Most people are candidates for IV moderate sedation. Prior to your appointment, a thorough medical history will be obtained and a patient specific sedation plan will be established.  If there are any challenges associated with your care, they will be discussed prior to the appointment.  Occasionally a medical consult may be obtained for more information or for medical clearance prior to your appointment. A small subset of individuals do not qualify for IV moderate sedation due to specific medical conditions. If you have medical conditions that prevent the safe delivery of anesthesia in an outpatient setting or if you require a deeper level of sedation, a referral may be necessary.

IV moderate sedation is incredibly safe. Dr. Miller completed advanced training to obtain a higher level of sedation permit that allows him to provide this service.  He is credentialed to provide anesthesia to high risk individuals, maintains current advanced cardiac life support and basic life support certifications, and undergoes regular continuing education in the field of dental anesthesiology.  Moderate sedation is delivered safely by ensuring that you stay conscious and maintain your own airway to avoid risks associated with over sedation. Dental sedation comes with slightly higher risks to people who have pre-existing health conditions.

The Texas State Board of Dental Examiners requires advanced training and permit levels to dental providers who wish to perform IV sedation.  Dr. Miller completed his course on IV moderate sedation and the sedation of high risk individuals through two years of residency in advanced general dentistry at UT Health in San Antonio.  A very small number of dentists hold this permit that allows the practice of IV sedation for dentistry.

Dr. Miller uses two types of dental anesthesia. 

1. Intravenous (IV): This is where a small plastic catheter is placed into a vein on your arm or hand for the continuous delivery of saline.  Through a small port on the side, drugs are administered directly into the bloodstream until you reach a level of comfort to perform the procedure.
2. Tablet:  On rare occasions, a pill will be prescribed in advance so that the patient can begin to feel relaxed even prior to arriving at the office.

Most patients do sleep when sedated with IV moderate sedation.  It is not uncommon to sleep or all of the procedure. A small subset of patients remain awake but totally relaxed and care free.  Each individual responds differently to sedation.  The goal is to make you relaxed enough to complete your dental care as comfortably and as safely as possible.

Once you are sedated, local anesthetics or numbing agents are used in the mouth to block the nerves that innervate the teeth.  This is done to decrease and eliminate pain.  Although you should not feel sharp pain, pressure can sometimes still be felt when teeth are removed. This should not feel unpleasant due to the calming effects of the sedation.

This depends entirely on the individual. Some people take longer to return to baseline after dental sedation, while others are fine within a short period of time. On average, most people are completely back to themselves within a few hours of leaving the dentist office. 

-If you are being sedated, you need to avoid eating for six hours prior to the appointment. 

-Clear liquids are ok up until 2 hours prior to the appointment. 

-Please take all medications as you are normally prescribed unless otherwise stated by Dr. Miller. 

-A responsible adult above the age of 18 must be present to drive you home at the end of the procedure.

-Wearing comfortable non restrictive clothing will is preferable for the IV.

-You may bring a blanket to stay warm and comfortable. 

-It is important to Avoid smoking, alcohol or substances prior to and following the appointment.

 When you arrive at your appointment, Dr. Miller will review your case, answer all questions you may have, and review the consent forms.  Then you will receive electrodes that are connected to a monitor to view your vital signs throughout the procedure.  An IV will be placed in your arm or hand. After you have reached an appropriate level of sedation, local anesthetic will be administered to block painful sensations in the mouth. Dr. Miller will monitor you throughout the entire procedure and until a majority of the drugs have worn off and you are cleared to be dismissed.

Wisdom teeth commonly cause problems due to incomplete or incorrect eruption, lack of space, pain, infection, and difficulty cleaning.  Most but not all wisdom teeth should be removed.  Each case is independent and the risks/rewards will be discussed with you.

The most common time to remove wisdom teeth is between the ages of 16-24.  It is recommended that the appointment is scheduled at a time when you can take adequate time away from school or work to rest and recover.

Any surgical procedure carries risk.   Although complications associated with dental surgery are small, they do exist.  Most common risks include infection, delayed healing, and damage to adjacent teeth or anatomical structures that are sometimes temporary but can also be permanent.  You are entitled to a fully informed consent and discussion of your specific procedure and the risks associated with doing or not doing the procedure.  You are also entitled to make your own decisions about your treating doctor and recommendations for referrals can be made when needed.

Complication from wisdom teeth can arise at any time. Wisdom teeth are much more easily removed at a younger age (less than 25) because the bone is not as dense, the roots are usually incompletely developed, and the healing time is faster.  Removing wisdom teeth after the age of 25 increases the chances of complications, infection, difficulty removing the teeth, and delayed healing.  Additionally, not removing the wisdom teeth could jeopardize adjacent teeth by causing bone loss or tooth decay.

The sedation medications usually wear off quickly at the end of your procedure.  It is common to feel a little drowsy and to have your mobility and balance be slightly impaired for a short period of time afterwards.  

If you had surgery, you can expect for your mouth to feel numb for several hours.  You may have a gauze in place to assist with bleeding.  Post op instructions will be thoroughly reviewed and all questions will be answered.  It is normal to expect some amount of discomfort after surgery but pain should be controlled with prescribed medication.  Dr. Miller will follow up with you at 24 hours and one week after your procedure.

Dr. Miller prefers to manage pain consistent with current literature and in respect of the opioid crisis.  Pain can best be managed with a specific combination of extra strength Tylenol and Ibuprofen at specific intervals if there are no contraindications to these medications.  When necessary, adjunctive medications can be prescribed to help with pain but are usually not needed.  Dr. Miller may also give medications into the IV to help decrease inflammation and manage pain at the end of the procedure.  Some discomfort should be expected but pain can and should be managed with medication.