Anesthesia Question from newbie

[twosoulsearthreads]

Hello everyone. I'm twosoulsearthreads and I'm a dental phobic person.
I have a question about anesthesia for dental work.
I received regular dental care until 1992 when I became phobic because I developed PTSD and was unable to tolerate being "immobilized" and "hurt" (I do realize unintentionally) after a rape.
I tried unsucessfully to have dental work done several years ago with the aid of 10 mg oral Valium 1 hour prior to the appointment. I wasn't at ALL sedated by this, and we had to abort the attempt.
I am finally at a place where I am able to (and absolutely must) have dental work done.
I have spoken with an understanding dentist who is willing to give me Nitrous for my work. That is the only agent he uses in his practice. I don't believe that this will be sufficient anesthesia for the procedures and am going to ask my physician to order a prn po dose of medication to augment the Nitrous.
I am a physician assistant, so I know my meds pretty well. I am considering 1 mg of Xanax, 1 hour prior to the procedure. I can't find any drug interaction lists for Nitrous Oxide and just wonder if this would be considered a safe combination. I do understand that this is internet advice and will not hold anyone responsible if I do have an untoward reaction.
Is there anyone here willing to discuss augmenting Nitrous Oxide with an oral agent?
Wow.....
Thanks.
Chris

 

[oliviacw]

For people with control issues, I'm not sure if sedation is always the best choice. If you're worried about people holding you down and hurting you, it might be more helpful to bring along a friend who can sit with you during the procedure. I did this once, for a broken tooth and subsequent root canal and crown. She was able to sit at the foot of the chair and rub my leg, and talk to me and tell me that everything was going fine. I felt safer with someone else there to watch what was going on, than if I had been "out of it" and losing control.

 

[Gordon]

I would be mightily pissed off if your doctor prescribed medication behind my back. Both with you and your doctor. Please discuss supplemental sedation with your dentist first, there's no point in getting the dentist's back up for nothing.

There is no problem with oral sedatives and nitrous, in fact they work pretty well together, but Oliviacw's suggestion is a good one. The feeling of loss of control from oral sedatives might not be helpful in your case.

 

[twosoulsearthreads]

Thank you both for your input! Oliviacw; I'm sorry, I forgot one other try, which was with a dentist who is also a priest in our church and our youth choir director. I trust him VERY much, and could tolerate the exam and xrays but the procedures had to be aborted. He was FANTASTICALLY patient with me, and even prayed with me before the procedure. It was to be a bridge. I was so freaked out by the time I left that I went into the hospital again for a couple of weeks, with flashbacks and dissociation.

I KNOW this is creepy, and I sure thank you guys for not running and saying "eeeeeew!!! a wierdo!!!" I have been completely well now since 1998 and am PETRIFIED of going back into that black place, but honestly my mouth is so bad now that I don't open it at all. My teeth have broken where I had root canals in the past and my speech is impaired, not to mention the cosmetic implications. I am a medical professional, yet I feel so utterly incapable and terrified. I spoke with an attending at a nearby dental school and they won't do it. I spoke with the dentist at the clinic that treats our local population of severely mentally disabled, and they cannot do it because their clinic is through the government. I did find the one dentist who did the one session under IV anesthesia but he said the risk is too great to always have my dental work done that way, and if I can't tolerate it, I should just have all my teeth pulled and get dentures. I'm afraid that my gag reflex is so hyperresponsive that I wouldn't be able to tolerate the uppers and I'd be stuck with no teeth! I can't see patients with no teeth!

I was definitely NOT going to withold my oral sedation from my dentist. I was already in tears when he came in for his examination because his assistant had just told my hubby and I that they NEVER give even Nitrous to anyone over 13. I felt duped cause I'd already made it through the xrays, etc, and there's no REASON not to give an adult Nitrous! So when the dentist came in for his exam, I wasn't prepared anymore, to ask all of my questions. I did ask if he prescribed any oral sedation and he said no. He did say that under the circumstances he would give me Nitrous. I agreed to an appointment in the middle of November for a root canal. Since that day (Monday) I have been having nightmares every night and my hubby and I are getting NO sleep. So I started trying to research combining an oral agent with Nitrous, and this is where I ended up. I plan on phoning the dentist and telling him about my research and requesting permission to take the oral agent, but I wanted to have a specific PLAN to present to him, so as not to waste his time.

If the combination of Xanax and Nitrous sounds okay to you, then that is the plan I will present to my dentist. I thought I'd ask my doc for a script for one 1 mg. Xanax tablet, and take 1/2 tab an hour before the procedure and if I freak out at the onset, take the 2nd half tablet at the onset of the procedure.

I'm really only trying to keep my sanity here. I'm finally able to lead a normal life other than my dental problems and I don't want this to cause me to backtrack.
Thanks so much....
Chris

 

[Gordon]

Thank you for being so open about things. I don't understand why so many dentists are so "macho" about sedation on their patient's behalf

Have you had xanax before and was it helpful to you? The favourite oral sedative for US dentists is Halcion, which is probably better since it has a shorter duration of action, and won't leave you zonked for too long after the dental treatment.

 

[twosoulsearthreads]

I think that the machoism of some dentists or other people who perform procedures stems from a feeling that requesting anesthesia suggests a lack of skill in the practitioner. ie: if the practitioner is good enough at his craft, there should be minimal discomfort. This doesn't take into account individual tolerances for pain, or anxiety. If a practitioner has never experienced anxiety, he/she truly can't comprehend the experience. We phobics KNOW that we're irrational. That doesn't change any of "our" facts, though.
I had 0.5 mg of Xanax once. It was the Thursday after 9/11, when I had a very bad anxiety day, and I remember the medicine helping immensely. That was my only experience with it. I have never prescribed or used Halcion, so I don't know how well it would work. I'll try it, though. Given that 10 mg oral Valium did NOTHING for me, but 0.5 mg of Xanax sedated me, would you recommend 0.125 mg 1 hour prior and an additional 0.125 at the time of the procedure if required? Or do you think I should take the 0.25 mg at once?
I really appreciate your reading these and answering. It is exceptionally kind of you to do this!
Thank you,
Chris

 

[Gordon]

Sorry, halcyon is not available in the UK where I practice, so I have no useful knowledge of the doses. However, as a general rule of thumb it's not good practice to titrate oral sedatives, I'd go for the lower dose first off but be prepared to abort the procedure if it wasn't enough and try the higher dose next time.

 

[twosoulsearthreads]

OK. Thanks. I'll let you know how it works out. I appreciate your help. My first appointment is next week.
Sincerely,
Minde

 

[twosoulsearthreads]

Oh, man! Today is the day that I've been steadily getting more and more anxious over; the day the "fixing of the mouth" begins.
My physician wasn't comfortable with Halcion, so I've been prescribed 0.5 mg Xanax 1 hour before the procedure. The dentist okayed it as long as I had a driver, which I do. My husband will be with me.
I want to thank you, for your kindness and information.
I am sick with worry, though, so I'm going to start a "dairy" on the appropriate thread.
Chris

 

[twosoulsearthreads]

Done! One root canal with some kind of temporary top. Getting 3 posts put in, in two weeks. The 0.5 mg Xanax, Nitrous, hubby grounding me by holding onto my leg, and the dentist letting me sit up every few minutes so I wasn't lying down all the time did the trick!
Thank you, thank you, thank you!!!!!!
Chris