Dr. RAJ MISRA

Dr. Misra is a graduate from Loma Linda University’s Dental Anesthesiology program, a two-year post doctorate degree.  Prior to this he attained his undergraduate degree from Texas Tech University in 1988 and his doctorate degree from Baylor College of Dentistry in 1994.  Dr. Misra furthered his education by completing a hospital based general practice residency at the Olin E. Teague VA Hospital in Temple, Texas in 1995.  He received extensive training in hospital dentistry and I.V. Conscious Sedation.  He joined Mobile Dental Care and provided bedside dental care and treatment to nursing home patients.

Dr. Misra started his private practice in Restorative and Cosmetic Dentistry within the Fort Worth area.  After practicing dentistry for over 10 years, he decided to challenge himself further and become a Dental Anesthesiologist.

His anesthesiology training consisted of medical rotations in cardiology, internal medicine, and anesthesiology at Riverside County Medical Center and Loma Linda University Medical Center, which provided him with valuable exposure to complex medical and surgical cases.  The remainder of his training was conducted at the Special Care Dentistry (SCD) clinic at the Loma Linda School of Dentistry.  The SCD clinic manages a flow of nearly 5,000 patients each year, mostly comprised of pediatric   and adult special needs patients.  Overall, the training at these facilities provided Dr. Misra an exceptionally well rounded education in the field of anesthesiology.

COMMONLY ASKED QUESTIONS

What is sedation and general anesthesia?   Most dental cases can be done under local anesthesia alone or sometimes in conjunction with an oral sedative and nitrous oxide sedation.  However, certain complex cases, anxious patients, and children may require a more controlled and deeper level of anesthesia.  This degree of anesthesia in such cases can vary between moderate-deep sedation and general anesthesia.  Deep sedation reduces consciousness, pain and anxiety while maintaining the patient’s ability to respond to commands.  On the other hand, general anesthesia provides a temporary loss of consciousness which may be necessary in certain cases.  Dr. Misra is exceptionally well trained at providing all levels of anesthesia so that your dentist can fully focus on your oral surgical procedure.  This allows for a safer, more predictable and comfortable experience for both the patient and the dentist.

Is it safe?  Patient safety is our ultimate goal.  The use of conscious sedation, deep sedation and general anesthesia is safe and effective when properly administered by trained individuals.  The American Dental Association strongly supports the right of appropriately trained dentists to use these modalities for the management of dental patients and is committed to ensuring their safe and effective use.  Dr. Misra continually strives to provide his patients with an unparalleled level of safety by conducting a comprehensive preoperative evaluation, conducting physiologic and visual monitoring of the patient as needed from the onset of anesthesia to recovery and having available appropriate emergency drugs, state of the art equipment and maintaining competency in their use.  You can rest assured that Dr. Misra will provide you with a safe, controlled and hospital grade anesthetic experience in the comfort of your dentists office.

Who decides the level of anesthesia?  Your dentist is best qualified to assess whether you would benefit from iv sedation/general anesthesia for your proposed dental treatment.  The type of anesthesia used will depend upon the age and the physical condition of the patient as well as the type and length of the surgery.  The medications that Dr. Misra will utilize are completely individualized to each patient to ensure a pleasant and safe experience.

Why is anesthesia necessary?  There are many groups of people who benefit from iv sedation/general anesthesia during dental procedures.  Patients who are physically or mentally handicapped, experience anxiety, gag easily, experience discomfort while keeping their mouth open for extended periods of time, and have a low pain threshold are all candidates for dental anesthesia.  IV sedation/general anesthesia provides increased patient comfort, excellent working conditions for the dentist and it can save you, and your busy schedule, the inconvenience of multiple dental visits.

Why would a child need  sedation or general anesthesia just to have their teeth fixed?  Unfortunately, many children suffer from serious, potentially painful dental diseases.  Unlike such health conditions as colds or flu, dental diseases won’t go away on their own.  When treatment is required for a serious dental condition, general anesthesia may be recommended to make delivery of that required treatment possible in a safe and comfortable manner.  Children have natural fear of the unknown.  Anything you can do to relieve these anxieties(bring a favorite blanket, teddy bear or toy) will greatly improve your child’s experience.  Like adults, children tolerate surgery and anesthesia better when they are well prepared.  Reassure your child by explaining everything beforehand.  Although it is natural for parents to have anxiety when their children are about to have surgery, it is best not to convey this to your child.  Your composure as a parent is essential.  Nothing calms a child more than a confident parent.

What happens during surgery?  Your anesthesiologist, Dr. Misra, will continuously monitor your response to anesthesia and surgery.  The type of anesthesia planned and the medical condition of the patient dictates the type of monitoring used.  If the patient has serious medical problems even if local anesthesia alone is planned for surgery, the anesthesia care provider may decide that pulse oximetry, blood pressure and EKG monitoring would be in the patients best interest.  The following are used by Dr. Misra during your office visit to insure the safest and most effective anesthetic experience.  The EKG to continuously monitor the heart and rhythm, a bluetooth precordial stethoscope to continuously monitor the heart rate and respiration, pulse oximetry to continuously monitor blood and oxygen levels, oxygen for maximum patient safety, non invasive blood pressure and temperature is taken throughout the dental procedure, and lastly deep vein prophylaxis is used during treatment to maintain circulation in the legs especially during long procedures.

Why are so many questions being asked about my health history?  Because anesthesia and surgery affect the entire body, it is important for the anesthesia care provider to be able to anticipate the affects of all anesthetics in relation to the drugs and medications that the patient is taking and may have been used in the recent past.  This includes all prescription or non-prescription drugs:  over-the-counter, herbals, or “street drugs”.  Even marijuana, alcohol and tobacco use affects the way anesthetic drugs work in the body.  Many patients may have chronic medical conditions, such as diabetes, renal failure, heart or lung problems that can make routine dental work challenging in the conventional dental office setting.  These conditions necessitate careful monitoring of vital signs during the procedure.  Additionally, anesthesia may be provided in order to control pain, anxiety and deleterious physiological responses, such as elevated blood pressure and heart rate, that accompany them.

Are there special instructions to follow before my surgery?  It is very important that the oral intake (solids and liquids) restrictions be understood and followed.  As a general rule, patients cannot eat any solid foods after midnight the night before anesthesia/surgery.  This includes all foods and liquids, chewing tobacco, chewing gum, candy, mints, throat lozenges, etc.  Under some circumstances, you may be given permission to to drink clear liquids up to four hours before your anesthesia/surgery.  Medications may be taken at any time before surgery with only a small sip of water.  These restrictions are to protect the patient from inhaling food during surgery/anesthesia.  If this occurs the risk of pneumonia is very high and could even be life threatening.  If restrictions are not followed, it may require postponing the surgery.

Will I need someone to take me home and what can I expect when I get home?  Patients usually go home fifteen to thirty minutes after the end of surgery.  It is important that a competent home caregiver(responsible adult) be with you throughout the day of surgery.  This individual will be responsible to drive you home after the surgery/anesthesia is over.  Anesthetic drugs have occasional after effects including nausea, dizziness, sleepiness and loss of normal body coordination.  Some patients may experience a sore throat and minor aches.  Usually there are no limitations twenty four  hours after discharge from the office.  The majority of patients don’t have dizzy spells or bodily weakness the next morning.  The decision to continue ones daily activities should be based on the presence of any unusual signs or symptoms.  It is important to drink plenty of fluids to stay hydrated and take pain medication as directed by your surgeon.