Sedation for gum and implant surgery Patient guide

Gum and implant surgery is done under local anesthesia, alone or with nitrous oxide, oral sedation, IV moderate sedation or general anesthesia. Florida's moderate sedation permit requires at least 60 hours of didactic training. Florida Rule 64B5-14.002 bars a dentist from moderate sedation, deep sedation or general anesthesia without a permit.

Elegant woman posing with hand on neck, photo for Sedation for gum and implant surgery

What types of sedation do periodontists use?

Periodontists use anesthesia and sedation from numbing alone to general anesthesia, and Florida Rule 64B5-14.001 defines each level.

Level	What the patient experiences	Florida permit
Local anesthesia	Loss of pain in one area, fully conscious	None
Nitrous oxide	Breathes nitrous oxide and oxygen through a nose mask; stays able to respond	None; training required
Minimal oral sedation	A single oral sedative dose relieves anxiety; stays able to respond	None
Moderate sedation, IV or oral	Drowsy, keeps the airway and responds to speech and touch	Moderate sedation permit
Deep sedation or general anesthesia	Partial or full loss of protective reflexes; under general anesthesia, unconscious	General anesthesia permit

The effects of nitrous oxide wear off soon after the mask is removed, per the ADA. CODA requires periodontics residents to train to competency in adult minimal sedation by mouth and moderate sedation by injection, such as IV. Does gum surgery hurt?

What does Florida require for a sedation permit?

Florida requires a Board of Dentistry permit before a dentist uses moderate sedation, deep sedation or general anesthesia. Rule 64B5-14.002 reads: "No dentist licensed in this state shall administer or employ the use of general anesthesia, deep sedation, moderate sedation, and pediatric moderate sedation until they have obtained a permit as required by the provision of this chapter, unless specifically authorized otherwise by this chapter."

Moderate sedation permit: formal training at a CODA-accredited dental school or program, or an accredited teaching hospital, with at least 60 didactic hours.
Clinical training must include personal administration for at least 20 patients.
Every moderate sedation case needs three trained people: the operating dentist, a monitor and an assistant.
The dentist must hold current ACLS training.
Nitrous oxide requires a training course of no less than two days.

The permit rules do not apply in licensed hospitals and ambulatory surgery centers. Ask which permit the treating dentist holds. Questions to ask about sedation.

Who gives general anesthesia in a periodontist's office?

General anesthesia in a Florida periodontist's office is given by a physician anesthesiologist or by a dentist who holds a general anesthesia permit. A general anesthesia permit requires at least a two-year CODA-accredited residency in dental anesthesiology, or oral and maxillofacial surgery residency or board status.

Rule 64B5-14.0032 lets a dentist with a moderate sedation permit treat adult patients while a physician anesthesiologist performs the sedation.
Rule 64B5-14.0034 lets a general anesthesia permit holder sedate a moderate sedation permit holder's patient in that dentist's office after an added board inspection.
Only one patient may be induced at a time per anesthesia provider.
The treating dentist keeps a full copy of the anesthesia record in the dental chart.

Dental anesthesiology became a recognized dental specialty in March 2019, per the ADA. Preparing for surgery.

Do I need to fast before sedation?

Fasting is required before sedation, on the schedule in the American Society of Anesthesiologists table that the ADA's 2025 sedation guidelines reprint.

Intake	Minimum fast
Clear liquids: water, juice without pulp, carbonated drinks, clear tea, black coffee	2 hours
Light meal: toast and clear liquids	6 hours
Fried or fatty food, or meat	8 hours or more may be needed

The ADA guidelines call for modified fasting for patients taking drugs that slow stomach emptying, such as GLP-1 agonists. For moderate and deeper sedation, the ADA requires verbal and written instructions before the visit, including fasting. The ASA notes that patients are usually asked not to eat or drink after midnight before a sedation procedure. Follow the office's written instructions. Tell the office about every medication, and ask which ones to take that morning. Preparing for surgery.

Can I drive home after sedation?

Patients who receive sedation need someone else to drive them home. The ASA states sedated patients will most likely be woozy or weak and unable to drive.

Cleveland Clinic advises a ride for sedation and no ride for local anesthesia or nitrous oxide alone.
The ASA suggests someone stay with the patient for the first 24 hours.
The ASA notes patients may be told not to drive or drink alcohol for a day.
The ASA advises putting off important decisions for a day or two.
Florida's moderate sedation rule requires the record to state to whom the patient is discharged.
The ADA requires the dentist to document that consciousness, oxygenation, breathing and circulation are satisfactory before discharge.

Most patients go home soon after the procedure, usually within one hour, per the ASA. Gum surgery recovery.

Questions

Will I be asleep during gum surgery?

Under moderate sedation, consciousness is lowered, patients respond purposefully to speech or light touch, and they breathe on their own, per the ADA's definitions. Under deep sedation, patients respond only to repeated or painful stimulation. Under general anesthesia, patients cannot be aroused. Ask the office which level it plans to use.

What is the difference between oral and IV sedation?

Oral sedation is swallowed, and Florida treats a single dose of one oral sedative as minimal sedation, with no permit required. Florida's Board of Dentistry requires a moderate sedation permit to give repeated oral doses toward moderate sedation, citing unpredictable absorption. IV sedation goes into a vein in small doses until the intended level is reached.

Is nitrous oxide safe?

The ADA describes nitrous oxide as a safe and effective sedative agent mixed with oxygen and breathed through a small nose mask. Florida requires a delivery system with fail-safe features and a minimum oxygen flow of 30%. The patient stays able to hear and respond, and the effects wear off soon after the mask comes off.

Is IV sedation safe for dental work?

Florida regulates IV moderate sedation closely. The dentist needs a moderate sedation permit and current ACLS training. Three trained people must be present. The patient is monitored continuously by EKG, pulse oximetry and capnography, and vital signs are recorded at least every 5 minutes. Ask the office about its emergency protocols and equipment.

Can I take my usual medications before sedation?

Ask before the visit. The ASA advises asking the physician which medications to take before a sedation procedure, since some should be continued and others should not. The ADA guidelines call for a review of medical history, medication use and fasting status before moderate sedation, and adjusted fasting for drugs that slow stomach emptying.

How is sedation billed?

Sedation is a separate line on the estimate. IV moderate sedation is coded D9239 for the first 15 minutes and D9243 for each additional increment. Deep sedation or general anesthesia uses D9222 for the first 15 minutes. Nitrous oxide is D9230. Ask the office for a pre-treatment estimate that includes the sedation codes.

Sources

Reviewed by Steve Schadt, Director of IT and Medical Compliance: 25 years in dentistry, medicine and HIPAA compliance. Updated 2026-10-02. Checked against the sources listed. General information, not medical advice.