Nitrous--a major bust (worthless)

Went to my new dentist today, earlier than I had planned (which was a prophy with nitrous in about 6 months), but have a broken filling that needs fixed. I was somewhere between nervous and terrified, literally shaking as I filled out the health forms. And my nice, quiet office was filled with screaming, running, ghastly brats, so my few minutes to breathe and calm myself was nonexistent. Then get to the room, talk a minute to ask a few questions, then get the mask on and try to relax. Nothing. Freaking nothing. No tingling, no floating, maybe a nanogram of relaxation. We tried it twice. He wants to reschedule to an early morning appt (with no screaming brats) and hope for a better result. I did that, but am disappointed, furious, frustrated (I just wanted to get the damned thing done and over with) and at a loss to know what to do next. It didn't help that he is encouraging me to try it without local, as it's an old filling, he doesn't have to replace the whole thing, and the "nerve retracts" in old fillings? Great. The razor's edge between the horrible shot and the horrible pain. Lovely. I want to not care about what is happening, which is what nitrous is SUPPOSED to do, and I want a shot so I'm not screaming in pain. Duh.

Is there any chance that the morning appt is going to be better? NO ONE is every giving me local anesthetic again without major drug intervention. What if we get started on this procedure, there's pain, and no effect of the nitrous? What then? Jeez, this just gets worse all the time. I'm about done with dentists.

Clem - from my reading nitrous works best when titrated to the individual. What percentage was in the mix? Did they up it when you got no response?

I don't advise you to go without local. I had an old amalgam replaced and the LA didn't work properly even though the actual shot was comfortable and so I had to keep stopping them...no extra LA was forthcoming (don't ask - not UK) - it wasn't horrendously painful but it certainly wasn't what I expected from my first filling after 18 years or similar and I decided they weren't working on me ever again.

Maybe you still haven't found the right dentist for you...go seek out TheWand, it's the obvious solution. If he knew he had a good painless technique for the local, he wouldn't be suggesting you do without one, I wouldn't have thought. The nerve is still there unless it is necrotic...Dr Miriam Stoppard a UK TV Medical Doctor wrote in a book on health for women in 1980s that you should never see a dentist who doesn't use local since they likely won't remove all the decay in order to spare you pain....so I'd be wary of someone suggesting only partly replacing the old filling - are we talking amalgam or composite here - wonder what Gordon would say?
I know composite can be topped up (because Gordon told me once lol) but if your nerve is registering pain, I would have thought you'd have to do a complete redo to do a proper job.

I think we need a 'head bang on wall' smiley, just for you....I don't envy you your struggle to find Mr Right Dentist.

OK--nitrous and me are the very best of friends!!!--I want my very own nitrous machine!!! I loooovvvveee it!!!

The only time it didn't work for me was at my biggest appt--4 hours long--
I was sooo bummed--they said it was probably because I took xanax before the appt--every other time it was well-----calgon take me away!!!

I cannot wait until my next appt....

He said the oxygen was flowing at 4 L and the nitrous at 6 L, so doesn't that make it 60%? He wouldn't ever say it as a %, which I thought was strange. He also said he wouldn't go higher because then you need a pulse oximeter and somebody to monitor me, so maybe he's keeping it lower than some others because of his small practice? I'm confused. I do know someone else in town with a bigger practice so I may be moving again. this is so stupid. I really thought I had found the right guy. And I know what nitrous can feel like, and at that level it would be fine, so I'm going for it. And I was advised to take some Xanax before the next one, maybe I was too nervous (????????????????) for the damned stuff to work. Although it worked before and I was scared as all get out. I hate this.

From our new RA sedation page: www.dentalfearcentral.org/help/sedation-dentistry/laughing-gas/

'Usually, the mix is about 70% oxygen to 30% nitrous oxide.

In medicine, sometimes a mix of 50% oxygen to 50% nitrous oxide is used. This is known as entonox or, more commonly, “gas and air”.

Looks like you were 10% below maximum then.
I suppose a xanax to relax you additionally could well do the trick...worth a try I suppose if you are not afraid to abhort once again.

Did you ask him if he does comfy injections/uses topical etc etc ?

It's done, got through it OK. Called my MD and got a 1 mg tab of Ativan to take before appt, which seemed to help quite a bit. The nitrous worked better--so maybe early morning, Ativan, plus the whole day yesterday taking Xanax regularly so I wouldn't stew over it, all helped. I insisted on LA--I thought over other times I've tried to go without and never could finish, so why put myself through that? He gives the block in 3 bits, letting each penetrate a few minutes before the next, going deeper each time. Seemed to work pretty well, and none of the horrible minute after minute of that thing stabbing my jaw, just counting the time until it was done. Each shot lasted maybe 10-20 sec. I did need one more (extra) as the chin "fatness" that he uses as a landmark for good anesthesia didn't develop at first. I had a choice of short-acting, long-acting, or the infinite-lasting anesthesia, the first time ever I've been given a choice. And I was warned that in some cases the shot can cause extended numbness or permanent nerve damage (although the chances are very very low), which came up in another thread, and no one, including me, had ever been warned. I hadn't either until today. I do suspect that it happens more often than the profession would like to admit. Anyway, I appreciated the honesty. He told me everything that was happening, also appreciated. There was no physical pain. He said he has a very good, new on the market in the last year, topical anesthetic drug, also appreciated. He seems up on what's new, and using it as appropriate.

What would I have done differently? I wish the nitrous worked better on me. I'd like to get to the level of "highness" I had with the crown a few years ago, although there were more than enough negatives with that practice that I will avoid them like the plague.

The only thing left to judge is the bill, I guess. I do like him, pretty much anyway, he is more honest that the others I've had lately. it was tolerable but not really enjoyable, but maybe that's too much to ask. Frankly, I think some dentists don't like you to be too comfortable--it's the sadist in them that prompted them to go into dentistry in the first place.

It's better here, so I'll stick with him for a while. And whew, I'm done. Thank whatever deity that may exist.

What I really want to know is why agents that are supposed to relax a person, and seem to do so for others, don't work on me? I got the barest buzz from the nitrous, but with the Ativan it was probably the minimum I would need to get by in dental work requiring the injection, but I'd like the lala land that some speak of. Anyone? Ideas? Surely I can't be the most freaked out person ever--I can make it through cleanings fine, make appointments, etc. Is there something wacko with my metabolism? The supposed short-acting LA he used (no epi) lasted a little more than 3 hours, it was supposed to last 1-2.

Don't know the answer to your last question except we are all different and all metabolise stuff at different rates and the same person may react differently on different days.

Really glad it was tolerable for you. It sounds like he did go to quite a lot of trouble to make it as pleasant as possible so that's great to hear. Also great that there was no physical discomfort.

No dentist has ever mentioned the parathesia thing to me...I first read about it on here....I understand it is rare though and that it nearly always eventually resolves.

It would be very sad if people were choosing to endure extreme pain during treatment just because of a theoretical risk of parasthesia. I suspect that's why it's not mentioned.

Certainly sounds like you should stay put for now - his attitude sounds pretty good. Still dumb to suggest going without LA though.

Yeah, I agree about the LA-less suggestion. I think he'll be OK, though. Certainly an improvement. And I have more confidence that I've found a protocol that will get me through the shot, although more lala and less awareness would be greatly appreciated.

The best part is that I now have 6 months of dentist-free life before my next cleaning! And I will emphasize that the best part of dentistry for me is walking out the door when it's done.

Clem said:

What I really want to know is why agents that are supposed to relax a person, and seem to do so for others, don't work on me? I got the barest buzz from the nitrous, but with the Ativan it was probably the minimum I would need to get by in dental work requiring the injection, but I'd like the lala land that some speak of. Anyone? Ideas? Surely I can't be the most freaked out person ever--I can make it through cleanings fine, make appointments, etc. Is there something wacko with my metabolism? The supposed short-acting LA he used (no epi) lasted a little more than 3 hours, it was supposed to last 1-2.

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Just wanted to say that you are not alone in this question. I have a very similar problem (have not tried nitrous in years...I had it very young and have been told it worked ok, I don't remember the experience though). More recently though, I have had issues with both IV sedation (not sure if this was GA or not, pretty sure it was though) and local anesthetic. Neither last for the intended time frame and it is soo frustrating! When I had my wisdom teeth removed they couldn't even get me to go "under" the anesthesia. The nurse claimed she gave me a sufficient dose to put me to sleep but I just got a little dizzy and then returned to normal in a matter of seconds! I kept resurfacing throughout and afterward I went home and watched TV for hours (they said I should sleep it off but I wasn't drowsy or tired). That was my first experience with anesthesia that is supposed to put me to sleep and I haven't had any surgeries since so I don't know if this was a fluke or not *knock on wood*.

Local anesthetic only seems to last a max of 10 minutes...as soon as I start to feel my lip "get fat" it's already wearing off and it is always completely worn off by the end of the procedure. My goal is to just try and stay numb through the drilling, the rest isn't really potentially painful with a filling but if I ever need a root canal this could present as a real problem. These days I always rush the dentist to hurry up and start the second I feel numb because I never know how long that window of opportunity will last before sensation returns and she often has to give me multiple doses. And as you said, I'm not the most freaked out person ever so I truly don't think it's all anxiety related...it must be biological to some extent. I wonder, have you ever had other types of procedures requiring anesthesia where you have had problems? I'm just curious because I'm always worried this problem will carry over if I ever need any other type of surgery. I want to try some of that Epi-free LA you had next time! That might solve at least one of my problems...maybe it would last for longer than a whole 10 minutes! Lol

Hi Kitkat
Your dentist probably needs to try you on a different type of LA - some of them last much longer than others. The standard lidocaine is not the best option for everyone by any means..it's the cheapest though. More info here:


The stuff without epi is supposed to last less long and that is the main drawback of using it.

If you ever need a GA again, I would suggest you get an anesthesiologist rather than a nurse/anesthesiologist , the former is also a qualified medical doctor.

You haven't got ginger hair have you? Doesn't sound like much fun.

Nope, I'm a brunette. I did read that post about red heads though and found it very interesting. Thanks for the tips Brit! Thanks for the head's up about the Epi too, I thought it was the other way around for some reason. And you're right! It certainly was not fun to discover that the sedation does not work just before you are about to have jaw surgery! lol Fortunately the LA functioned well through that procedure and I did not experience any sensations at all, pain or otherwise...occasional sounds though. :/ I went to an oral surgeon that specialized in jaw/maxillofacial surgeries and that was the heaviest sedation they offered/recommended. I was in high school and didn't have much say/knowledge about what was going on at the time. Overall, it actually wasn't at all a horrific or traumatic experience though so I consider myself lucky and grateful. Even though I kept resurfacing I felt relaxed and not fearful (perhaps because I felt no discomfort???). Could have been worse but it was definitely a strange experience regardless.

Kitkat--I don't seem to have any problems with IV sedation/MAC anesthesia or whatever it is. I've had it for knee arthroscopy, a wisdom tooth, etc and it always worked fine. Just the oral meds and nitrous don't do much of anything. And I've never had any problem getting numb, although sometimes it needs a little more to be truly painless. I just don't want to do IV sed for "routine" dental work because you have to be driven to and from, can't go back to work, etc., it's just so much extra hassle (and money).