For most surgical procedures at our office, IV sedation is the standard option — and the option most patients prefer once they understand what it actually involves. The sedation is administered by Dr. Volland personally, with eight years of Naval surgical anesthesia experience and the certifications a hospital operating room would expect. The patient experience is calm, the recovery is straightforward, and the safety record of in-office IV sedation by a board-certified OMS is excellent.
If you've never had IV sedation, the most important thing to know is this: it doesn't feel scary, it doesn't feel like surgery, and you don't remember it. Most patients describe waking up afterward and asking "is it done already?" — because the procedure is finished and they have no memory of it happening.
Before your appointment. You'll receive specific instructions: nothing to eat or drink for 6-8 hours before sedation (depending on what you ate), no alcohol or recreational substances for 24 hours prior, and arrange a driver to bring you home and stay with you for several hours afterward. Most patients arrive with a family member or friend who waits during the procedure.
When you arrive. You're brought back to a private surgical suite where vital signs are taken and an IV is placed (a small needle in your arm, similar to a blood draw). You're connected to monitors that track your heart rate, blood pressure, breathing, and oxygen levels throughout the procedure. The local anesthetic is administered after sedation begins, so you don't feel the injections.
Going to sleep. Medications are administered through your IV. Within 30-60 seconds, you become deeply relaxed and drift to sleep. You're breathing on your own throughout — IV conscious sedation is different from general anesthesia in this respect. Your protective reflexes (cough, swallow) are preserved.
During the procedure. The surgical procedure proceeds normally while you sleep. Dr. Volland and the surgical team continuously monitor your vital signs. Most patients have no awareness of the procedure happening; if you do briefly wake at any point, additional sedation is administered immediately to return you to sleep.
Waking up. When the procedure ends, the sedation is allowed to wear off naturally. You wake gradually over 10-30 minutes, often groggy at first. You're moved to a recovery area with monitoring continued. Most patients are ready to go home with their driver within 30-60 minutes of the procedure ending.
The rest of the day. You'll be drowsy for several hours and shouldn't drive, operate machinery, sign legal documents, or be alone. Most patients sleep for 2-4 hours at home. By evening, the sedation is essentially gone; you may have some surgical discomfort but the sedation effects have worn off.
Office-based IV sedation requires specific training, licensing, and continuing certifications. The credentialing standard varies meaningfully across providers — here's what Dr. Volland brings to your sedation.
The board certification for oral and maxillofacial surgery, requiring completion of accredited residency, written and oral examinations, and demonstrated surgical competency. Includes formal training in office-based anesthesia administration.
Washington State Department of Health permit authorizing administration of general anesthesia and deep sedation in office settings. Requires demonstrated training, equipment standards, emergency preparedness protocols, and ongoing renewals with site inspections.
American Heart Association certification in management of cardiac arrest, arrhythmias, stroke, and other life-threatening cardiovascular emergencies. Standard credential for hospital surgical teams; less universal in office-based practices.
American Heart Association certification in pediatric resuscitation and emergency management. Relevant for adolescent patients receiving sedation, particularly for wisdom teeth procedures in 16-19 year olds.
American College of Surgeons certification in management of acute trauma, including airway management, hemorrhage control, and trauma resuscitation. Relevant for any sedation-related airway or hemorrhage emergency.
Eight years of active-duty surgical practice including residency at Naval Medical Center Portsmouth and operational service aboard the USS Nimitz. Hospital-based anesthesia experience exceeds typical office-based training pathways.
Different procedures and different patients warrant different sedation approaches. The choice is yours after discussion at consultation; IV sedation is the default for most surgical procedures but is not the only option.
Numbing injections at the surgical site. You're fully awake and aware throughout the procedure. Suitable for routine procedures (single tooth extractions, simple bone graft, minor surgical work) where the procedure is brief and the patient prefers no sedation.
When this is appropriate: Brief procedures, patients who prefer to stay awake, situations where a driver isn't available, certain medical conditions where sedation isn't preferred.
Medications administered through an IV induce a sleep-like state. You're breathing on your own and your protective reflexes are preserved, but you're not aware of the procedure and don't remember it. Local anesthesia is also given to numb the surgical site.
When this is the standard: Wisdom teeth removal, surgical extractions, single and full-arch implants, bone grafting, sinus lifts, most surgical procedures performed in our office. Most patients prefer this option once they understand what it involves.
Complete unconsciousness with airway management. Generally reserved for hospital-based settings or specific clinical situations requiring deeper sedation than IV conscious sedation provides. The Washington GA Permit authorizes administration in our office for select cases.
When this is appropriate: Complex full-arch cases with extensive concurrent procedures, patients with specific medical needs, pediatric patients requiring deeper sedation, situations where IV conscious sedation isn't sufficient.
In-office IV sedation by a board-certified OMS has an excellent safety record. The structural elements that make it safe are specific and verifiable.
Before sedation is scheduled, your medical history, current medications, and any medical conditions are reviewed in detail. Patients with certain medical complexities (uncontrolled hypertension, recent cardiac events, severe sleep apnea, pregnancy, certain medication interactions) may require modified protocols, hospital-based sedation, or sedation with additional monitoring. The pre-sedation evaluation is not a formality — it determines what level of sedation is safe for your specific situation.
Throughout the procedure, you're continuously monitored: heart rate, blood pressure, oxygen saturation, end-tidal CO2 (capnography), and respiratory rate. Monitoring devices are calibrated and tested before each procedure. A trained surgical assistant has continuous responsibility for monitoring while Dr. Volland focuses on the surgical procedure itself.
The office is equipped with emergency airway management devices, reversal agents for sedation medications (specifically flumazenil for benzodiazepines and naloxone for opioids), an automated external defibrillator (AED), and emergency medications for cardiac, respiratory, and allergic emergencies. Staff conduct regular emergency response drills. The Washington GA Permit requires demonstration of these capabilities for permit issuance and renewal.
After the procedure, you're moved to a recovery area where monitoring continues until you meet specific discharge criteria (stable vital signs, appropriate consciousness level, ability to maintain airway, etc.). Discharge requires a sober adult driver and post-procedure instructions provided in writing. We don't discharge sedated patients to taxis, rideshare services, or unsupervised situations.
IV sedation is the standard option for most surgical procedures at our office, though local anesthesia is always available when patients prefer to remain awake. Here's where sedation is typically used:
Wisdom teeth removal. Single-session removal of all four wisdom teeth is performed under IV sedation as the standard. Most wisdom teeth patients (typically 17-25 years old) prefer sedation for what would otherwise be 30-45 minutes of awake oral surgery.
Surgical extractions. Teeth requiring surgical removal (broken at gum line, ankylosed roots, retained root tips) are routinely performed under IV sedation. The combination of sedation plus local anesthesia makes complex extractions much more comfortable for patients than awake procedures.
Single dental implants. Single implant placement under IV sedation is the most common approach for patients who elect sedation. The procedure itself is straightforward (30-60 minutes), but sedation eliminates the anxiety associated with surgical procedures. Local anesthesia alone is appropriate for many single implant cases when patients prefer to remain awake.
Full-arch implant procedures. All-on-4 and full-arch implant cases are performed under IV sedation as the standard. Multi-hour procedures involving extractions, implant placement, and same-day provisional teeth — for nearly every patient, sedation is the right choice.
Bone grafting and sinus lifts. Standalone bone grafting procedures and sinus lift surgeries are typically performed under IV sedation when they're the primary procedure. When grafting is combined with extraction or implant placement (most common), sedation covers both procedures simultaneously.
For procedures not requiring sedation — consultations, suture removal, post-op evaluations, simple imaging — no sedation is used. Patient choice is always preserved; if you'd prefer local anesthesia for any surgical procedure normally performed under sedation, we'll discuss whether your case is appropriate for that approach.
IV sedation at our office is priced based on the duration of sedation required for your specific procedure. Routine sedation (30-60 minutes for single implants, surgical extractions, and similar procedures) typically costs $400-$700. Longer sedation durations (multi-hour full-arch cases) are priced based on time but generally remain in the $700-$1,200 range as standalone fees.
For full-arch implant cases at Elite, IV sedation is included in the all-inclusive $15,000 per arch pricing — there's no separate sedation fee for full-arch cases. For all other procedures (wisdom teeth, surgical extractions, single implants, bone grafting), sedation is priced separately and disclosed in your written treatment estimate before scheduling.
Insurance coverage varies. Many dental plans cover IV sedation when it's medically necessary in conjunction with surgical procedures. Some plans classify it as elective and exclude coverage. Medical insurance occasionally covers sedation for medically complex patients or when procedures are performed under medically necessary anesthesia. We verify your specific coverage before treatment and provide a written estimate of any patient responsibility.
HSA and FSA funds are eligible for sedation costs. For patients without insurance coverage who prefer to avoid out-of-pocket sedation expenses, local anesthesia is available for most procedures.
Office-based IV sedation administered by a board-certified oral and maxillofacial surgeon has an excellent safety record. Serious complications occur at very low rates (typically reported in the range of 1 per 100,000 to 1 per 365,000 procedures depending on the study). The factors that make it safe are specific: pre-sedation medical evaluation that screens out patients with elevated risk, continuous monitoring during the procedure, immediate availability of emergency response equipment and reversal medications, and the surgical team's certifications (ACLS, PALS, ATLS, BLS).
What makes Dr. Volland's sedation specifically safe is the combination of board certification, the WA General Anesthesia Permit, full advanced life support certifications, and eight years of hospital-based Naval surgical practice. The credentialing is more comprehensive than what's required for many office-based providers.
The key difference is breathing. Under IV conscious sedation, you're breathing on your own throughout the procedure. Your protective reflexes (cough, swallow) are preserved. You appear to be asleep but you're technically in a deeply relaxed state. Under general anesthesia, you're not breathing on your own — your airway is managed (typically with a breathing tube), and you're completely unconscious. General anesthesia is a deeper level of sedation that requires more extensive monitoring and is typically reserved for hospital-based settings.
For nearly all oral and maxillofacial surgical procedures, IV conscious sedation is the appropriate level. General anesthesia is rarely needed for office-based procedures and is reserved for complex cases or specific medical situations.
No. Local anesthesia is administered after sedation begins, so the surgical site is fully numbed before any procedure starts. The sedation eliminates anxiety and awareness of the procedure; the local anesthesia ensures no pain at the surgical site. Most patients have no memory of any discomfort from the procedure.
If you do have any awareness of the procedure (which is uncommon under IV sedation), additional sedation is administered immediately to deepen your sleep. The combination of sedation plus thorough local anesthesia produces a procedure that's comfortable from start to finish.
No — under no circumstances. The sedation medications affect your judgment, reflexes, and motor function for several hours after the procedure even when you feel relatively alert. Driving, operating machinery, signing legal documents, or being responsible for others (children, dependents) are not safe activities for at least 24 hours after IV sedation.
You must arrange a driver to bring you home and stay with you for several hours. Rideshare services and taxis are not acceptable substitutes — your driver needs to be a sober adult who can monitor your recovery and respond if any issues arise. Most patients arrange a family member or friend.
You'll receive specific written instructions before your appointment. The general guidelines: nothing to eat or drink for 6-8 hours before sedation (water clear up to 2 hours before is sometimes permitted depending on the situation), no alcohol or recreational substances for 24 hours before, continue most prescription medications with small sips of water as directed (some medications are held — your pre-sedation evaluation specifies which), and arrange a driver who can bring you and stay during recovery.
Wear comfortable clothing with sleeves that can be rolled up for IV placement. Remove contact lenses, dentures, and piercings before the procedure. Don't apply heavy makeup, lipstick, or nail polish (clear nail polish is fine). Arrive 15 minutes before your scheduled time for vital signs and final preparation.
Many patients are nervous about the IV — needle anxiety is common. We use small-gauge IV catheters and can apply numbing cream to the IV site beforehand if you let us know you're anxious. The IV insertion takes a few seconds and is typically uncomfortable rather than painful (similar to a blood draw). Most patients find the IV is the worst part of the experience — and it's brief.
If your anxiety is severe enough that the IV itself feels intolerable, we can discuss options including oral pre-sedation (a pill taken before the IV is placed) to reduce anxiety to manageable levels before the IV insertion. Tell us about needle anxiety at consultation so we can plan accordingly.
Coverage varies. Many dental insurance plans cover IV sedation when it's medically necessary in conjunction with surgical procedures (typically including wisdom teeth, surgical extractions, and implant placement). Some plans classify it as elective and don't cover it. Medical insurance occasionally covers sedation for medically complex patients or when the procedure itself qualifies as medically necessary.
We verify your specific coverage before treatment and provide a written estimate of any patient responsibility for sedation. HSA and FSA funds are eligible for sedation costs and can effectively reduce out-of-pocket cost by your marginal tax rate. See our insurance page for verification options.
If you're scheduled for a procedure that may involve IV sedation — or you want to discuss sedation options before scheduling — bring it up at your consultation. Most patients find IV sedation is far less intimidating than they expected once they understand what it actually involves.
Schedule a Consultation →