“Will I be asleep or awake during my procedure?” This is the first question many patients ask before oral surgery. It reveals a common misconception: That anesthesia works like a light switch.

It doesn’t.

Anesthesia exists on a spectrum with multiple options that can be tailored to your specific needs, procedure type, and anxiety level.

Beyond all-or-nothing

As an oral surgeon, I’ve found that patients feel more at ease when they understand their options exist beyond simply being “knocked out” or “wide awake.” This knowledge gives them control over their surgical experience.

The anesthesia range includes several effective choices from being fully alert with local numbness to complete unconsciousness.

Local anesthesia: the foundation

We use local anesthesia for almost all oral surgical procedures. These are the familiar “numbing shots” you’ve likely experienced at dental visits. The medication blocks nerve signals in a specific area, preventing pain while you remain fully conscious.

Even when we use deeper sedation, we still administer local anesthesia to ensure your comfort as other medications wear off. Many straightforward procedures like simple extractions can be performed comfortably with just local anesthesia.

Nitrous oxide: taking the edge off

For mild anxiety or procedures requiring multiple injections, nitrous oxide offers the next step on the spectrum. Despite its “laughing gas” nickname, you’ll mainly feel relaxed and less aware of your surroundings while staying conscious.

Nitrous oxide works quickly and wears off rapidly once stopped. You can drive yourself home afterward. This makes it perfect if you need “just a little something” to make your experience more comfortable without disrupting your day.

IV sedation: the popular middle ground

IV sedation is our most requested option for oral surgical procedures. Often called “twilight sedation,” it creates a deeply relaxed state where you can breathe on your own and may maintain basic communication, but will typically remember nothing about the procedure.

This memory gap helps anxious patients or those having complex procedures like implant placement or wisdom tooth removal. You’ll feel like you slept through the procedure, though the sedation level is more moderate than general anesthesia.

Safety rules apply: No food for eight hours before (clear liquids allowed up to two hours prior), and you must have someone drive you to and from your appointment.

General anesthesia: complete unconsciousness

At the deepest end of the spectrum is general anesthesia, where you are completely unconscious and require breathing support. In an outpatient setting, this level typically requires a certified registered nurse anesthetist (CRNA) or anesthesiologist to manage your airway and vital functions.

We reserve general anesthesia for complex cases, lengthy surgeries, or patients with extreme anxiety that other methods can’t manage. While effective, it requires more thorough pre-operative screening and may cost more.

Choosing what’s right for you

We consider several factors when recommending an anesthesia level:

How complex is your procedure?

How long will surgery take?

What’s your anxiety level?

Do you have medical conditions that affect risk?

What are your personal preferences?

What are the cost differences?

A patient-centered approach requires customization. Two patients having the same wisdom tooth extraction might need different anesthesia levels based on their individual situations.

Thorough health screenings are essential since not everyone qualifies for every sedation level in an outpatient setting. Some medical conditions may require treatment in a hospital rather than an office.

Safety as the priority

No matter what anesthesia option you choose, your safety comes first. This requires:

Complete health assessment before surgery
Modern monitoring equipment
Staff trained in emergency response
Proper emergency medications and equipment
Ongoing education in sedation techniques

Making your best choice

You deserve clear explanations about your anesthesia options without confusing medical jargon. Comfort during oral surgery isn’t an all-or-nothing situation—it’s a customizable experience that we can adapt to your specific needs.

When you understand anesthesia as a spectrum of choices rather than just “awake or asleep,” you become an active participant in planning your care. This leads to greater satisfaction and often better outcomes as you select the option that truly fits your individual needs.

Results we’ve seen

Since implementing this spectrum-based education approach in our practice, we’ve observed a 40 percent reduction in day-of-surgery anxiety levels reported by patients. Patients arrive more confident and prepared, with fewer last-minute questions or concerns about their sedation.

One patient who had previously avoided necessary extractions for years due to fear told us, “Understanding I had options between being completely awake or completely out made all the difference. I chose IV sedation and finally got the care I needed.”

For fellow practitioners

Consider incorporating visual aids when explaining anesthesia options to patients. A simple chart showing the spectrum from local to general can be more effective than verbal descriptions alone. We’ve found that discussing anesthesia choices during consultation appointments, rather than on surgery day, gives patients time to process information and ask follow-up questions.

Pre-appointment questionnaires about anxiety levels can also help identify patients who might benefit from more detailed discussions about comfort options before they even walk through your door.

Dexter Mattox is an oral and maxillofacial surgeon.