sedation   or   general   surgery,   and   certain   oral   or periodontal  surgery  procedures.  Most  routine informed  consent  can  be  easily  accomplished  during the   verbal   verification   of   diagnosis   and   treatment presentation. PAIN  AND  ANXIETY  CONTROL When dental surgery is indicated, whether oral or periodontal, there are several pain and anxiety control methods  available  to  make  the  surgery  as  smooth  as possible  and  put  the  patient  at  ease.  The  three  basic levels of anesthesia are local, conscious sedation, and general.   You   should   review   Dental   Technician, Volume  1,  Chapter  7,  "Oral  Pharmacology,"  to  help you better understand the following information Local Anesthesia The primary effect of local anesthetic agents is to penetrate   the   nerve   cell   membrane   and   block   the conduction of nerve impulses from the point where the local anesthetic is active. This produces anesthesia in the   local   area.   Local   anesthesia,   using   infiltration, nerve  block,  or  a  combination  of  both  techniques,  is used in surgery cases to numb the surgery area. Most  dental  surgery  procedures  require  two  or more injections of a local anesthetic. For this reason, it is  a  good  practice  to  include  two  aspirating  syringes with  each  instrument  setup.  This  will  let  you  supply the dentist with a loaded anesthetic syringe for as long as needed with minimum loss of time.  Since anesthetic solutions  are  bitter  and  there  is  leakage  from  the injection sites, you will need to irrigate and aspirate the fluids from the patient's mouth after injection. Conscious Sedation Conscious sedation is a minimally depressed level of  consciousness  that  retains  the  patient's  ability  to independently  and  continuously  maintain  an  airway, and   respond   appropriately   to   verbal   commands. Conscious sedation involves using various drugs or a combination  of  drugs  to  achieve  pain  and  anxiety control  while  maintaining  the  patient  in  a  conscious state at all times. The common routes of administration of  conscious  sedation  are  oral  premeditation, inhalation,   and   intravenous.   Local   anesthesia   is administrated with all types of conscious sedation. General Anesthesia General   anesthesia   is   a   controlled   state   of unconsciousness accompanied by a partial or complete loss  of  protective  reflexes,  including  the  ability  to maintain   an   airway   independently   and   respond   to verbal  commands.  General  anesthesia  renders  the patient unconscious through depression of the central nervous  system,  thus  eliminating  patient  cooperation as a factor. The administration of general anesthesia is performed  by  an  anesthesiologist  in  the  hospital operating room. Local anesthesia is also administered at the treatment site. ORAL  SURGERY  PROCEDURES While  there  are  many  oral  surgery  procedures, some are more commonly performed than others. You should be knowledgeable of those that are commonly performed.  In  the  following  paragraphs,  we  discuss surgical procedures you will need to know. TOOTH  EXTRACTIONS Tooth   extraction   is   an   oral   surgery   procedure classified  into  three  types:  simple,  complicated,  and impacted  extractions.  These  are  explained  briefly  in the following paragraphs. Simple Extractions Simple  extractions  involve  removal  of  a  tooth  or root that does not require bone removal or sectioning. The  deciduous  (nonpermanent)  or  permanent  tooth extracted is erupted and usually diseased or malposed. Retained  roots  may  be  buried  in  the  tissue  and  not visible  in  the  oral  cavity.  Retained  root  tips  may  be present because of fractured teeth, advanced decay, or any incomplete post-surgical  procedure.  They  can  be identified on radiographs. Complicated Extractions Complicated   extractions   involve   removal   of   a tooth  or  root  that  requires  surgical  sectioning  and/or bone removal. Impacted Extractions Impacted  extractions  involve  removal  of  a  tooth that is partially or completely covered by bone and or soft  tissue. This   extraction   may   involve   tissue incision,  excision,  or  bone  removal.  Two  types  of impactions are associated with oral surgery: soft tissue and bony impaction. Soft  tissue—occurs  when  the  tooth  is  blocked from  eruption  due  to  the  gingival  tissue.  It  may  be partially erupted with a portion of the tooth visible in the mouth. 5-3