As another oral surgery resident who stumbled onto this thread, I'll add another 2 cents. We do a required 4-6 months of anesthesia as an "anesthesia resident" running our own rooms, then spend the rest of our residency administering IV light/deep and GA in our own clinics. We are required to do at least 100 general anesthetics (anesthesia rotation doesn't count) while the residents in my program average closer to 200. I intubated over 200 times during my anesthesia rotation. We have a monthly conference on anesthesia throughout our 6-year residency given/attended by both our faculty and anesthesiology faculty. About 20% of our board exams is purely anesthesia. Anesthesia is an important topic in our journal and is the focus of many seminars at our national meeting every year. I mention all this to make the distinction between oral surgeon's training and general dentists who simply take a 60-hour course to sedate 20 people and intubate one of those ACLS mannequins. As far as monitoring, we use a minimum of EKG, pulse ox, heart rate, NIBP, respiratory rate. One of our clinics also uses capnography which I personally like. It's mainly versed/fentanyl with propofol or ketamine as needed. Obviously, there is disagreement in the dental community stemming from oral surgeons not wanting general dentists to administer sedation given their lesser training. When general dentists have complications, it still affects oral surgeons because all dentists are painted with the same brush in the public's eye. After finishing dental school, I never realized how much could go wrong until I did my anesthesia rotation during residency.
As far as local vs sedation for a procedure....it just depends on how difficult the procedure will be....which we really can't comment on here without an xray & exam. I take out lots of wisdom teeth under local, but there are many that would really benefit from sedation.
I also want to point out the difference between oral surgeons and all the other non-anesthesiologists (GI) who administer IV sedation. GI docs have no formal anesthesia training and really only intubate in codes and ICU patients (as far as I remember). Oral surgeons were specifically excluded from the stink between the ASA and non-anesthesiologists using propofol in 2004:
http://www.aaoms.org/docs/media_kits/anesthesia/asa_propofol_letter.pdf
Also remember that most of our anesthetics are short (<30min) and the procedures are relatively un-invasive. Usually ASA I/II patients, although almost half the sedation patients at our VA are ASA III. When the health history or procedure gets complicated, we take it to the OR with the real anesthesiologists. Patient selection is obviously key here, which (in my humble opinion) is one of the reasons we have such an enviable safety record. One review from insurance claims revealed a morbidity/mortality incidence of 1 in 704,000 patients over a 17 year period. Yes, the selection biases from insurance pool apply. Another interesting article on safety is here:
http://www.aaoms.org/docs/media_kits/anesthesia/joms_anesthesia_results.pdf
This post was longer than I intended, sorry.
