (Versed)
propofol (Diprivan)
nitrous oxide

General anesthesia

General anesthesia is used for longer procedures, or if you have a lot of anxiety that might interfere with your treatment.

You’ll be completely unconscious, have no pain, your muscles will be relaxed, and you’ll have amnesia from the procedure.

The medication is given through a face mask or IV. The level of anesthesia depends on the procedure and the individual patient. There are different risks with general anesthesia.

general anesthesia medications
propofol
ketamine
etomidate
midazolam
diazepam
methohexital
nitrous oxide
desflurane
isoflurane
sevoflurane

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What are the side effects of dental anesthesia?

Side effects of dental anesthesia depend on the type of anesthetic used. General anesthesia has more risks involved with its use than local anesthesia or sedation. Reactions also vary based on individual factors.

Some reported side effects with sedation and general anesthesia medications include:

nausea or vomiting
headache
sweating or shivering
hallucinations, delirium, or confusion
slurred speech
dry mouth or sore throat
pain at the site of injection
dizziness
tiredness
numbness
lockjaw (trismus) caused by trauma from surgery; the jaw opening is temporarily reduced

Vasoconstrictors such as epinephrine added to anesthetics can also cause heart and blood pressure problems.

These are some reported side effects of anesthetics. Ask your dental care team about your specific medication and any concerns you may have about the medication.

Special precautions when taking dental anesthetics

There are conditions and situations in which you and your doctor or dentist will discuss if dental anesthesia is the best choice for you.

Treatment consent is an important part of the pretreatment discussion. Ask questions about risks and safety precautions that will be taken to ensure a positive outcome.

Pregnancy

If you’re pregnant, your dentist or surgeon will discuss risks versus benefits of anesthetics for you and your baby.

Special needs

Children and those with special needs require careful evaluation of the type and level of anesthetics they need. Children may need dose adjustments to avoid adverse reactions or overdose.

The Food and Drug Administration (FDA) issued a warning about numbing agents commonly used for teething pain. These products are not safe for use in children under age 2. Do not use these medications without discussing it with a healthcare professional.

Children and adults with special needs may have other medical complications which increase risks with anesthetics. For example, a study found children with cerebral palsy had the highest number of airway-related adverse reactions to general anesthesia.

Older adults

Older adults with certain health problems may need dose adjustments and careful monitoring during and after surgery to ensure their safety.

Some people might experience delirium or confusion and memory problems after surgery.

Liver, kidney, lung, or heart problems

People with liver, kidney, lung, or heart problems might need dose adjustments because the drug might take longer to leave the body and have a more powerful effect.

Certain neurologic conditions

If there’s a history of stroke, Alzheimer’s disease, Parkinson’s disease, thyroid disease, or mental illness, there may be an increased risk with general anesthesia.

Other conditions

Be sure to let your dental team know if you have a hiatal hernia, acid reflux, infections or open sores in the mouth, allergies, severe nausea and vomiting with anesthetics, or are taking any medications that can make you drowsy like opioids.

People at risk from dental anesthesia
Risks are also higher for those with:
sleep apnea
seizure disorder
obesity
high blood pressure
heart problems
children with attention or behavior disorders
chronic obstructive pulmonary disease (COPD)
gastric bypass surgery
substance misuse or substance use disorder

What are the risks of dental anesthesia?

Most people don’t experience adverse reactions with local anesthesia. There are higher risks with sedation and general anesthesia, especially in older adults and people with other health complications.

There’s also an increased risk with a history of bleeding disorders or with medications that increase the risk of bleeding like aspirin.

If you’re taking pain medications such as opioids or gabapentin, or anxiety medications like benzodiazepines, let your dentist or surgeon know so they can adjust your anesthetic accordingly.

Risks of anesthesia
The risks of anesthesia include:
an allergic reaction. Be sure to let your dentist know about any allergies you have; this includes to dyes or other substances. Reactions might be mild or severe and include rash, itching, swelling of tongue, lips, mouth, or throat, and difficulty breathing.
anesthetics articaine and prilocaine at 4% concentrations may cause nerve damage, known as paresthesia
seizures
coma
stopping breathing
heart failure
heart attack
stroke
low blood pressure
malignant hyperthermia, a dangerous increase in body temperature, muscle rigidity, breathing problems, or increased heart rate

The takeaway

Anxiety related to dental procedures is common but can complicate treatment. It’s important to discuss all your concerns about the procedure and your expectations with your dental care team before.

Ask questions about the medications that will be used and what you can expect during and after treatment.

Share your medical history, including any allergies and other medications you’re taking. Be sure this includes over-the-counter drugs, prescriptions, and supplements.

Ask about any special instructions you need to follow before and after the procedure. This includes food and drink before and after treatment.

Ask if you need to arrange for transportation after the procedure and any other information you need to know.

Your dental provider will give you instructions to follow before and after the procedure. They’ll also provide a way for you to contact them in case you have any complications or questions.

How we reviewed this article:

SourcesHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

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Lim MAWT, et al. (2017). The use of general anesthesia to facilitate dental treatment in adult patients with special needs. DOI:https://synapse.koreamed.org/DOIx.php?id=10.17245/jdapm.2017.17.2.91
Practice guidelines for moderate procedural sedation and analgesia 2018: A report by the American Society of Anesthesiologists Task Force on moderate procedural sedation and analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. (2018).https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2670190
St George G, et al. (2018). Injectable local anaesthetic agents for dental anaesthesia. DOI:https://dx.doi.org/10.1002%2F14651858.CD006487.pub2
Yoon J-Y, et al. (2016). Current trends in intravenous sedative drugs for dental procedures. DOI:https://dx.doi.org/10.17245%2Fjdapm.2016.16.2.89

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Medically reviewed by Christine Frank, DDS — Written by Malini Ghoshal, RPh, MS on December 13, 2019

Understanding Dental Anesthesia: Types, Side Effects & Risks

What are the types of dental anesthetics?

Local anesthesia

Sedation

General anesthesia

What are the side effects of dental anesthesia?

Special precautions when taking dental anesthetics

Pregnancy

Special needs

Older adults

Liver, kidney, lung, or heart problems

Certain neurologic conditions

Other conditions

What are the risks of dental anesthesia?

The takeaway

How we reviewed this article:

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