By Jeffrey W. Chandler, DDS, MD — Elmhurst Oral Surgery

In over two decades of practice, I’ve heard every version of the sentence: “I’m terrified of dental work.”

Sometimes it comes with a specific story: a painful extraction as a child, a procedure that felt out of control, sounds and sensations that have stayed with someone for years. Sometimes there’s no single memory attached to it; it’s just a baseline dread that has kept people away from care far longer than they should have stayed away. And sometimes people come to me already having been told they need oral surgery, be it wisdom teeth, implants or bone grafting, and they are quietly, genuinely frightened about how they’re going to get through it.

IV sedation is one of the most meaningful tools I have for those patients. And I want to take the time here to explain it honestly, not just to reassure you that it’s safe, but to tell you exactly how it works, what my training and responsibility look like, and what you’ll experience from the moment you arrive to the moment you head home.

Because I’ve found that when people are empowered with knowledge, the process becomes a lot less frightening.

What IV Sedation Actually Is

Let me start by clearing up a misconception I hear regularly: IV sedation is not general anesthesia. The two are related but meaningfully different.

General anesthesia renders a patient fully unconscious, suppresses all protective airway reflexes, and typically requires a breathing tube and a dedicated anesthesiologist. It is used for major surgical procedures in hospital settings. It can be used in oral surgery for significant procedures or in the cases of patients who need full sedation and is those cases procedures would take place in a hospital setting.

IV sedation, also called intravenous conscious sedation or monitored anesthesia care, produces a profoundly relaxed, deeply calm state in which most patients have little to no memory of the procedure, but remain able to breathe completely on their own and can respond to simple prompts if needed. There is no breathing tube. Your protective airway reflexes remain intact. You breathe room air or supplemental oxygen through a small nasal cannula.

What patients typically describe is something like waking from a very comfortable nap. Many are surprised that anything happened at all. The procedure that caused them weeks of anxiety has become, in their memory, essentially nothing.

That is exactly the point.

Why Oral Surgeons Are Uniquely Qualified to Administer It

This is something I feel strongly about, so I want to explain it clearly.

Oral and maxillofacial surgeons are the only dental specialists who receive comprehensive, hospital-based training in anesthesia and sedation as a core component of their residency. After completing dental school, OMS residents spend four to six years in a hospital-based surgical training program that includes extensive rotations in anesthesia, not as observers, but as active participants managing anesthesia for surgical patients across a range of medical complexity.

When I administer IV sedation, I am not deferring to another provider in the room. I am performing the sedation and the surgery, with a trained clinical team monitoring your vital signs throughout. This is the established standard of practice in oral and maxillofacial surgery, and it is both legal and appropriate because of the depth and specificity of our anesthesia training.

Illinois, like all states, requires oral surgeons to hold a specific permit to administer IV sedation in an office setting. Maintaining that permit requires ongoing education, periodic office inspections, and demonstrated compliance with patient safety protocols. This is not a credential that exists on paper, it is actively maintained and audited.

The safety data on IV sedation administered by oral and maxillofacial surgeons is excellent. Published research on tens of thousands of outpatient sedation cases shows a very low rate of complications, the overwhelming majority of which are minor and manageable within the office setting.

What We Do Before Your Procedure

Safety in IV sedation begins long before the day of surgery. During your consultation, I review your complete medical history in detail, every medication, supplement, allergy, and health condition. This isn’t paperwork formality. It directly shapes how I plan your sedation.

Certain medications interact with sedatives and need to be paused or adjusted beforehand. Medical conditions like uncontrolled diabetes, significant heart or lung disease, or obstructive sleep apnea affect how the body responds to sedation medications and may require clearance from your primary care physician or specialist before we proceed. I will never take shortcuts with this process, and I won’t proceed with sedation if I have unanswered questions about your safety.

Fasting is essential. You will be instructed not to eat or drink, including water, for a specific period before your procedure, in most cases approximately 6 hours. This is not an arbitrary inconvenience. An empty stomach is critical to preventing aspiration, the risk of stomach contents entering the lungs during sedation, which is one of the most serious potential complications of any anesthetic procedure. I will give you precise fasting instructions based on your specific appointment time, and I ask that you follow them exactly.

You will also need to arrange for a responsible adult, a family member or trusted friend, to drive you to the office and take you home. You will not be able to drive yourself home, and we will not discharge you into a rideshare without a trusted adult present. Plan to have someone with you for the rest of the day.

Wear comfortable, loose clothing with sleeves that can be rolled up easily for the IV placement. Leave jewelry at home. Arrive on time so we can get you settled without rushing.

The Day of Your Procedure: What Happens Step by Step

When you arrive, my team will take you back to the treatment area and get you settled comfortably in the chair. We’ll take your vital signs including blood pressure, heart rate, and oxygen saturation and confirm your health history and medications one final time.

Placing the IV. A small, flexible catheter is placed into a vein, most often in the back of your hand or the inside of your forearm. We take care to make it as gentle as possible. Most patients tell me it’s no more uncomfortable than a routine blood draw. Once the IV is in, we secure it in place and connect it to a fluid line.

Monitoring begins. Before any medication is given, you are connected to continuous monitoring equipment: a pulse oximeter on your finger tracking your blood oxygen levels and heart rate, a blood pressure cuff, and cardiac monitoring leads. These run continuously throughout your procedure and into your recovery period. My team is watching these numbers in real time for the entire time you are in my care.

The medication. Sedation medications are administered directly through your IV line, allowing me to precisely control the dose and adjust it as your procedure progresses. Within a few minutes of the first medication, patients typically feel a warm, deeply relaxed sensation. Anxiety fades. The room gets quieter in their mind.

Local anesthetic is also administered to completely numb the surgical site. IV sedation manages your anxiety and awareness; local anesthesia manages pain at the tissue level. Both work together to ensure your comfort. 

During the procedure. Most patients have little to no memory of what happens during the actual surgery. You may hear muffled sounds or be vaguely aware of activity, but you are not in distress. If I need a simple response from you, maybe to open wider, or to let me know how you’re doing, you will be able to respond to that. But you are deeply comfortable and, for most patients, the time passes as if it didn’t exist.

Waking up. When the procedure is complete, I stop administering sedation medications and allow you to emerge naturally. This process is gradual and gentle. You’ll begin to become more aware of your surroundings, though you may feel groggy, a little sleepy, and mildly disoriented. This is completely normal and expected.

My team will remain with you throughout recovery, monitoring your vitals until they are stable and you are alert enough to be safely discharged. This typically takes 30 to 60 minutes, though it varies by individual.

What to Expect in the Hours After

You will go home and rest. That is the most important thing you can do on the day of surgery. 

The grogginess from sedation can linger for several hours, which is why driving , or making any important decisions, is not permitted for the remainder of the day. Residual effects of the medication can be subtle but real.

You may feel slightly nauseous; this is a known side effect of sedation medications and typically resolves quickly. Eating lightly after surgery, starting with cool, soft foods when you’re ready, helps. Staying hydrated is important.

Your surgical team will go over all post-operative care instructions with your escort before you leave the office. Written instructions go home with you. I understand that whatever you hear in the chair immediately after sedation may not fully register.

Most patients are genuinely surprised by how manageable the day is. The procedure they dreaded is behind them, and what they mostly remember is waking up and it being over.

A Word to My Patients Who Are Most Afraid

I want to speak directly to the patients reading this who have the most anxiety. Who have been putting off necessary or life-changing treatment for months or years because the fear feels too big. I hear you, and I don’t dismiss that.

Fear of oral surgery, fear of anesthesia, fear of losing control, these are real and deeply human responses. I don’t expect you to simply reason your way out of them. What I can offer you is this: come in and talk to me. Not to commit to anything, not to schedule surgery on the spot, just to talk. Tell me what happened, what you’re afraid of, what you’ve been through before. I’ll listen.

I run a single-surgeon practice because I believe the relationship between surgeon and patient matters enormously. When you come to Elmhurst Oral Surgery, you are not a number. You will see me at your consultation, and I will be the one performing your procedure. I will know your history and your concerns because we will have discussed them in detail, together. 

IV sedation has allowed patients who never believed they could get through oral surgery to come out the other side – comfortable, healthy, and frequently disbelieving that it went so smoothly. 

If you have questions about sedation, or if you’ve been putting off a procedure because of anxiety, please reach out. We’re here.

(630) 833-0395 | elmhurstoralsurgery.com

This content is intended for general educational purposes and does not constitute individualized medical advice. Please consult directly with a qualified oral surgeon about your specific health history and candidacy for IV sedation.