Question about Nitrous Oxide - please help, life at risk, terrified

Been having nervous breakdowns. Yes, plural! Nervous breakDOWNS.

The short of it: I am a nervous patient but I can not have IV sedation, oral pills or GA because of reasons explained here. I need a severely decayed and infected molar pulled (not a wisdom tooth) and would prefer Nitrous Oxide sedation due to adverse reactions/BAD hypersensitivites to sedatives and opioids---- but I also have pre-existing anxiety disorder, and research on the Internet says that Nitrous can be bad for people with pre-existing anxiety disorder; while I believe this is true, I don't think my OS will work on me unless I have SOME kind of sedative because my gag reflex and anxiety is a total pain in the butt..

Here's the story: In 2007 my #2 molar (no wisdom teeth, I am 23 years old) started disintegrating and finally left a black, decayed hole in the roof of my mouth. It never gave me a problem until October of this year when it became abscessed. I was put on 10 days of Amoxicillin and it was resistent. My stomach was ripped so much inside and out from the Amox. My dentist found my anxiety to be too great for her to deal with. So I made an appointment with another dentist, 2 weeks later, and a second 10-day round of Amoxicillin which made me even sicker, but helped the abscess a little better.

Anyway this dentist took one look at it and decided it was too complicated from severe decay, and also it is slightly curved, so he referred me to an Oral Surgeon.

Here is my problem:
I have pre-existing panic disorder, mild dental phobia, anxiety disorder, etc. I NEVER HAD ANY OF THAT prior to the year 2007, so I did get a lot of work done with just local shots and no problems in the past (before 2007). 2007 was a year that marked the reason why I can no longer tolerate sedatives (benzodiazepines).

In 2007 I was put on sedatives (aka benzodiazepines) due to seizures induced by a birth control pills. Benzodiazepines are the drugs we know as Klonopin, Valium, Versed, Xanax, Ativan, Rivotril, Halcion, etc.
The benzo I was on to counter the side effects from those birth control pills was Xanax. I did NOT know that Xanax was an addictive drug, so after only a few weeks of daily use, I was hooked. When I wanted to discontinue it, it was too late; I was dependent upon it. I did withdraw from it a year later (2008), but the withdrawal syndrome it caused in me is "protracted," meaning I am still affected by the withdrawal syndrome and I am therefore hypersensitive to any drug in the benzodiazepine family. Following withdrawal of it, I had rebound panic attacks and withdrawal seizures. I was put on Klonopin, another benzodiazepine, to counteract the seizures induced by the Xanax withdrawal. I am still on the Klonopin.
I have not had a seizure since then.
I do not have Epilepsy.
I was checked out and cleared by both a Neurologist and a Cardiologist (my bp/hr can be high sometimes but it is benign).
I have been on the Klonopin since (2008) but now I am faced with necessary dental work and I still have a severe hypersensitivity to sedatives such as those that would be put in an I.V. for sedation and I also have quite a history of random panic attacks.

My central nervous system is quite sensitive from that whole ordeal, and I was advised to stay away from other medications as much as possible; especially those kinds of meds like sedatives or opioids, etc.

so.... because I am on Klonopin, a benzodiazepine, and I am a recovering Xanax dependent, there is a good chance that the I.V. sedation drugs will either not work (due to my brain's tolerance to those kinds of drugs) OR they may have an adverse reaction (this is very likely due to my messy history and cold turkey withdrawal syndromes with benzodiazepines aka "sedatives.")


SOOOOOOOOOO I may opt for Nitrous Oxide sedation, as they say it does not work like an opioid or a benzo, its effects are very mild and if you have a bad reaction just take the mask off. I really do not want to be put under GA for a single regular tooth extraction!!!!

But I hear that Nitrous is not a good idea for people with pre-existing anxiety?

Nitrous Oxide is given to alleviate anxiety, but it is not good for people who have anxiety ? what? HELP!

GA, oral pills, or I.V. Sedation, is just not an option for my very sensitive nervous system.

..... It's kind of like if someone has an allergy to benzodiazepines (aka "sedatives") - there are no other alternatives that are deemed equally as safe it seems other than Nitrous Oxide sedation and I hear wonderful stories from the dental offices about it but I come online and read horror stories of people having panic attacks from it.

I am aware that it can make someone feel a little strange.. but all I need is something that will just keep my gag reflex at bay and allow me to relax for just a few moments while my tooth is being extracted.

It seems to be the SAFEST OPTION for my extremely FRIED Central Nervous System. But if it is not recommended for people with pre-existing, unrelated panic issues, well, I just don't know what to do?

I have been on 20 days worth of Amoxicillin waiting for just a consultation, it has ripped my stomach apart to the point I am weak and dehydrated, I have stressed myself out about this so badly that my fiancee has missed work over me.


All I really need is some more info on Nitrous Oxide sedation as my alternative. I really do not want to risk frying up my nervous system again with sedatives/opioids.

Thanks so much....

Andrea

I can not really speak to the medical things you mentioned with Nitrous but I can speak on Nitrous as I used it for all of my work.

With nitrous you are 100% aware of what is going on around you. It makes you feel warm and tingly, and super relaxed. Im talking so relaxed I fell asleep in the chair while they worked on me. Its almost a similar feeling as to having a few alcoholic drinks where you become just buzzed enough to be carefree, but still aware.

Like you mentioned if you have an adverse reaction to the nitrous they just turn it off and push straight oxygen to you and its out of your system in just a couple of minutes.

I am terrified of the dentist and pretty much will gag anytime something is put in my mouth, if it gets too dry, or if I start to panic. I have used nitrous for numerous root canals and root planing procedures and it was amazing. I felt 100% relaxed and could pretty much just go into a trance while they did all kinds of stuff to my mouth. Without it there would have been no way I could even get 1% through it.

You shouldn't be anxious about the nitrous. It works really well and you are still conscious and aware of everything. It pretty much makes you stop worrying and "not care" about anything going on in your mouth. You can tell if you need more or less nitrous pretty easily. Just tell the dentist and he/she will adjust the flow accordingly. The effects really wear off quickly. Once in the middle of a root planing I really had to use the bathroom, so I asked them if they could stop. They took off the mask for a minute while they finished up what they were working on, raised the chair up, and I was good to walk to the bathroom and return no problem. Then they put the mask back on and it was back to happy land!

You mention that your first dentist sent you to another because of anxiety, but later you say that you have a "mild dental anxiety?? I would say that I have alot (or did) of anxiety about dentists and my dentist did not find me difficult (according to her).

I am like you and others. I cannot stand anything in my mouth that I do not have control over. And I had great fear before having my five teeth pulled a year or so ago. However, I also am afraid of using any type of nitrous or valium. Gagging has always been my biggest and truthfully, my only, fear of the dentist.

I had the teeth pulled with only local and I can tell you that it is not as difficult as it sounds.

First, the right dentist will not really be in your mouth causing you to gag. As someone who gags easily and can get that way from brushing my teeth, I can assure you that they work off to the side. The tools are small (except for that HUGE pliers....just kidding . It is small, too), and even if they have to dig for a root (worse case scenario), it is with very small picks.

I was amazed at how easy it was to have teeth pulled. I told my dentist that it went quicker and easier than having a cavity filled. Perhaps we could just pull teeth instead of filling them? She was not amused.

Anyhow, I would consider the other option of using nothing if your anxiety is mild. If it is gagging that is your major fear, then as someone who has it, too, then my experiences of having five teeth pulled (two were broken) showed me that no sedative is necessary.

Hi thanks so much for your reply. Well I thought I was severely phobic until I read some other accounts which sounded much worse than me.

Perhaps I still am severely phobic and there are just varying degrees of the severity. I saw my OS yesterday and I was shaking uncontrollably in the chair. White knuckling. My tachycardia was unbearable (rapid pounding heart rate). I am not afraid of pain, this is true; I am afraid of the shot - not the needle itself but the actual medication - when absorbed into the bloodstream can cause very bad symptoms. I am also afraid of having to lay there still while someone is cutting my mouth open and pulling things out of it; the blood, the tissue tearing and swelling, and yes very much of the gagging. I don't have a gag reflex unless I am scared, and it is bad. Bad enough that a dentist discharged me as a patient once because I pushed her hand away when she was drilling one of my teeth. It was an accidental reflex on my part. When someone is gagging me to the point, I just have a natural response to push their hand away.

Another reason I asked for nitrous as an option is because I do not want epinephrine in my shot-- I have other health problems and medications that make me feel it i necesary to not have the epinephrine... only problem is I am not sure if my Oral Surgeon will let me have the plain anesthetic without the epi.
I heard Nitrous can help control pain so I thought maybe it could augment the ""non-epi" carbocaine...provided my Os lets me use the carbocaine. Every other dentist I went to offered the plain shot with no epi..... they just didn't have the tools to properly extract my tooth; why is my OS being anal about it?

I'm trying to get my cardiologist to kind of step in and say "Hey, epi isn't a good idea, no epi." but I have to see them first and that is on Weds, and my extraction appt is on Thurs, so if my cardio makes any medication changes I'm gonna be all freaked out from THAT by the time Thurs comes! *sigh*

Anyway one of my fears is losing control or not liking the way nitrous will make me feel and I think of it as a last resort.. like if I'm absolutely inconsolable. I just don't know. I can keep my head on straight in the waiting room and everything it's just as soon as I sit in the dentist chair is when I lose it.

Andrea

I had nitrous for the first time on Tuesday(i'm 38).I'll admit,I was scared as heck,because I didn't know how I'd react to it(there's some meds that make me very ill) or how it would make me feel(I don't like feeling not in control).When I first realized they started the nitrous and I was feeling weird,I almost panicked...until I relaxed and told myself that this is how i'm suposed to be feeling and that it was ok.

The dentist asked me afterwards how everything went,and I ended up telling him and everyone that knew I was heading to the dentist.....had I had a dentist use nitrous on me 17 years ago,I would have gotten my teeth taken care of back then and wouldn't have been so scared and lived with this pain for all this time.

I still have one more appt.,and yeah,i'm still scared and will need all the help I can use to get me there and keep me there,but once it's over with,I think I can go to my regular check ups without much fear.And I will be going,every 6 months.