When I think about anesthesia, I think about the patient and their perception of the treatment that they are about to receive. I noted early in my career that the same procedure is perceived in many different ways across many different patients. I have patients who prefer anesthesia, even if I’m just looking at them, and there are patients who will tolerate any procedure and insist on never having anesthesia administered to them.
I think what’s important here, amongst everything else, is the conversation with us and our patients, or you and your doctors, around your preference for how you want procedures to go. We have to be flexible as practitioners to meet you and your needs, your philosophical wants for how to be taken care of.
It’s important, as a patient, for you to communicate your wants, your needs, your fears, and your concerns so that we can understand how to take care of you best. Sometimes we can employ things like IV sedation, nitrous oxide, and other medications in addition to local anesthetics. Finding the right approach so that you can get the care that you need is so important to us, and we can do this together with the proper amount of communication.
When a patient tells me they are nervous about dental work, I write it down the same way I would write down a medication or an allergy. It changes how I plan the visit, how much time I schedule, and what I use to keep them comfortable. It also changes the long-term outcome, because a patient who dreads the chair eventually stops coming, and the mouth keeps changing whether anyone is looking at it or not.
This is how I think about the options, from the numbing gel at the start of a routine visit to IV sedation for surgery: what each one feels like, how it is regulated in New York, and what the research does and does not show.
A 2021 meta-analysis of population studies in the Journal of Dentistry estimated that about 15 percent of adults have dental fear or anxiety, 12.4 percent have high levels, and 3.3 percent have severe fear (Silveira et al., 2021). A 2026 meta-analysis using the Modified Dental Anxiety Scale put the rate of high dental anxiety at 18 percent, with wide variation between studies (PubMed). The spread tells you how much the number depends on who is asked and how.
What the fear leads to is the bigger problem. Researchers have described a cycle for decades: fear leads to delayed visits, small problems grow, treatment becomes more involved, and the experience reinforces the fear. One study testing that model found that 38.5 percent of people with moderate to high dental fear fit the full pattern of avoiding the dentist, needing treatment, and coming in only when something hurt. Among people with no dental fear, the figure was 0.9 percent (Armfield, 2013).
Some of the patients who come to me for full mouth reconstruction or dental implants are at the far end of that cycle. Their problems were small and fixable years earlier. Making the chair a place people are willing to return to is part of how I prevent that.
Most of what I do, including porcelain veneers, crowns, and fillings, is done with local anesthesia alone. You are awake, you can talk to me, and the only area that loses sensation is the one I am working on. The American Dental Association describes local anesthetics as the foundation of pain control in dentistry, with a long record of safety, and requires dentists to stay within the maximum safe dose for each patient (ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists, October 2025).
Patients ask whether one anesthetic works better than another. The two most studied are lidocaine and articaine. A 2026 meta-analysis of 36 randomized trials found that articaine set in slightly faster and lasted slightly longer, with no difference in how often the anesthesia worked (Gong et al., 2026). In my experience, giving the anesthetic enough time to take full effect before I start matters at least as much as which one I use.
The Potentially Dreaded Injection
For most anxious patients, the injection is the part they dread. These are the approaches with evidence behind them. We try to do everything we can to make this as painless as possible.
Topical gel numbs the surface of the gum before the needle. Cold works too. A systematic review in adults found that precooling the site reduced pain after the anesthetic was delivered compared with topical gel, although the two performed about the same at the moment of needle insertion (Journal of Clinical and Experimental Dentistry, 2025).
Most of the sting comes from the pressure of fluid entering tissue, so a slow injection is a more comfortable one. Computer-controlled delivery devices regulate that flow automatically. A 2026 randomized crossover trial of 40 adults found significantly lower injection pain with a computer-controlled system than with a conventional syringe, and most participants preferred it (BMC Oral Health, 2026). An earlier systematic review was more cautious and concluded the trials were too different from one another to prove the devices better (PubMed). I would call the evidence encouraging and still early.
The numbness that lingers after you leave is its own complaint, especially for patients going back to work or out to dinner. Phentolamine mesylate, sold as OraVerse, was approved by the FDA in 2008 to reverse soft tissue numbness after a procedure. In the trials behind its label, it shortened the median time to normal lower lip sensation by 85 minutes and upper lip sensation by 83 minutes compared with a sham injection (OraVerse prescribing information, DailyMed).
Before I start, we agree on a hand signal that stops everything. I tell you what you are about to feel before you feel it, and appointments are scheduled with enough buffer that I never have to hurry.
Believe it or not, the thing that works best here is distracting one’s awareness and their brain. Talking to a patient, music, having television, having someone’s headphones in, and also some shaking or vibrating, while administering the anesthesia, can do a lot to distract the brain from picking up on the anesthetic being administered.
Local anesthesia blocks pain in one area. Sedation acts on the whole nervous system to reduce anxiety. The ADA, using definitions from the American Society of Anesthesiologists, describes four levels (ADA, 2025):
The guidelines make two further points. The level depends on the drug and the dose, not on whether it arrives as a gas, a pill, or an IV. And any dentist providing sedation has to be trained and equipped to rescue a patient who drifts deeper than intended.
Nitrous oxide, or laughing gas, is breathed in through a small mask over the nose, mixed with oxygen. It produces a relaxed, sometimes tingling feeling while you stay awake and able to talk. It takes effect within minutes, and at the end of the procedure you breathe oxygen to clear it. The ADA notes that nitrous oxide combined with other sedative medications can produce deeper levels of sedation, which is why it is always given with monitoring and never casually added to other drugs.
We find in our practice that nitrous oxide can be of such great benefit in lessening one’s pain and anxiety. We have found it so effective in our practice that, in building our new space at 575 Madison, we plumbed it through the entire office, and all 17 treatment rooms have it. We wanted to make it easier to administer for our patients who find it beneficial.
The nice part about nitrous oxide is that it’s easy to use. There don’t seem to be many side effects, and it resolves almost immediately once the nitrous oxide is no longer administered. It’s also good to know that when one is receiving nitrous oxide, they receive oxygen at a percentage that is greater than in the ambient air. Most of our patients end up feeling quite good after receiving this and after the treatment.
Oral sedation means taking a prescribed anti-anxiety medication by mouth before your appointment. A single medication at a standard dose produces minimal sedation. Under ADA guidelines, exceeding the maximum recommended dose or combining more than one oral sedative puts the patient in moderate sedation, which carries stricter training, monitoring, and equipment requirements. In New York, a dentist needs a separate certificate from the State Education Department to provide moderate sedation by mouth (NYSED Office of the Professions). Oral sedatives last for hours, so you will need someone to take you home.
We find that, for our patients who prefer to take a medication prior to an appointment, typically they will have a Xanax or Valium. This is taken prior to the appointment and can be a really helpful solution for those who suffer from pain or anxiety.
IV Sedation and General Anesthesia
Intravenous (IV) sedation delivers medication through a small line in the arm or hand, which lets the level be adjusted precisely during treatment. It is used most often for surgery, including implant placement, bone grafting, and extractions, and for patients with severe anxiety. General anesthesia goes further, to full unconsciousness. New York requires a parenteral conscious sedation certificate for IV moderate sedation and a general anesthesia certificate for deep sedation or general anesthesia (NYSED). At these levels, the ADA requires a review of your medical history and medications beforehand and continuous monitoring of oxygen, breathing, heart rate, and blood pressure throughout.
Moderate and deeper sedation also require fasting. The ADA’s 2025 guidelines note that fasting instructions may need to change for patients taking medications that slow stomach emptying, such as GLP-1 agonists. If you take Ozempic, Wegovy, Mounjaro, or Zepbound, tell us well before any sedation appointment. My partner has written about what GLP-1 medications do to your mouth more broadly.
Before any sedation, ask:
For reference, the ADA guidelines require pulse oximetry even for minimal sedation, written emergency protocols in every office, and rehearsed emergency drills at least every six months (ADA, 2025).
The choice depends on the procedure, how long it will take, your health history and medications, and how you feel about dental work. For many of my patients, an unhurried visit with good local anesthesia is enough. Others need more, and I would rather know that before we start than halfway through. We make the decision together at your consultation, and it can change from one appointment to the next.
If you are traveling in for treatment, we plan sedation and recovery around your schedule. Our out-of-town patient page explains how we sequence visits.
Dentistry uses local anesthesia, which numbs one area while you stay awake, and four levels of sedation: minimal (such as nitrous oxide or a standard dose of an oral anti-anxiety medication), moderate (higher-dose oral or IV sedation), deep sedation, and general anesthesia. The ADA defines each level by how responsive you remain and whether your breathing needs support.
Dental sedation has a strong safety record when it is provided by a trained, certified provider with the monitoring and emergency equipment the ADA guidelines require. In New York, moderate sedation and general anesthesia each require a specific certificate from the State Education Department. Ask your dentist which level they are recommending and who will administer it.
Not necessarily. Many implant procedures are done with local anesthesia alone, sometimes with nitrous oxide or oral sedation added. IV sedation is common for longer or more complex surgeries.
For moderate sedation, deep sedation, and general anesthesia, yes. The ADA follows American Society of Anesthesiologists fasting guidance, and instructions may be adjusted if you take a GLP-1 medication. Follow the specific instructions your dental team gives you.
It depends on the anesthetic and the injection site. Lip and tongue numbness usually outlasts the procedure by a few hours. An FDA-approved reversal injection can shorten soft tissue numbness by more than an hour for many patients.
This is again where the conversation is important with us when you’re receiving treatment in anesthesia. Some patients want to be very numb, and some want the lightest possible. We have different strengths of anesthesia, and there are different blends of anesthesia that last different amounts of time. We can use different types of anesthetics depending on what you need or want as a patient.
Does One Manhattan Dental offer sedation?
Communication is best around what one’s wants and needs are, and also understanding past appointments and past procedures, and how you react to them: what you found worked and what didn’t work.
If fear of the dentist has kept you away, or you have a procedure coming up and want to talk through your options first, tell us when you book and tell me at your consultation. We will build the plan around it. Call One Manhattan Dental at (212) 223-3632 or book online.
For more on how we think about care, listen to the Not Just a Dentist podcast.
This article is for educational purposes and does not constitute dental or medical advice. Any treatment decision should follow an in-person examination and diagnosis.
