Failed extraction - now oral sedation (UK)

[scaredwomble]

I have been reading this forum off-and-on for a fair while now, but this is my first post. Sorry it's a bit long but I thought I'd introduce myself a little bit first.

I live in the UK, and I've been really nervous about the dentist for years and years - because of past bad experiences.... seems like my previous dentists have done about 90% of the things on the "Experiences that Trigger Dental Phobia" list. I have always had weak teeth and gums and struggle with going to see a dentist regularly for check-ups. The strange thing is, I've had two root canals and I don't have a problem with them. I am ok with fillings too, and am a little tense with deep cleaning. I considered myself to have a mild phobia. In the past 5-6 years, I found a dentist who had a very gentle manner with me. Little did I know that she was somewhat incompetent (but that is another story...) and I was doing OK precisely because she was neglecting my teeth by giving me only superficial cleaning, etc. I thought I had beat my dental phobia, only because I hadn't had any painful procedures in a while!

This all changed a month ago when I suddenly developed a gum abscess and a trip to the emergency dentist revealed a badly decayed and cracked tooth. I hadn't even known it was happening because there was NO pain. Anyway the dentist said I had to have it out. This was a NHS dentist, so I decided to go private for a second opinion. They took X-rays and said that the tooth was split, and too difficult to save. All this time though, I had no pain in the tooth itself, which was very weird. But I felt forced to go through with the extraction because the tooth had broken.

I hadn't confronted the possibility of an extraction for YEARS. I had the last one done years ago, and from what I can recall, it wasn't a pleasant experience, but the dentist took it out despite my fear and shaking. This was a molar and the dentist warned me that it would be complicated, and the tooth might splinter, requiring some stitches or sutures after all the bits were removed. Frankly this did not help my fear one bit -- because for days leading up to the appointment, I was having trouble sleeping or concentrating on anything else! I was building myself up into a terrible fear again, because of my terror of extractions. I felt I could handle anything else - BUT extractions. I was assured I would be numbed and would not feel anything, but I guess it was the thought of the "struggle" to remove the tooth that terrified me, pain or no pain.

Anyway, despite my desperately wanting to flee every time I entered the waiting room, I made it to the dentist's office to get my tooth removed after a sleepless night tossing in cold sweat. He knew I was a nervous patient but he hadn't really treated me before so I guess he did not know me. When I sat in the chair, I started trembling... this was normal for me after some time away, not seeing the dentist-- but usually, the dentist would reassure me. But I guess today things were a bit different with the extraction. However, rather than proceeding with the procedure, my dentist said that I did not look in any fit state to undergo the procedure. I was pale, trembling and clenching my fists. But I was doing everything within my power to stay sitting in the Chair, and only wished he would get on with it!!! However, he said maybe I should do it another day - which made me feel worse, naturally, as I had worked myself up so hard to get there that morning. I did ask to have a friend sit with me in the room while the extraction was being done, and I was given a series of injections. He then took out a large fraction of the tooth that had already broken, and there was only a tiny bit of blood, no big deal at all.

But when it came to the extraction of the main tooth itself, he couldn't do it. I didn't understand why, but he kept saying I was too nervous. But I didn't understand what I was doing to hinder him.... just that I was digging my fingers into my palms... But every time he pushed on my tooth, my head kept moving. I didn't know if I was supposed to resist the pressure. He kept saying I was just too nervous and gave up, and then I broke down. I felt I had utterly FAILED, after working myself up to go to the chair and get it over and done with!!! And now I was stuck with the problem for another day, but he just said that he thought sedation was the better option for me, and he'd send me to a clinic that offered sedation.

I felt utterly devastated, and this experience has been filed away into the "negative" pile of dental experiences I've had, particularly because now my tooth feels sore and throbbing from the yanking and pushing.... (and because I've just realised how much pressure is required to yank the tooth out!!!!). I've made contact with the other clinic, and they are offering me "oral sedation" although I have NO idea what it involves, and how it would make it easier for me. I'm still feeling terrified.

Does anyone have any words of wisdom for me???

scared womble

[brit]

Hi Scaredwomble
I know you feel disappointed in yourself and him but I think you and the dentist deserve a pat on the back.
You for being so keen to go through it despite your fear and him for being so concerned at your nervousness that he felt it best to abhort despite having got so far.
He is partially at fault though in a sense because he wasn't equipt (not all dentists are) to deal effectively with your fear....you needed a discussion and verbal reassurance not to be left wondering what you were doing wrong to make it so impossible for him. He may have been afraid that he'd be open to an assault claim if he proceeded since your body language was effectively withdrawing its consent if you see what I mean. You can withdraw your consent at any point in a procedure.

I'm sure oral sedation will help relax you although it does not affect everyone in the same way...he did at least refer you on...although I get the impression you have gone elsewhere..is that right?

Two other points - he did let your friend in the room? Wasn't clear..it would be unusual to deny that request in UK since in NHS everyone has the right to a support person.
Your gentle dentist letting you down...well maybe..but even deep cleaning doesn't have to be painful - in fact if it is deep cleaning it is normal to be numbed for it either with local or just with special numbing gels such as oraqix. The NHS clean included in the check-up 'if necessary' is very cursory and if you have gum issues and don't floss regularly or even if you do, likely to be inadequate especially as you age.
More info here: http://www.dentalfearcentral.org/dental_cleanings.html
http://www.dentalfearcentral.org/deep_cleaning.html
As for normal cleanings..many a moderator on this board can testify that hygienists do vary in gentleness and it doesn't necessarily relate to how good a job they are doing...so find yourself a thorough gentle one.
I'm sure the sedation will work well for the extraction and then I'd find yourself a preventitive orientated private practice for ongoing comfortable anaethetised care. Let us know how you get on. There are some promising practices on our DentistFinder for Central London.

[scaredwomble]

Thanks a lot for your reply, Brit.

Yes, we needed a discussion about what I was doing wrong, simply being told I was "too nervous" was not helpful and in fact, made me feel like I was to blame for not having gone through the procedure. It's possible that I made the dentist very nervous.... I wasn't resisting treatment in any way, or refusing to cooperate, it was just my overall extreme tenseness and my fist clenching that probably upset and unnerved him! He was probably not too experienced in dealing with phobic patients and hated seeing me looking like a rabbit in headlights.

I did contact the clinic they referred me too, it was all done very promptly and efficiently, so kudos to my dentist for arranging it so quickly. They offered me oral and i.v but seemed to recommend the oral sedation - maybe until they gauge how nervous I really am....

The gentle dentist let me down in the sense that I visited her annually for a check-up and cleaning and she had missed my decaying tooth. The emergency dentist told me that my upper molar had decayed so badly, to the point of cracking and splitting when I clenched my teeth at night, resulting in the abscess. But my last visit to the dentist was under 10 months ago and I was never made aware of any problems at all! This dentist isn't in the UK though, and I will never use her again - but this is another example of being let down by a dentist. I have had a few nightmare experiences with bad dentists, and other bad experiences with competent but really insensitive ones... it just keeps going on and on.

I am not really fussed by deep cleaning, I am nervous but it doesn't bother me too much, I just clench my fists and then let them get on with it! But the intense pressure from the extraction seems more than I can stand, I feel like they are trying to snap my jaw in two.... I know, I know... silly, but it feels that way... I am really concerned about the oral sedation, I hope it'll knock me out sufficiently for the work to be done without too much trauma and distress. Already, having undergone the experience of all that pushing, etc. I am feeling even WORSE than ever about the extraction.

super scared womble

[brit]

There's more info on oral sedation here: http://www.dentalfearcentral.org/oral_sedation.html

It is true that some dentists do report that nervous patients make them nervous in turn...ironic but true....especially when you think how often better communication from both parties could go a long way to resolving concerns.

I'm sure it will all go much better next time for you...the last tooth extraction I had with just local was for braces when I was about 14 and it was fine....comfortable injection with topical first, lots of reassurance and just a few seconds of pressure and it was out. There are better ways to spend an afternoon but nothing too scary. Good luck.

[scaredwomble]

Hi Brit,

I fully agree the problem is with communication; what I sense is that a lot of dentists do NOT really grasp the real fears of dental phobics, and they think that a few simple words of reassurance (which are meaningless to us!) are sufficient. And sometimes when they explain the procedure, they neglect to mention exactly what you will feel. Because it is a lie that you are so numbed, you won't feel anything. Although it wasn't painful in my mouth, the intense pressure was unnerving and I felt discomfort in other parts of my muscles, even my neck because it was trying to resist the pressure to avoid falling off the headrest. It didn't just last a few seconds. Maybe he couldn't get a good grip or something. But I've been left feeling rather traumatised by it... and dreading even the appointment under sedation.

I read the section on Oral Sedation on this website but I still don't understand what it feels like... will I be conscious during the procedure and remember it all afterwards? I understand that some of the drugs used are sleeping pills/anti-anxiety drugs, so will I be knocked out or just too groggy to care? I also understand that the drugs used in the US and UK are different, so I don't know if the effects are the same. Is it also possible I won't be sedated enough and undergo a horrible experience?? (or can they tell before doing anything, so they won't start unless I'm properly doped up?)

scared womble

[scaredwomble]

OK, now the referral clinic has contacted me again, and I have been referred to the Oral Surgeon for a surgical extraction. Not exactly sure what this means but they have given me a pill (Temazepam) to take one hour before arriving at the clinic for my appointment. Seeing that I have to take the Tube to get to the clinic, I wonder if its a good idea to go really early, sit in a nearby cafe, take the drugs and then try to chill out before the appointment, instead of trying to navigate the Tube with a groggy head? (even though I will be with a friend).

I wonder, will 1 pill of Temazepam be adequate to sedate me for the procedure?

So petrified now, just thinking about it gives me cold sweat.

scared womble

[Stress Doc]

Hello:

Temazepam (restoril) is a benzo that is a sedative/hypnotic and can be used as a sleeping pill. It works well with anxiety disorder.

Typical dose is 15mg, but 30mg is not uncommon. It takes about 1-2 hours to reach full affect. They are probably giving you this medication as a pre-sedative, ask them.

If you have never taken the medication it might be wise to be close to the OS office before you take it. It is a safe medication but everyone reacts differently.

Hope this helps.

Blessings

[scaredwomble]

Hi StressDoc!

No, this is the oral sedative they are giving me for my surgical extraction. I asked them... I am supposed to take it an hour before checking in for my appointment.

As this is a referral clinic, I haven't even met the surgeon who will be working on me, this is an added cause of anxiety for me! To be confronted tomorrow morning by a couple of strangers while mildly "under the influence".....

stressed womble

[Stress Doc]

Hi:

I understand your concerns. The good news is these type of procedures are done everyday by OS. They are very routine and have about zero issues. They are typically very short and have zero pain.

You will do great. OS's are well trained and experienced. They specialize in things like this. You will feel great when this is done. The medication should relax you nicely and relieve the anxiety. This will be much easier than you think. I can promise you the anxiety and fear is causing much more pain and discomfort than this procedure.

Be sure to tell us of your success.

Blessings and Peace

[scaredwomble]

Hi StressDoc,

Yes, I know, worry is always irrational, and yet when the adrenaline gets pumping, it really isn't that easy to get rid of it! I haven't quite got the hang of anti-stress techniques just yet.... baby steps.

I couldn't sleep all that well last night either, I think my adrenaline kept me awake. It was dreadful and yes, I wished it would be all over and done with, but the memory of what had happened on Wed was all too fresh and awful.

I took the oral Temazepam an hour before my appointment as instructed, and then took a couple of buses in, so I could sit down instead of running all over the Tube and stressing out. I didn't really notice any difference as I approached the clinic; I was still nervous, and I could not really attribute my spacy feeling to the Temazepam, it was much more likely because of my sleepless nights worrying about the extraction!

Anyway, it turned out to be a surprising experience. The oral surgeon was very professional, explained everything to me without scaring me with any gory details, or making me paranoid about saying it was "difficult". I don't think he wanted to mislead me into thinking it would definitely be easy either, as the tooth had had a root canal in it and was brittle, and might break into smaller pieces during the extraction. However, he numbed me up, checked that I was properly numb, and then began the procedure. I only felt instruments wiggling in my mouth, a bit of pressure here and there, but nothing I couldn't bear - and certainly NOTHING like what I experienced on Wed when it felt like the dentist was trying to break my tooth off (!).... and it was all over, from beginning to end, in 10 mins! It was unbelievable, I didn't feel any pain or real discomfort even. I only heard a tiny click and didn't even know when the main tooth bit was removed. The dentist was encouraging and positive all along the way so I was constantly reassured. This is not even a clinic that says it caters to phobic patients, but they do offer oral and IV sedation. I cannot say that Temazepam had much of an effect on me - the most I can say is that MAYBE it took the edge off my anxiety, but I was still nervous in the chair, and I was fully conscious of what was going on. Certainly not amnesiac, and it didn't make me the slightest bit sleepy (despite my sleepless night). Perhaps it was only a very small dose that they gave me. Anyway I was out of there and the main bleeding stopped very quickly. The extraction site is a mite sore now, but not very much worse than what I felt on Wed with the injections, etc. Certainly not unbearable, and probably easily sorted with some paracetamol.

I am so relieved it's over. Lesson learned, and I will be extra assiduous with caring for my teeth in the future, seeing that I lost this tooth because of a mix of my own neglect as well as my EX-dentist's negligence. I will return to the other clinic to have my teeth cleaned, all the missing fillings replaced, etc. and then try to maintain a strict oral health regime.

I'll write a brief review of this referral clinic in the other section. I think my overall experience there was positive, although I do not know whether they cater to severe phobics.

Thanks, StressDoc and Brit for your encouragement and help.