Q.

What anesthetic options do I have for oral surgery?

A.

There are many good options available for pain and anxiety control during oral surgery. The options you have in our office our nicely outlined on the page, Anesthetic Options for Oral Surgery.

Q.

Who gives the anesthesia in your office?

A.

Dr. Lawrence administers the anesthesia during your procedure. Oral & Maxillofacial Surgery is a unique specialty in that the doctors receive advanced training in anesthesia during their residency in oral surgery. Dr. Lawrence had the benefit of this training in oral surgery at the University of Michigan as well as during his general practice residency at Miami Valley Hospital in Dayton. The Ohio State Dental Board specifically recognizes oral & maxillofacial surgeons as being qualified to administer a variety of pain and anxiety control techniques in their practices. Additional required continuing education specific to anesthesia is required by the state dental board on a biennial basis. Additionally, Dr. Lawrence maintains current American Heart Association training in ACLS (advanced cardiac life support) and BCLS (basic cardiac life support).

Q.

Are there other trained personnel involved with the anesthesia procedure?

A.

Yes. A minimum of two assistants are required to be present during the surgery. All assistants have current BCLS (basic cardiac life support) training. Assistants also participate in the Oral and Maxillofacial Surgery Anesthesia Assistants Program. This course teaches basic science specific to the application of anesthesia in the oral surgery office.

Q.

How will I be monitored during my procedure?

A.

If you are undergoing a procedure with the use of IV Sedation or General Anesthesia you will be monitored with direct and continuous observation by the doctor and the two assistants. Technical monitors include ECG, Pulse Oximetry, Automatic Blood Pressure, Pre-cordial Stethoscope monitoring of respiration. Supplemental oxygen is delivered during all sedation and general anesthetic procedures.

Q.

What types of emergency systems are in place for anesthetic cases?

A.

The office maintains emergency equipment to deliver oxygen, provide suction, advanced airway maneuvers, urgent medical management and AED (automatic electronic defibrillation). Dr. Lawrence maintains current ACLS training and all assistants remain current in BCLS.

Q.

Do you numb the area of surgery if I go to sleep?

A.

Yes, most of the time. The numbness (local anesthesia) usually lasts for 2-3 hours. The use of local anesthesia usually translates into a lower dose of other anesthetic or sedative drugs, thus hastening your recovery.

Q.

Will I be numbed (given a local anesthetic) before going to sleep?

A.

No, the local anesthetic is administered after the sedative or anesthetic medicine. You will not feel the local anesthetic injection if you are having general anesthesia.

Q.

Can the person escorting me to the office stay in the operating room during my procedure?

A.

No, if you are under sedation or anesthesia we want to focus 100% of our attention on you. Other friends or family present in the room can distract the attention of the doctor and assistants. It is in your best interest to have the doctor and assistants giving you their undivided attention. After your surgery is complete, we will move you into the recovery area. At that time the person that came with you will be brought back to be with you as you continue to recover.

Q.

Will I wake up in the middle of my surgery?

A.

No, our anesthetic technique establishes a constant level of sedation or sleepiness. Because the medication wears off quickly, you will emerge (or recover) from your anesthetic within a few minutes of the time the surgery is complete. It is important to understand that having deep sedation or general anesthesia is not like turning off and on a light. There is a “grey” zone between “awake” and “asleep” with this use of these techniques that is often referred to as “twilight sleep”. In this state there is little if any anxiety and very little if any recall.

Q.

How will I be put to sleep, will it be with a mask?

A.

There are several options for the induction of anesthesia or sedation. A mask can be used to give you nitrous oxide and oxygen, commonly known as "laughing gas". Nitrous oxide will not put you under anesthesia or make you unconscious, but it does make you less sensitive to things that may other wise be uncomfortable, such as getting an injection or having an IV catheter placed. Some of our patients prefer to begin their sedation or anesthesia with an IV placement without the nitrous oxide. Having an IV placed does not have to be a dreaded experience. Dr. Lawrence has extensive experience in placing IV's and will select the place to start your IV that he feels will best serve your anesthetic needs, with your safety and comfort in mind. Most of the time, having an IV started is easier than having a blood test taken or having an intramuscular (IM) injection.

Q.

Should I take my regular medications before surgery?

A.

Yes, regular medications should be taken according to your usual schedule with sips of water prior to surgery under sedation and anesthesia. There are special circumstances that would be discussed at the time of your consultation. At your consultation Dr. Lawrence may advise holding certain medications until after your procedure.

Q.

What anesthetic options do I have for oral surgery?

A.

There are many good options available for pain and anxiety control during oral surgery. The options you have in our office our nicely outlined on the page, Anesthetic Options for Oral Surgery.

Q.

Do I need to get my wisdom teeth out now or can it wait?

A.

It is first important to determine if they need to be removed or if there is any chance that they will be functional. Not all wisdom teeth have to be removed. Each person is different and each wisdom tooth can have its own set of considerations. But, in general, the earlier they are removed the better. The earlier you get them out the less likely the root is completely developed. The older you are the more developed your roots are, creating more of a chance of being near the nerve in the lower jaw. This nerve supplies feeling to the lower lip and chin. Fully developed roots create more risk for injury to this nerve.

Q.

Is the extraction painful if I choose local anesthetic?

A.

No, the area will be numb. You may feel pressure from the actual extraction but you should not feel any pain. In unusual cases it may be difficult to obtain profound local anesthesia (numbing). In those cases, Dr. Lawrence usually recommends the use of general anesthesia.

Q.

Where will the surgery be done?

A.

Most surgeries are done in our office. Our operating rooms are referred to as operatories. Some surgeries are best done in the hospital operating room. When surgeries require the use of the hospital facilities Dr. Lawrence will determine if it can be done as an outpatient or if it would be advisable to have an overnight stay.

Q.

Will I need a “pre-med” for my appointment?

A.

There are rare heart valve and congenital heart (birth) defects, or history or past history of infective endocarditis that require antibiotic pre-medication or prophylaxis. Your physician or cardiologist would be able to advise you as to the necessity of this type of treatment. It should be noted that the American Heart Association has changed its recommendation on this issue. Another indication for antibiotic pre-medication is for patients with prosthetic (artificial) joints. This recommendation needs to be made by the orthopedic surgeon involved with the management of your artificial joints.

Q.

Are antibiotics necessary for wisdom tooth and other oral surgery?

A.

Antibiotics are not prescribed to all patients having oral surgery. If there is significant active infection or other circumstances that warrant the use of antibiotics Dr. Lawrence will prescribe them for you.

Q.

How do you take out impacted teeth?

A.

Impacted teeth require surgical techniques to gain access to the tooth and to remove the tooth. This almost always involves an incision. It may be necessary to remove some bone over the tooth and in some cases it is necessary to divide the tooth into several pieces. Resorbable sutures make a specific suture removal appointment unnecessary.

Q.

How much pain will I be in?

A.

Pain is a subjective thing. Everyone responds to surgery in a unique way. Some will require no pain medication; others will get by with over the counter medication such as ibuprofen, Aleve, Tylenol or aspirin. Others may need to use a narcotic pain medication as a supplement to the over the counter medications. We will provide you with detailed instruction on the use of pain medicines that we recommend. It is always helpful for us to know your history of pain medication use with previous injury or surgery.

Q.

What kind of medication will I need to take after surgery?

A.

The type of medication will depend on the severity of the procedure and your past history of pain control. With wisdom tooth surgery Dr. Lawrence will typically prescribe Ibuprofen 600 mg and will recommend that the patient alternate with two Extra Strength Tylenol, every two to three hours. Dr. Lawrence will sometimes prescribe a narcotic/Tylenol combination, which will be used only to rescue any discomfort not resolved with ibuprofen and Tylenol.

Q.

How long will I be in pain?

A.

This is a variable that is impossible to predict. However, with more difficult procedures (surgical extractions or removal of impacted teeth) you can expect the pain and swelling to reach a peak on about the third day. Pain that last longer than the third day or is increasing after three days may be an indication that you should call the office.

Q.

Is there coverage after hours?

A.

Yes, for patients treated by Dr. Lawrence he is on call or has back-up available should you need assistance. You will be given instructions on how to reach Dr. Lawrence following your surgery.

Q.

What is a dry socket?

A.

Dry socket is an intense inflammation of the jaw bone. It usually occurs 2-5 days after the extraction of a tooth. It seems that the normal healing processes either do not get established early on or are interrupted in the first few days. The result is an intense inflammation (not infection) that causes an increasingly intense and unresponsive pain. If you suspect that you are experiencing a dry socket call the office. We can help you get comfortable with this condition, but you must be seen.

Q.

How do you treat a dry socket?

A.

Medicated dressing is placed within the socket. This dressing will numb the inflamed bone of the socket and provide relief. The dressing needs to be changed a day or two later. It will be replaced as needed for two or three visits.

Q.

What kinds of foods will I be able to eat after surgery?

A.

It is important to increase your caloric intake after surgery to help your body heal. You will be able to easily eat the following: Jello, applesauce, yogurt, ice cream, pudding, oatmeal, mashed potatoes, pancakes, scrambled eggs, macaroni and cheese. Stocking up on these items early will be beneficial.

Q.

How long should I use an ice pack after my procedure?

A.

Usually, using an ice pack within the first 24 hours is the most effective. However, if it makes the patient feel better, it is okay to use it throughout the recovery process.

Q.

How long will I need to take off work after surgery?

A.

This varies from person to person and depends on the type of surgery. Some require only the day of surgery; some go back to work the same day. Others may need 3-5 days following more extensive surgery. By keeping up with our pain medication schedule, getting plenty of rest and eating healthy foods, you should be able to resume most of your regular activities soon.

Q.

Can I drink from a straw after my teeth are extracted?

A.

You may drink clear liquids through a straw (i.e. juice, water, tea, etc.), however, you should not drink thick liquids through a straw.

Q.

What is a dental implant?

A.

A dental implant is a small “anchor” or “root replacement” made of titanium. It is inserted into the jaw to take the place of your missing tooth root. After the surrounding bone has attached to the implant your general dentist will take an impression to fabricate a crown to be seated on the implant. The new crown should look, feel and function as well as, if not better than any other dental restoration.

Q.

Will I have to have general anesthetic to have my implant placed?

A.

In most cases patients have the placement of an implant done with a local anesthetic. If you are a very anxious dental patient then this should be discussed with the doctor at the time of your implant consultation and he will help you determine what type of anesthesia is best for you.

Q.

Will my insurance company cover my implant?

A.

There are several insurance companies that do have implant coverage. The first step is for you to contact your insurance company and ask if your policy includes implant coverage.

Q.

Are you a provider for my insurance plan?

A.

We do participate in a number of insurance plans; however we are not in all plans. Most plans have allowances for coverage by out of network providers. This means that you may still be able to see Dr. Lawrence. If Dr. Lawrence is not a contracted provider in your plant you should understand how the out of network issue is handled by your plan. You should contact your insurance company by calling the number on your card or inquire with your employer about preferred providers.

Q.

Will I have to pay co-pay?

A.

Yes, co-payments and deductibles are payable at the time of your services. In most cases we can calculate an estimated co-payment prior to your surgery so that you will know approximately what the out of pocket expenses will be on the day of your surgery. For further information visit our website on financial arrangements.

Q.

Will extraction of wisdom teeth go under my medical or dental insurance?

A.

Some medical insurance plans have a clause that allows for coverage of full bony and partial bony impacted teeth. Most of the time, dental extractions of all types are under your dental plan.