Ever heard the old statement, "That was a lot like pulling teeth!"? Some things in life are not easy! If you have been referred to an oral surgeon for an extraction, there is a high likelihood that your extraction is anticipated to be more difficult than average. Some people are okay with being awake for surgery. But you should realize that it is impossible to not know what is happening during surgery if you are not heavily sedated, or asleep. The following three factors enter into the reasons that can prevent people from going to sleep for surgery: cost, a fear of going to sleep, or their health is not acceptable for that type of care.
Cost: Many patients want to be asleep or unaware of their surgery but do not want to pay the expense to receive it. Without an IV, they should not expect to have no memory of the procedure, but that does not mean the procedure cannot still be done painlessly. I have had many patients tell me that they did not "feel" the "novocaine" (otherwise called lidocaine, carbocaine, septocaine, marcaine, etc.) injection, and even though they were wide awake didn't realize the tooth had been removed. Patients have only experienced this if the tooth actually came out very easily. But patient expectations of the experience vary widely. The more difficult the procedure (which sometimes is hard to determine beforehand) the more appropriate IV treatment becomes, regardless of added cost. If cost is a factor for you, I may prescribe an oral sedative to be taken an hour before your appointment, to be used in conjunction with local anesthesia. This is a light sedation only, but still requires a driver to and from my office. Oral sedation is much less expensive than an IV procedure.
Fear of Anesthesia: I tell people that the risk of driving away from my office on a sunny day and being seriously hurt or worse in their car is a greater risk than going to sleep in my office. Anesthesia fears are real, and you should discuss this frankly with your surgeon. Anesthetic agents today are very safe and effective, and usually wear off quickly, allowing patients to go home not long after their procedure. After 30 years of practice, all of our patients have awakened, and you will too!
Health: I have had 90-year-old patients tell me they want to be asleep for their extraction. This is usually unsafe, and inappropriate in an office setting. Some younger patients may be inappropriate candidates for office-based anesthesia, depending on their overall health. Oral surgeons are very astute at determining who is an appropriate candidate for IV (intravenous) sedation or general anesthesia. Patients can be treated in a hospital setting if their health warrants it.
If a healthy person wants to know absolutely nothing about their surgery, they need an IV, which will increase cost. I have never in all my years of practice had ONE patient return after an IV procedure and say that it cost too much. They have all loved it. As an oral surgeon, that ability to place patients safely under anesthesia for their procedure is what sets us aside from all other surgeons. No one else is trained in that way.