My sedation didn't work, now more scared!

This is my first post here but I did some reading here prior to my surgery. I am in the USA.

I had been having some on and off pain in my lower jaw, which I suspected was due to a partially erupted lower left wisdom tooth that had some decay. After a particually bad case of pain (it comes and goes), I finally pushed my fear aside to go to the dentist for the first time in several years. I had a cleaning, and the rest of my teeth are fine. But the one wisdom tooth had to go (along with the one above it, which was biting down into the lower jaw). Although I was terrified, I made an appointment 1 month after that for the extraction, under IV sedation.
The doctor prescribed me an antibiotic for pre-medication as well as 7 days post-op. I have a bad gag reflex and have a big problem taking pills. These were capsules (big ones!), so in speaking to the pharmacist, he suggested I break them open into applesauce. Although it tasted HORRIBLE, I was able to take the predose (of 4) an hour before surgery...which was yesterday morning.

I went to the dentist with my wife, and I was shaking almost uncontrollably...especially after I saw a teenage girl leaving who had apparantly just had the same thing and she was all numb and dizzy. I got in to the chair (the assistant remembered me from my cleaning) and it took about 5 minutes before I was able to let the doctor start an IV (also afraid of needles). I remember I was shaking, but I kept my eyes closed. I remember him telling me to relax and that he was going to give me some sedative, Versed. Due to the amnesic affects of Versed, the rest is hazy. I do remember having heavy eye lids and blurry vision. I remember him saying he was going to give me the local anesthic, and I remember gagging on it. Then I remember him putting something heavy rubber thing in my mouth to keep it open and I was gagging and (according to him, yelling because I was gagging). Then he put someting against my tooth (later told it was a mirror) and asked if I felt it, which I did (as I was gagging). I remember him saying that he couldn't do the procedure and he got up.
I thought this occured over the course of 5-10 minutes...turns out I was in the chair for about 45 minutes.
He gave me a total of 10mg of Versed, which according to a paramedic friend, means I should have been out all day
The oral surgeon told me (after my wife came back in) that I was not able to be sedated this way and my gag reflex was too strong and I was too upset, and I would need to see a surgeon who could do some form of general anesthea.
I am now more terrified and fustrated than ever! I kept tellling myself (with my wife's constant reassurance...she's great!) that when I woke up it would all be over and I wouldn't have to deal with the pain or the worry anymore. But all this experience left me was more terrified and afraid of trying again.
I remember gagging in the chair. The sugeon later told me that "I was yelling, and I can't yell because there are other patients and doctors, and if I yell, then he gets yelled at because he must be hurting me".
I honestly don't remember yelling, but I do remember gagging and moaning from that. I do remember hearing the pulse monitor and several times hearing it slow down and asking the assistant if I was okay. I think perhaps I was relaxing as he was giving me more Versed? I know I had some fear of crashing from the sedative, having never had it before. I am the kind of person who under-medicates, because of the fear of side effects.

So now I need to find an oral surgeon who can do this. And I am very afraid of general anesthea because of the increased risks and procedures that accompy it. I think the surgeon mentioned Propofol, but I'm not sure. I was still half out of it. He told me that depending on what they do, I might be able to do general without a breathing tube (something that scares me). It now also scares me that I might not be totally asleep during general or the induction. I mean if 10mg of Versed doesn't do it for me, what will??? He said that he could have given me up to 12mg, but that was "a hole he didn't want to go down" because once he started the procedure, there was no stopping if I needed more.
The surgeon told me I was a in 1-in-500 case. Great...time to go to Vegas and do some gambling I guess.  
I don't remember being all that numb in the chair, but after I left the office, I was numb on that side for several hours. Feeling in my lower lip didn't return for about 5 hours. I almost wonder if maybe he didn't wait long enough for the local to take affect? I would think he would know how long it should take? Perhaps I was numb but the gag reflex was so bad that it was more of a problem for him? I have always had trouble with the gag reflex and they can not do rear bitewing x-rays because of it.
Frankly, this surgeon seemed nice when I was talking to him before hand (met him for a consult a month ago too) and he was telling me about a phobia of his. But I remember in the chair, it seems like he got fustrated with me very easily. I remember I was crying and apologizing as I was coming around.

The surgeon said he can write a letter for my insurance company to justify general anesthea if they need it. I have so-so dental insurance...but thankfully I have a very good boss and plenty of time off at work.

So now I don't know what I'm going to do. I guess I need to find an oral surgeon who can do the general...something I am very afraid of. Not to mention the fear of going through this all again possibly for nothing.

I have not been to a regular doctor for a physical in several years (same general fears)...I wonder if I should go and get blood tests and all before trying to do general anesthea, since I know that can be risker.

A psychiatrist crosses my mind also...

(Whew, long post. Thanks for reading)

Wow, Thunderknight, you poor thing. That sounds like a truly horrible experience I'm so sorry that the IV sedation didn't work for you...I've had it twice now and it went absolutely fine...which isn't of any help to you, I'm afraid. I do know from my dentist that it took quite a while to work on me (not that I remember this at all) but I trust him totally and he also teaches sedation at a big London dental hospital.
I really don't like the sound of him telling you off for yelling - that's really not fair at all. It wasn't your fault. If you have to find a new dentist anyway, I wonder if you could find one who could talk through with you this awful experience, and see if there's any way to procede other than having a general anaesthitic.

Hi

Well done for going to your appointment despite your fears. It takes a lot of courage to do that when you're terrified .

Although I've never had sedation at the dentist's before (I'm far too scared of it ), the experience you describe sounds very similar to something that happened to me during a procedure in hospital a few years ago. Bear in mind though that this is just me talking from my experience - it might be different for you .

I went into hospital as a day patient to have an endoscopy (camera down the throat to look at my stomach - yuck!) under sedation. Obviously I wasn't looking forward to it at all and like you I was shaking because I was pretty much terrified. I was given 10mg of Midazolam (which I think is called Versed in the US?) and told to relax... Except that I couldn't relax - major panic ensued! I've had this drug before as a premed before surgery so I know that when it works, you don't really know what's going on around you because even though you're still conscious, you're pretty much out of it.

Anyway, about 10 seconds after the drug was injected, I started to panic because it wasn't making me feel spaced out like it had before and I thought they were going to start before I was fully sedated. I still felt wide awake and was shaking and hyperventilating and all the rest of it. Although my memories of what happened are hazy as well, I do remember them trying to put the endoscope down my throat and me wriggling about, panicking and ripping it out every time they put it in. To cut a long story short, they couldn't complete the procedure because I was far too stressed and couldn't lie still. I have to say though that they were very nice about it (thankfully ).

I was still wide awake later that morning until I got to about lunchtime when I finally managed to calm down - and then suddenly became extremely tired and fell asleep for about 6 hours!

Afterwards, I learnt that the reason the sedation hadn't been successful was because I'd produced so much adrenaline due to me panicking that I'd counteracted the effects of the drug. If I'd been calmer to start with, then chances are that it would have worked better. Once I'd calmed down enough, it was like a delayed reaction when the drugs sort of started to kick in.

A similar thing happened with the local anaesthetic when I had a filling once as well. I wasn't really numb in the chair and it hurt like &%*^. Later on, when I got home, half my face was numb for hours!

I have to say though that sedation does work for the vast majority of people - many report very positive experiences. It has worked for me in the past as well so it could be that this was a 'one off' for you.

Some people find it helpful to learn some relaxation techniques so that they're a little calmer about things when they go for their appointment (this is something I'm still working on! ). Is there anything that could be done so that you're not quite so scared before you have the drugs?

A lot of this all depends on what your fears are... Like for instance, in the (rather long ) example I gave above, I panicked because I thought they were starting before I was sedated. Maybe if they'd have waited longer it might not have been so bad.... I dunno.

Please don't think that you're alone though - you've come to the right place . We're all in the same boat in one way or another so we do know how it feels.

There will be a way for you to get through this -  it's just a question of finding what works for you .

Hope this helps... Please feel free to post .

P.S. Don't worry about long posts - as you can see, I'm much worse!

That is interesting about the adrenoline counteracting the sedative. I wonder if it is safe to give a beta blocker to counteract the adrenoline in a situation like that, or if that would cause too much stress on the heart.

I think what I need to do is find a better oral surgeon!!!
Seriously though, I need to find one that will sit down and fully discuss a plan of action of what he can do for me and what they will try if method one fails, etc. I think I messed up in this appointment by assuming too much. I assumed that if I got to the point of getting the IV, the Versed would do its job and I wouldn't remember anything and next thing I'd know was that I would be walking to the car without my 2 wisdom teeth. I didn't carefully consider what might happen if it failed to work and was this oral surgeon able to use alternative methods.
I just sort of assumed "he's the dentist, he does this all the time, if I can overcome my fear of going and sitting in the chair, then he will know what to do and soon it will be all over. I mean he is the dentist, right? "

Thunderknight said:

I wonder if it is safe to give a beta blocker to counteract the adrenoline in a situation like that, or if that would cause too much stress on the heart.

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As far as I'm aware, it is OK to do that (I also take beta blockers before situations which are likely to make me panic). But, you need to talk to your doctor about that as s/he will probably know more about it than your dentist.

Like all drugs though - it does depend on the dosage, the situation and on you. I usually take 40mg of Propranolol before an appointment at the dentists because the fact that I'm already panicking is bad enough without all the palpitations, raised blood pressure and all the rest of it. Sometimes though, I can be so wound up that I might as well not take the beta blockers because they don't seem to make any difference whatsoever.

Thunderknight said:

Seriously though, I need to find one that will sit down and fully discuss a plan of action of what he can do for me and what they will try if method one fails, etc. I think I messed up in this appointment by assuming too much.

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No you didn't mess up - we all react differently to different things on different days. We can't predict what's going to happen in the future, if we could, I'm sure we'd all be a lot better off (and I'd have won the lottery by now !).

Discussing your fears and/or a plan of action is a really good idea though - that way your dentist knows what you're scared of, how they can help and also, you can go through your treatment options.

Thunderknight said:

I didn't carefully consider what might happen if it failed to work and was this oral surgeon able to use alternative methods.

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You weren't to know that it might not work though . IV sedation works really well on the majority of people and there are plenty of success stories on here to prove that. But at the same time, it isn't necessarily the best thing for everyone - for whatever reason. For instance, there's no way in a million years that I'd have any sort of sedation because the thought of it scares me just as much as going to the dentists in the first place (got serious control/trust issues). Some people prefer to try and beat their fear using other methods e.g. psychology, hypnosis, desensitisation etc.

Like most things, there are positives and negatives with sedation. The main negative is that if what you actually want is to be free of the fear, then because you're sedated, you're not really in the right state of mind (depending on the type of sedation) to learn new 'good' experiences to replace the old 'bad' ones that made you scared in the first place (depending on your fear(s) obviously). It's more of a means to an end so to speak - to get you through your appointment without the worry, stress and panic. The main positive side is that if what you want is just to get it over and done with and not know much about it, then sedation could be the answer for you. Maybe oral sedation or nitrous oxide might work better for you?

Thunderknight said:

I just sort of assumed "he's the dentist, he does this all the time, if I can overcome my fear of going and sitting in the chair, then he will know what to do and soon it will be all over. I mean he is the dentist, right? "

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Some people are a lot better at dealing with nervous patients than others. It's possible that he's so used to IV sedation working on others that your reaction may have taken him by surprise. But from the sounds of it, as gumgirl mentioned, you might be better finding a new dentist. Someone who will discuss your fears and what can be done to help you.

If you do decide to look for someone else, you might find it helpful to make a list of what scares you and also what might help to alleviate some of the fear, along with any other needs (i.e. sedation), then you've got something you can talk through with a dentist to see if they're the right one for you.

Hi Thunderknight:

I recently completed treatment with a great phobia dentist in NYC. I did not do the iv sedation thing. I had complete confidence in him.
But I do know a thing or two about iv sedation. I had it ten years ago. Back in 1995 (now that would make it 11 years ago, wow), I had to have work done. I had put it off and i didn't want to wait any longer.
I found a dentist not too far from me who would put me out for the whole thing. Do my mouth in one visit. I could not believe it.
The charge for the IV sedation was a whopper. $500. And that was 11 years ago. But let me tell you something. You don't feel a thing.
I got there early, (you can't eat from the night before). I sat in the chair and they did an iv in my hand. I remember asking him "how will this thing work" and one of them replied "it's works on the areas in your brain, you'll go to sleep". I woke up and they were finishing up. I felt absolutely nothing.

And they don't put a breathing tube down your throat. This is a little different than when you go into the hospital for an operation. That kind of Anaesthesia is much much deeper. This dental iv sedation (the dentists are completely trained in this). they know how much to give you. They knock you out , do the work, and you wake up and all you are is numb because everything was done while you were out.

If I were you, I'd look into this. sounds like it would be perfect for you.

take care,
Melody

hi there i had horrible experience today im sick to stomach still iv didnt work so i came home same as i went in only sore mouth and 3000 euro short my full dentures still in dentist what will i do now need to have teeth out badly but too terrified now

Hi Thunderknight
It sounds to me like you havent found the right dentist for you.... I hadnt been to a dentist in 20+ years until a couple of weeks ago. The dentist in fact said I was the most phobic patient he had ever seen. Told my husband -she is off the charts__ He called me 2 or 3 times before the first appt. Every time, I cried apologozing..... he listened to me and assured me he would be there for me every step of the way. The first visit is I stood outside the door for 20 mins had a fit-trying to get up the courage just to walk in the door. I did it thought. THe normal 40 min initial exam took that poor man 2 1/2 almost 3 hours. I didnt even realize I was that long. I couldnt even manage to sit in the chair. But I did it.... His assessment- the first thing I needed done badly was a root canal..... You can image how that scared the heck out of me. We booked the appt for last Monday. I told myself I didnt care if my teeth rooted out of my head I just couldnt go.... On Sat, Sun that wonderful man called me at home to boost my confidence and tell me again he would not hurt me, i was in control and I could stop at any point. I tell you the calls helped me 200%. I didnt know a dentist could be this nice. On the morning of the appt he called again to reassure me and make sure I took the Ativan he gave me. With the Ativan and laughing gas I was super relaxed (never ever thought that was possible) and I got the root canal. Pain Free.... Didnt think that was possible either. I am still a dental phobic person for sure (at least for now) but I trust the dentist now and his compassion has made all the difference in the world. Just one girls opinon but you need to find the right person who can make you feel comfortable and confident in his abilities. Not all dentists are created equal. Dont give up.... I am not.... now that I found the right one for me... There is someone out there that can help you and make you feel confortable. See someone else and see what they say... do you need something to relax you first so the IV sedation will work properly? See what another one says.....