Sedation Dentistry

What are the types of dental anesthetics?

Anesthesia means a lack or loss of sensation. This can be with or without consciousness. Some patients want to goto a deep sleep and be unconscious, some patients Iike a less deep anesthesia, where you are still conscious about your surroundings. Either one, you will be meeting our dental anesthesiologist, Dr. Thomas Einstein, MD.

Today there are many options available for dental anesthetics. Medications can be used alone or combination with IV sedation for better effect. It’s individualized for a safe and successful procedure. Before you have your procedure, you will consult with our dental anesthesiologist.

The type of anesthetics used also depends on the age of the person, health condition, length of the procedure ( cleaning 1 hour, extractions 1.5 hours and full mouth rehabilitation cases take 6 to 7 hours).

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

Local Anesthesia

Local anesthesia (“an injection”) is used for simpler procedures like a cavity filling, which requires a shorter time to complete and is generally less complicated. You are injected by Dr. Goodman with lidocaine or mepivacaine,  if you don’t tolerate epinephrine.

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

Most local anesthetics take effect  very quickly (within 5 minutes) and last 30 to 120 minutes.


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, which is pretty amazing.  Imagine being super uncomfortable at the dentist, undergoing a procedure with Dr. Goodman under sedation and in the end not remembering anything about this procedure anymore.
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.

In deep sedation, you’re generally not aware of your surroundings.

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

With IV sedation, your heart rate, blood pressure, and breathing must be carefully monitored in moderate or deep sedation.

Medications Used for Sedatio

  • 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. For example a veneer case with 10, 14 or 28 teeth involved can take many hours.

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 depth of anesthesia depends on the procedure type and the individual patient. Our dental anesthesiologist will consult with you.

For more detailed questions, suggestions as risks and benefits, please talk to the anesthesiologist before the procedure.  

General Anesthesia Medications

  •  Propofol.
  • Ketamine.
  • Etomidate.
  • Midazolam.
  • Diazepam.
  • Methohexital.
  • Nitrous Oxide (Laughing Gas).
  • Desflurane.
  • Isoflurane.
  • Sevoflurane.

What are the side effects of dental anesthesia?

Please consult with our anesthesiologist directly.
We provide you the contact and guide you through the process.

Laughing Gas

The most commonly used technique used in conscious sedation dentistry is inhalation sedation with nitrous oxide and oxygen (N2O2) or “laughing gas.” The goal is that with laughing gas, the patient can eliminate dental anxiety, making the patient more comfortable. This also allows Dr. Goodman to effectively complete the planned dental care procedure while the patient is sedated.

Consult with us to find out if this pain-free procedure is right for you. A small rubber inhaler will be placed over your nose and adjusted so that you feel completely comfortable. During this time, you will be breathing 100% oxygen.

Once the patient is comfortable breathing oxygen, the sedation dentist, Dr. Goodman will gradually introduce nitrous oxide. Over the next three to five minutes, the patient will be asked, “What are you feeling?” as the amount of nitrous oxide is slowly increased. The signs and symptoms that most patients experience when receiving laughing gas include an initial feeling of lightheadedness, which gradually leads to an all-over feeling of warmth. Many people mention a comfortable “vibrating” or “humming” sensation. It is common to feel one’s fingertips and hands become “numb.” This same sensation may develop in the mouth, which is a benefit to the sedation dentist (and patient) during the dental care treatment. Some patients will mention that their arms and legs feel “very light.” Interestingly, other patients will say that their arms and legs feel “so heavy I can’t even move them.” If either of these occurs to the patient, it is perfectly normal. The individual might notice that he or she is perspiring a little, too; this is a normal effect of nitrous oxide and oxygen dentistry.

The sedation dentist will talk to the patient throughout the dental care procedure and the individual will be able to respond without any problem. This is a major advantage, and a safety feature, of conscious sedation using laughing gas. If, at any time during the procedure, the patient feels that he or she is getting too much nitrous oxide or begins to feel uncomfortable, the patient should tell the dentist immediately and within seconds the dentist can adjust the flow of gases.

After the sedation dentistry treatment, the patient will once again receive 100% oxygen (for a minimum of three to five minutes). At the end of this time, the person should feel normal again. If he or she still feels even a little bit sedated, the dentist should give the patient oxygen for a few more minutes. In some situations, where a patient recovers more slowly, he or she might be required to have an escort (friend or relative) drive the patient home. Laughing gas inhalation sedation is highly effective in the management of mild to moderate levels of dental anxiety. It also is an excellent technique for persons who are extreme gaggers; laughing gas usually eliminates or minimizes gagging in most patients. Finally, laughing gas is highly recommended for apprehensive patients who have medical problems such as angina pectoris, high blood pressure, asthma or epilepsy, or patients who have had a heart attack. Inhalation sedation dentistry should not be used with those who are claustrophobic or unable to breathe through their nose.

* Please discuss these topics with Dr. Goodman before treatment and using laughing gas.*

Full Sedation with A Dental Anesthesiologist

As an option for very intimidated patients, we can have a dental anesthesiologist come in. Whether you need a simple cleaning or a full mouth reconstruction, we can put you under full sedation for a comfortable experience. While the dentist focuses on your teeth, the anesthesiologist will monitor your current state. Please inquire within.

Full sedation cases are one way to have extensive dentistry done with no pain and no recollection of the actual procedure. Dental anesthesia is a specialty field and in our office we have a dental anesthesiologist come and perform the procedure, while I focus on the restorative part only. I am a true believer in getting the best team possible for each procedure. 

Patient wakes up and is comfortable and ready to be driven home by a 3rd party. The American Society of Dentist Anesthesiologists (ASDA) comprises dentists who have completed a minimum three years of full-time postdoctoral training in dental anesthesiology.

In the case below, the great-grandson of Albert Einstein, Dr. Thomas Einstein, performed the dental sedation.

Q.) Why are people put to sleep for their dental treatment?

People are put to sleep in our office for their dentist to solve special concerns. For those who are very anxious or fearful, the patient will not be awake during the procedure, thus allowing him or her to relax and follow through with needed treatment.

For people who need extensive work, being asleep allows us to perform more procedures, whether you are doing several root canals, a full mouth reconstruction, or removal of your wisdom teeth. Patients who have special needs may be unable to cooperate with requirements to remain still for long periods of time.

Q.) What types of anesthesia are available?

We provide different levels of anesthesia, all in our office: General Anesthesia, Twilight Sleep, and/or Nitrous Oxide sedation. We routinely use a combination of medications, usually a long-acting tranquilizer plus narcotics administered intravenously, plus Nitrous Oxide gas and Oxygen to supplement the intravenous drugs.

We have an experienced anesthesiologist come to our office and monitor you, while Dr. Goodman performs all necessary procedures.

Q.) What is the difference between General Anesthesia and Twilight Sleep?

As we give more medication, the patient goes through different states of relaxation. The patient can choose to only have nitrous oxide (commonly called laughing gas) for a very relaxed state. However, the patient is still awake and aware of his or her surroundings.

As we give medications, the patient becomes more relaxed and may think he or she is sleeping (Twilight Sleep) but actually does not remember being awake. As we give more medication, the patient gently slips into a state of general anesthesia where he or she is completely asleep and totally unaware of the surroundings.

Q.) Will any dentistry be done on my first visit?

No, on your first visit the doctor will want to focus on getting to know you, consult with you about any concerns, fears or problems, give you a full dental examination, and create a dental treatment plan.

Q.) If I need a lot of work, how many appointments will I need?

Depending upon your particular situation, your dental needs can be treated in as little as one visit. We will discuss this with you in preparing your dental treatment plan. If you need a lot of work done, we can also have a dental specialist come to our office, such as a root canal specialist or an oral surgeon.

Q.) If I receive General Anesthesia, how long will it be before I can resume normal activities?

Usually we give a long-acting tranquilizer during treatment so the patient will sleep comfortably after he or she leaves the office. You should rest and relax the first day after treatment; and most people return to normal activities on the second day after treatment.

Dr. Thomas Einstein Dental Anesthesiologist, MD


Dr. Goodman and Dr. Einstein.



Dr. Joseph M. Goodman, DDS Beverly Hills Center for Cosmetic Dentistry Advanced Cosmetic and Implant Dentistry. 2nd Floor at 241 1/2 S. Beverly Drive Beverly Hills, CA 90212