Dentistry While Asleep

Why general anesthesia or “dentistry while asleep”?

Fear and anxiety can sometimes lead to people avoiding dental care. General anesthesia is the medical term for “dentistry while asleep” and it is a procedure that allows dental work to be completed while patients are unconscious. We find it to be very useful for adults, children, and people who have disabilities and are otherwise unable to sit through treatment. Sleep dentistry allows a person to have their dental treatment completed in typically one appointment. It can be used for restorative work like fillings, cleanings, teeth extractions, and cosmetic procedures such as crowns, veneers.

Our anesthetist Dr. Gino Gizzarelli and procedure overview

Dr. Gino Gizzarelli is very approachable and friendly. On the day of your appointment you will meet Dr. Gizzarelli before going to sleep. During this consultation he will discuss the procedure and address any questions you may have. For nervous adults an oral sedative can be provided to help you relax prior to the general anesthesia.  For younger patients, Dr. Gizzarelli can use gas inhalation with different flavours. After the procedure, you will be moved to recovery where a nurse will assist Dr. Gizzarelli in monitoring until you are awake and ready to go home.

Dr. Gino Gizzarelli’s Biography

Dr. Gino Gizzarelli completed his first degree in 1995 at the University of Toronto in Pharmacy. He worked as a full-time clinical pharmacist at Toronto General Hospital for 2 years before returning back to the University of Toronto to study dentistry.  Following his dental degree in 2001, he continued his studies in the same university and completed a 3-year Master’s degree in Dental Anesthesia.  During these 3 years, Gino trained in the operating rooms of the Hospital for Sick Children and Toronto East General Hospital.  Throughout his studies and until present, Gino has maintained a part-time clinical pharmacist position at Toronto General Hospital.  Dr. Gizzarelli is a member in good standing with the Royal College of Dental Surgeons of Ontario, the American Society of Dentist Anesthesiologists, and the Canadian Academy of Dental Anesthesia.  Dr. Gizzarelli is a diplomat of the American Dental Board of Anesthesiology and the National Dental Board of Anesthesiology.  He is a certified specialist in dental anesthesia (in Ontario).  He is an itinerant dentist anesthesiologist and teaches occasionally at the University Of Toronto Faculty Of Dentistry and at various conferences and CE courses.

Who benefits from dentistry while asleep?

• People who have dental anxiety or fear
• People who have a fear of needles or the drill
• Younger people who may have a lot of dental work and would like to complete treatment in one comfortable visit
• People with disabilities or other conditions which could make it difficult to receive dental treatment
• People who have had a traumatic previous dental experience
• People with very sensitive teeth
• People who have a strong gag reflex
• People who have a lot of work to be completed and want to have treatment completed in one easy visit
• People who have fear of noises, smell, and tastes associated with treatment
• People who need more involved treatment like teeth extractions

How does it work with my dental insurance?

Our office will help you in understanding your dental coverage. If you have insurance, we will send in an estimate for work needed along with the general anesthesia. This way, we can have pre-approval prior to your appointment and you will have peace of mind knowing what coverage you have before having treatment done. To make things even easier, we will bill and accept insurance payments directly if the insurance companies allows.

Having your dental fees paid directly to the dentist allows you to keep your own personal finances for other expenses like grocery bills, mortgage payments, or vacation plans.  Although some insurance companies do cover 100% of all dental care, most insurance companies have plan limits.  The limit can be in the form of percentage of fee covered, deductible, maximum allowance per year, fee guide limitations, or only covering select services.  Simply contact our Barrie dental office at (705) 737-2050 if you have any questions.

Note: If you have Ontario Disability Support Program (ODSP) coverage and you are over the age of 18, you are typically covered for general anesthesia in our experience. Similarly, if under the age of 18 and covered under the Health Smiles Program, you will likely have coverage. If you have no dental insurance we will provide you with a detailed written estimate of work needed and the associated costs.

Information for adults undergoing treatment with sedation/general anesthesia:

Important notes for before your appointment:

1. PLEASE DO NOT EAT SOLID FOOD (INCLUDING GUM AND CANDY) IN THE 8 HOURS PRECEDING THE SEDATION/ANESTHETIC APPOINTMENT.
2. DO NOT DRINK MILK, JUICES, OR COFFEE IN THE 8 HOURS PRECEDING THE SEDATION/ANESTHETIC APPOINTMENT.

Food in the stomach may result in vomiting and subsequent pneumonia during anesthesia.  This is unsafe and can be fatal. You may drink 1 -2 cups of water or apple juice up to 3 hours before the appointment. No other liquids are permitted. A light meal is strongly recommended for the evening before the anesthetic appointment.

• Take your medication as usual with a sip of water unless otherwise directed.
• If you are diabetic, please inform your dentist or myself ahead of time.
• Wear short sleeves, loose fitting clothing and flat shoes.

For appointments longer than 2-3 hours, please bring a complete change of clothing.

• Do not wear contact lenses; do not wear make-up, nail polish or hand/face creams/lotions.
• Please advise of any recent change in your health such as fever, vomiting, diarrhea, cold, or flu in the days before your appointment.
• Please confirm the person who will be taking your home that day. A taxi driver alone is NOT sufficient.  If no arrangements are made, your appointment will be cancelled.
• Please call if you have any questions or concerns 1 (416) 839-4777.

Important notes/what to expect during your appointment:

Before going to sleep, various monitors such as a blood pressure cuff will be placed on your arm and a sensor will be placed on your finger.  A small intravenous catheter is placed usually in the back of the hand.  Sedative medications are usually given intravenously and by inhalation on occasion.  When you first wake up, it is normal to feel disoriented and dizzy.  It usually takes 20-60 minutes to be alert enough to go home safely.

1. A responsible adult must accompany you home in a car or taxi. 
2. Rest of the reminder of the day. DO NOT WORK OR DRIVE OR MAKE IMPORTANT DECISIONS FOR 24 HOURS FOLLOWING ANESTHESIA.  Ideally a responsible adult should be with you until the next day.
3. Drink plenty of fluids (water, juice) after anesthesia but begin with frequent and small quantities. Do no drink alcoholic beverages for 24 hours after your visit.  If you are not experiencing any nausea or vomiting, you may eat solid foods as tolerated (please begin with light or easily digested foods).
4. The area where the IV catheter was placed may be bruised for a few days after your visit.
5. If there is local anesthetic (‘freezing”): be careful not to bite your lips, cheek or tongue.
6. A sore throat is common after an anesthetic.
7. Resume prescribed medications after the anesthetic.
8. If there are questions or concerns after the appointment, please do not hesitate to call.

Information for children undergoing treatment with sedation/general anesthesia:

For children that need dental treatment, general anesthesia it can be a great option to help them in having work completed effectively, quickly and most often in one appointment.  Dr. Gizzarelli will come and greet you and your child and see if there are further concerns or questions.

What to expect for your child before the sedation/anesthesia appointment?

1. DO NOT ALLOW YOUR CHILD TO EAT SOLID FOOD (including gum, candy) IN THE 8 HOURS PRECEDING THE ANESTHESIA APPOINTMENT.
2. DO NOT ALLOW YOUR CHILD TO DRINK MILK OR JUICES IN THE 8 HOURS PRECEDING THE ANESTHESIA APPOINTMENT. Food in the stomach may result in vomiting and subsequent pneumonia during anesthesia.  This is unsafe and can be fatal. Your child may drink up to 1 cup of water or apple juice up to 2 hours before the appointment. No other liquids are permitted.

3. Medications can be taken as usual with a small sip of water unless otherwise directed.
4. If your child is diabetics, please inform your dentist or myself ahead of time.
5. Dress with loose fitting clothing & please bring a diaper or a change of clothes.
6. Please advise us of any recent change in your child’s health such as fever, cold, or flu?
7. Please call if you have any questions or concerns (416) 839-4777.

What to expect for your child during the sedation/anesthesia appointment?

1. Your child will be given oxygen and usually sleep medicine through the mask to breathe.
2. Most children toss/turn, stretch out their arms, roll their eyes and their breathing patterns will change as they are going off to sleep.
3. After they are asleep, an intravenous catheter will be placed in their hand or foot that allows fluids and medication to be given.
4. A breathing tube may be placed in the nose.
5. Your child will be completely asleep for the entire procedure and no one is allowed to remain in the treatment area after your child is asleep.

What to expect for your child after the sedation/anesthesia appointment?

1. It usually takes approximately 30-60 minutes after the anesthetic before your child can go home safely. It is not uncommon for your child to cry when they wake up as they are still dizzy and disoriented.  The IV catheter will be in place until your child is awake.
2. A responsible adult must accompany your child home in a car or taxi.
3. Your child should be resting at home for the remainder of the day. They should not run or ride a bike until the next day.
4. Give your child fluids (water, juice) after anesthesia, begin with frequent & small quantities. If your child is not experiencing any nausea or vomiting, they may drink milk and eat solid food as tolerated (please begin with easily digested foods).
5. A sore throat or sore nose is common after anesthesia and will resolve on its own.
6. If there is discomfort: Tylenol, Advil, Or Motrin may be given based on their age & weight.  If nausea or vomiting: Gravol may be given based on your child’s age & weight.
7. Please do not hesitate to call: if your child vomits beyond 12 hours, if there is fever longer than 24 hours, if there is any difficulty breathing or if there any other concerns.