Pain? Dental Emergency?!

Call 402.397.STAR 


      Master, College of Conscious Sedation American Dental Society of Anesthesiology 


Dental Implants, bone grafting, teeth in a day, mini implants, dentures

Star Sedation Dentistry   

Specializing in Total Dentistry

                     With Advanced Infusion Therapy                   To Rejuvenate the Mind & Body




Sedation Dentistry

Pre-Operative, Peri-Operative, and Post-Operative Instructions for an easier visit and recovery

I have read the above risks and Dr and his team have discussed requirements and risks and have answered all my questions. I give Dr. Starkey and his staff to provide me with oral sedation, relaxing gas, and or IV sedation with adjunctive medications that will help with my recovery and surgery.

Patient signature_____________________________________________________Date_____________


Anesthesia Informed Consent

Local Anesthetic

  1.  I was told I would need to be given local anesthetic  to numb the area Dr. will be working on.
  2. I understand that local anesthetic can cause heart palpitations.
  3. I understand that that such shots can cause numbness that lasts longer than normal. In fact LA can cause nerve damage that lasts for weeks or months or my whole life though that is extremely rare.
  4. I understand that sometimes a shot can cause numbness of my eye lid and can cause drooping of my face on the affected side. I understand this is rare and that it is temporary.
  5. I understand that local anesthetic does not always work.
  6. I understand that giving shots especially in infected areas can hurt a great deal.
  7. I have been told there is local anesthetic without epinephrine  so that there is less heart palpitation risk  and I understand there is long lasting local anesthetic.
  8. I leave it up to Dr. Starkey to decide the kind of local anesthetic
  9. Or I want to discuss the kind of local anesthetic I would like to use  and then decide.

Dr. Starkey and his team have reviewed risks of local anesthesia and I have decided that local anesthetic with no epinephrine is what I want

I am okay with the Dr. and his staff using lidocaine with epinephrine or similar local anesthetic, I am okay with long acting anesthetic.

Patient to initial or to tell Dr. Starkey or his team the kind  of LA and 

then circle the type wanted to be used.

Post Sedation Dental recovery

  1. You are NOT to drive for 24 hours
  2. If there was surgery you are not to take any narcotic pain reliever for two hours after finishing the surgery. That is because you may get nauseated. Even though we use anti nausea drug.
  3. Cryotherapy- ice the affected area. We use a steroid to prevent swelling but additional icing will help prevent or reduce swelling and control pain.
  4. Milk shakes icey drinks are helpful.
  5. Any problems that seem out of ordinary call the office 402.926.4848
  6. Or call Dr. Starkey on his cell phone 402.740.9235
  7. If you cannot reach the doctor or the staff and it is an emergency then you are to go to the nearest Hospital emergency room.
  8. You will need to see the Doctor for post operative check approximately 10 to 14 days after surgery.

Before your dental surgery it is important to:

  1. Answer all your Questions obtain both verbal and written informed consent.
  2. Obtain a deposit for your dental surgery visit.
  3. It is important for you to give the name of your MD. And in some cases you may have a specialist that is more informed on your health issues. Sometimes it is important for Dr. Starkey to contact your MD and inform them of proposed treatment and medications we plan to use. Dr. Starkey will request your doctor advise us on any changes in protocol as well as updates that you may not be aware of. This requires you give us consent to contact their practice which means we need to have you authorize the HIPPAA documents stating we can contact other health providers as well as insurance companies.
  4. Tell Dr. Starkey if you have any problems with local anesthetic. We will need to give you local anesthetic not only for an easier visit for you but for easier post op recovery.
  5. Cancellations- You are required to give us 24 hours notice if the appointment is Tuesday through Friday. If your appointment is Monday you must notify us by noon on the Friday before that you cannot make the appointment. The objective is to prevent lost time  for the practice and contact a patient that might like to come in at that time. Late cancellations or no shows results in the loss of your deposit.
  6. Arrange a ride and an escort. You are NOT to drive. And someone needs to be available for you at home.
  7. If you have an upper respiratory tract infection you should call us early and reschedule your visit. We need you to be healthy and able to breath through your nose.
  8. Have appropriate drinks and food for post operative care.
  9. Reduce your anxiety and have a safer visit by following stress reduction protocol. For certain patients an oral sedative will be prescribed. You are to take one the night before, in the morning take one an hour before appointment, when you arrive at the office you will take a third oral sedative. You will have an extra tablet just in case. The objective is to gradually reduce your stress over time this will make for a safer more enjoyable visit.
  10. Under most circumstances you can have a light breakfast before coming to the office. For example toast and coffee so you follow close to a normal routine. 
  11. Plan for dental surgery in the morning so that you can be followed up in the afternoon if necessary and you are not pre occupied thinking about dental treatment and not eating.
  12. If you have fragile veins or difficulty getting an IV started please tell the Doctor at consultation so that we can prepare for such a challenge. This the doctor should know from your previous consultation. Otherwise please bring to his attention.
  13. Tell the staff of any changes in your health history when you arrive for dental surgery.
  14. Medications- take all your medications as you usually do unless Dr. Starkey says otherwise. If you are taking warfarin for example continue to take the medication and the Dental Team will deal with the bleeding issues.
  15. Check with Dr. Starkey about the amount of time you should be off work or do any exercise.

Anesthesia Informed Consent

And Anesthesia Instructions

Sedation Anesthesia Informed Consent

Dr. Starkey and his staff have informed me of the benefits of IV sedation and also the risks and disadvantages. I have read and understand the pre operative peri operative and post operative IV sedation instructions. 

I understand that I have to have a ride and an escort and I am to tell the Dr or staff any changes in my health history on the day of surgery. I have been told there is a deposit for IV sedation surgery and that I have to give notification 24 hours to 72 hours ahead of time or lose my deposit.

I understand that Dr. Starkey does not use narcotics in the IV sedation but uses a pain control medication that works well unless I have been taking narcotic pain relievers for a month or longer. 

I am to tell Dr or his team that I am taking narcotics regularly  and for how long. The reason is so Dr. Starkey does not use a pain medication that causes a reversal of narcotic medications in my system. That results in restless leg syndrome and irritability for several hours.

Please Circle 

I  do        I do NOT take narcotics on regular basis for at least a month. 

Dr. needs to know this for my protection and for better visit.

I have been told that IV sedation does NOT always work and Dr. Starkey cannot guarantee that the IV sedation will work.

I understand that Dr. Starkey and his team will be giving me supplemental oxygen and relaxing gas unless relaxing gas bothers me.

I am to tell Dr. Starkey if I do NOT want relaxing gas (nitrous oxide/N2O2)

The following are complications that I acknowledge as possible

  1. Amnesia  Usually just at time of visit but some times it can be for several hours after the visit or some period of time before visit.
  2. I can get a phlebitis at the site of the needle stick though it is rare.
  3. It may take several attempts to start the IV
  4. Dr. Starkey prefers using my right arm or wrist so that he and the monitoring assistant can easily see how the line is working.
  5. If I have an unusual condition such as Huntington's Chorea or loss of mental status for other reason that IV sedation can cause the neurological problem to become worse.  Moderate sedation without narcotics and with propofol and shorter visits can minimize the risk of such a problem but it will not eliminate it.

Peri Dental Surgery (Around the time of surgery)

  1. An hour before visit you are to take an oral sedative ONLY if that is recommended by the doctor. If you are able to take Advil (ibuprofen) with no health risk consider to take 800 mg of Motrin or four 200 mg ibuprofen tablets an hour before appointment.
  2. This makes IV start easier on you and actually much of visit.
  3. When arrive you may be asked to take an oral sedative and we will wait for 20 minutes or so to see how it affects you.
  4. Also we want you to make an appointment for follow up check of surgery or next step while you are waiting for the medication to take affect.
  5. Also please tell staff of any changes in your health history since you were last seen.
  6. Please tell staff if you ate or not and what you had to eat and drink.
  7. Stop in the rest room to relieve yourself  before being seated.
  8. We need you to gargle or use an oral rinse for 30 seconds if you will either in the rest room or you can do it when you are seated in the dental treatment operatory. 
  9. If you are allergic to Neosporin we need to know because we will be using this ointment on your gums and lips and teeth. The same goes for Betadine.
  10. After you are seated and reclined we will once again review your medical condition and what you are having done. It is a pre- anesthesia evaluation and is required by law and it is for your own safety really.
  11. The Sedation team will place blanket over you and and cover your nose with a nasal hood. We will have you breath oxygen for a few minutes to improve your cardiovascular output and then we will give you relaxing gas. This helps dilate your veins and makes IV placement easier for the patient.
  12. We will talk to you during the visit.  We want you to respond. You just won't recall talking. The objective is to keep the sedation moderate. Moderate sedation works well for most everyone; moderate sedation is safe sedation.
  13. At the end of surgery we will sit you up and have you rest sitting up for a period of time. Usually it is about ten minutes. You can go to the rest room  if you need to if you are able to stand and walk. Recovery from propofol is pretty quick but you have to be able to stand up and walk on your own.
Call us at 402.926.4848 for your next cleaning and check up

Dental  Surgery 

Anesthesia for a pleasant escape

Systemic dentistry  for a better life

Michael A. Starkey, DDS MS and The Team

Benefits of our Sedation Dental Center