Desperately need wisdom tooth extraction, but too afraid of the anaesthetic (med phobia)

[zeke]

Desperately need wisdom tooth extraction, but too afraid of the anaesthetic (med phobia)

Hi everyone


Have read here a few times but finally got up the nerve to post. This contains a dentist visit horror story, so those that may be triggered might want to look away now...





Basically, I have an infected lower wisdom tooth. It has to come out. I've been putting it off for years because I have a crippling phobia of medications. I was too afraid to have the local anaesthetic because I was so convinced it would kill me.


A few weeks ago I attempted to go in to have it extracted and it turned into an utter horror story. Once I'd finally got the nerve to have the injection (which took at least half an hour) the pain was unbearable. The first one into the sort of hinge bit of the jaw was OK, but then she injected under the tooth (where it's exposed because the gum is going) and I screamed and yanked the needle out. That wore off a bit, and then she sent me out into the waiting room to wait but I couldn't get numb enough. So she did it again. And again. This time the pain from the injection was travelling up the nerve into the side of my head and I was just screaming and crying in the chair, it was utterly unbearable.


I had 8 canisters of local and it still wasn't enough to numb me properly. She tested it by poking it with the end of something and again the pain made me scream and cry, it was just unbelievable, even after 8 canisters. (To further complicate things, I have atrial fibrillation, so i can't have the one with the adrenaline which I know is more effective, but there's no way I'm risking it. I also have hypermobility syndrome, which makes local anaesthetics less effective to begin with, which is probably what caused the not numb enough problem)


I tried a different dentist, thinking she might be able to do something differently. I was scheduled for the extraction last week but when I got there I couldn't go through with it. It's not fear of having the tooth out, I don't care about that, it's fear of the pain I had to go through the last time, and the fear of what the anaesthetic will do to me (even though I've had it once and didn't die). I couldn't do it, so she's referred me to the hospital.


There is NO WAY i am having a general anaesthetic/IV sedation. No way on this earth. Just no. My fear of the local is bad enough, but if I have the general I am convinced I will die. End of. I can't do it.


I have got to get this tooth out. I'm terrified the infection will spread not to mention the fact that it hurts like hell every day even on 4-hourly codeine. I know once it's done I'll never have to worry about the pain, or the fear, ever again. But I don't know what to do.


I thought perhaps nitrous oxide followed by the locals without epi, but I'm even scared of having nitrous oxide because I'm convinced it'll do something bad to me. I know it's instantly reversible and I know there are no bad effects but that doesn't help - the fear is just so immense, and what if something bad happens with the local while i'm on the nitrous and I can't tell them? I can't overstate how bad my phobia of drugs is, it is utterly crippling, I am utterly convinced they will kill me, and that's what's left me in this mess.


What can I do?

 

[chickenjen]

Re: Desperately need wisdom tooth extraction, but too afraid of the anaesthetic (med phobia)

I'm no medical professional, but I think I've read or heard somewhere that an infected tooth is difficult to get numb. Maybe you need your dentist or doctor to prescribe you a round of antibiotics to tame this infection, that way maybe the LA would work better.
Hope you feel better,
,
Jen

 

[littlestar88]

Re: Desperately need wisdom tooth extraction, but too afraid of the anaesthetic (med phobia)

I'm assuming that given your medication phobia this advice is not going to be helpful but maybe it will so I'll say it but feel free to ignore me! How would you feel about oral sedation? Its incredibly safe and may help relax you enough that the LA can work. If you could face it the Nitrous would have the same effect, just what you feel most comfortable with. I also agree with chickenjen that an infection could be making it hard to get numb and once treated it should be much less painful.

 

[zeke]

Re: Desperately need wisdom tooth extraction, but too afraid of the anaesthetic (med phobia)

Hi and thanks so much for the replies.


I've had antibiotics and it doesn't seem to have helped unfortunately. I also had bad reactions to them so I was unable to complete the course. And obviously I have problems taking them because of the phobia although I'm getting slightly better with that and I will at least try now. The first time around I had amoxicillin and metronizadole and that made me so ill I had to go to A&E. That was about a year ago. The second time I had 250mg amoxicillin and that wasn't too bad and I completed the course but it didn't get rid of the pain totally. A couple of weeks ago I had 500mg amoxicillin and i couldn't finish the course, I only managed 2 days. It made me feel so ill I couldn't cope with it.


The first dentist said she thought the infection might be making things more difficult, yes, but I think it's more likely to be my hypermobility/EDS. There's a thing on this site about it even but I'm not sure how to find the link from here.


I think I prefer the idea of breathing something in rather than taking a pill (although it's still really scary because what if it does something really bad to me?). With a pill, once it's in your system that's it, you can't do anything about it and if you have bad effects you're stuffed - whereas with Nitrous you can have little tiny bit and turn it off if it starts to do anything, yes? I don't know. Either are terrifying.

It's more the anaesthetic. I can cope with the thought of the nitrous a lot better than that, but it's once I'm under the nitrous and they get the anaesthetic in that I'm worried about. It's also the fact that the anaesthetic seemed to shoot up a nerve last time i had it and it gave me SO much pain in my head, I don't really understand why. And the pain where she injected it in under the tooth was awful, so bad I actually yanked the needle out myself. I'm terrified of going through that again, because I didn't know what the pain was or why it was happening or whether it was safe or was going to do something really bad to me.

On the other hand, I'm so tired of waking up every day and feeling the tooth and worrying about all this

 

[Carys]

Re: Desperately need wisdom tooth extraction, but too afraid of the anaesthetic (med phobia)

I can't overstate how bad my phobia of drugs is, it is utterly crippling, I am utterly convinced they will kill me, and that's what's left me in this mess.

Hi there, this is a thread for me to answer for sure! I too have a deep and utter phobia about medications, which had led to me avoiding the dentist and dental work for a number of years. I wrote a journal some months ago, which I will look up for you shortly. I had not taken even a paracetamol in about 14 years, such was my fear. I too was entirely convinced that I would die as soon as I had those LA injections. It is not overstating the situation to say that I mentally said goodbye to my family as I left for that appointment and felt the same way as if I was facing a lethal injection.

Ok, I presume your dentist is aware of your atrial fibrillation (I don't have this diagnosed condition, but I have benign ectopic heartbeats and irregularity which caused me to be petrified of the adrenaline based LA) ? Is the adrenaline based LA injection definitely counter-indicated if you have AF, or is it your fear that is making you believe that it is ?

The amount of adrenaline used in an LA is miniscule, your body produces more of the stuff in panic and anxiety than the weeny bit in the LA. Maybe your first port of call could be to check with your doctor/dentist about the possibility of using an epi based LA? I had a massive fear of the adrenaline and so I ended up insisting that an epi-free local was used, 5 injections later it had done nothing....then they used lidocaine with epi and it was instantly effective. If it is injected properly, using an aspirating needle (which tells the dentist instantly that he is injecting into tissue, rather than into a blood vessel) then the adrenaline just sits in your soft tissue and gradually absorbs away over hours at a very slow rate. It could be that it is simply that the epi-free injections don't work for you, and nothing more complex than that, so worth exploring that route first?

Sorry, what is EDS? Here is my journal...

My teeth - 'medicine' phobia and periodontal battle

Ok, so I've posted a few times, but thought I would start a thread where I can add posts as things happen. I am doing this partly for cathartic reasons, and partly because someone in the future may find it of some minor assistance in their own battle. I last visited my dental practice 1.5 years...

www.dentalfearcentral.org

 

[zeke]

Re: Desperately need wisdom tooth extraction, but too afraid of the anaesthetic (med phobia)

Thanks Carys, I'd read your posts with interest before I posted myself and I couldn't believe there was someone else out there that felt the same as me. Everyone else just looks at me like I've got two heads

With regard to the AF and the epi - I think it's a bit of both. The dentists have recommended the non-epi version, and I'm also too scared to try it anyway in case it sets anything bad off. But I didn't know that about the amount of adrenaline in it, I assumed it was quite a lot.

Mostly, I'm scared of suffering the same pain that I did last time. I don't know if she injected me wrong, or she hit a nerve, or what the problem was, but I honestly couldn't believe the pain - it shot right up into my head and everything, and stayed there until the LA started to wear off. Also the pain of having to be injected under the tooth (hard to describe the position), that was what really hurt me. She put a *lot* of numbing paste on it the second time but it didn't make any difference - the pain was deeper than that. I have no idea what that pain was, but it was nothing like the injection I had in the hinge part of the mouth (does that bit have a name?!) which was fairly OK.
It was horribly traumatic. I yelled and cried so much and for so long that the receptionist came in and said that children in the waiting room were scared. I wish I was joking.

 

[Carys]

Re: Desperately need wisdom tooth extraction, but too afraid of the anaesthetic (med phobia)

Hi again,

I've copied and pasted this, which you may find interesting, from a page on this site....

The amount of epi in local anesthetics is tiny compared to the amount your body naturally pumps out. The reason your body produces adrenaline is to prepare you for a fight-or-flight situation, and an increase in heart rate and blood pressure mean that you can run faster! If you do decide to do a runner, please let your dentist know first… that way, they’ll be able to remove any sharp objects between you and the door . On very rare occasions, the epi may be accidentally injected into a vein instead of muscle tissue (the local anaesthetic is usually ineffective in this instance). This can cause a very dramatic increase in heart rate. While not dangerous, such an experience can certainly be unsettling, but the chances of it happening again are extremely slim. Also, the use of aspirating syringes has become more common in recent years, and this prevents the accidental injection of adrenaline containing local directly into a vein.

Some people do appear to react more sensitively to the epi in injections than others. It is possible to use a local anesthetic without epi. However, not all dentists will stock this – so if you’re concerned, it’s best to ask.
Mepivacaine (carbocaine) and prilocaine work for a reasonable amount of time even without the epi and can be used instead. But it may be more difficult to achieve profound numbness without epi. In this case, using laughing gas or IV sedation in addition to the local anaesthetic may be helpful.

You can find the full page by navigating the 'common fears' menu above, and looking at 'reactions to local anaesthetics'.

Have you asked the dentist herself why she thought the pain was so bad when she gave the injection ? If she could offer you an explanation, like that she did it slightly incorrectly and hit some nerves, that might make you more confident that she knew what she had done and it wouldn't be repeated.

 

[zeke]

Re: Desperately need wisdom tooth extraction, but too afraid of the anaesthetic (med phobia)

Thanks Carys, very kind of you to paste that for me. I think the laughing gas plus the non-epi is going to be the next thing I try as per the end of that article. It's still scary but perhaps a little less so. I've been referred to Kings (I live in London) but I don't know how good they are with very anxious patients so that's another worry, that they'll be impatient and not listen to my fears like a 'normal' dentist maybe would.


I didn't ask her no, I was too busy screaming the building down I was in too much of a state to be rational about the explanations. She did say there was a lot of inflammation there (the tooth is loose too, so I think it moves around and irritates the tissue) It was the injection behind the tooth (on the tongue side of the gum) that did me in - the gum is quite receded there and I think the bottom bit of the tooth is exposed as a result which is probably where my daily pain is coming from.


The thing about hitting nerves - I thought that's what they *had* to do? It's the lower jaw, so don't they need to use a 'nerve block', whatever that is?


Oh, to answer your earlier question, EDS/Hypermobility - it's a connective tissue disorder. My joints are too mobile, and it also affects the collagen in your body. Apparently what happens with LAs (which I learned from this site, actually, after I got back from that hellish appt, on the common fears page about 'can't get numb') is that the LA seeps into the tissues and away from the injection site faster than it can properly numb the tooth because the collagen is faulty, so LAs aren't very effective. The cure apparently is just to use more, but I couldn't stand the pain of any more injections and I'd already had 8 cartridges of it and that was the maximum she said she could safely give. I was too scared to have any more because of the med fear.

Sorry to ramble on. I just feel like I'm never going to get out of this mess. It's on my mind constantly and the anxiety is wearing me down.

 

[45andAfraid]

Re: Desperately need wisdom tooth extraction, but too afraid of the anaesthetic (med phobia)

Wow Zeke, so sorry to hear about your pain and anxiety. I wish I were replying to say I relate but I don't and just wanted to say that I hope you find some relief or solution soon. An infected tooth is nothing to fool with. It can seriously affect your health and could possibly lead to death. Would you prefer to die over a tooth infection?

I am afraid of prescribed drugs. I'm not phobic but I'm afraid to take them. I was prescribed an oral sedative for my appointments because I gag too easily, plus gas (nitrous). I was afraid to take them because I never took any sort of sedative before, nor have I ever had gas. The two combined can be lethal if not monitored, but I do it every time I go for an appointment. I panicked the first week wondering what the sedatives would do to me. But I thought... I would rather take that chance then sit in the chair just freaking out and crying and gagging and making a complete fool out of myself.

Although I don't like medicines either, I cannot go to the dentist without sedation and even tho I opted to go without the nitrous, a couple of times now I've had to request it because the sedation wasn't enough. The gas takes the edge off and relaxes you into calm. Relaxes the muscles and after roughly 7, rather intense, appointments, I wouldn't have it any other way. Maybe one day.

I hope you keep posting and you post back with positive results.

Cheers mate!

 

[zeke]

Re: Desperately need wisdom tooth extraction, but too afraid of the anaesthetic (med phobia)

Hello everyone


I'm here with an update


I am booked in at Kings to have the tooth removed on Tuesday.


I will not be able to have sedation because they don't offer Nitrous Oxide to adults and I can't have the IV sedation because a) it's a benzo and I've had addiction problems in the past and b) I am totally alone in London and there is nobody to take me home or look after me.


They're going to have to try and do it under a local without epi again which I *know* isn't going to work. It didn't last time even after six or eight canisters of it and the tooth is still 'hot' - it's throbbing every night when I lay down to go to sleep and waking me up within half an hour in crying pain - even after a week's worth of amoxicillin.


I am *terrified*


Utterly utterly terrified. it is going to be agony


I don't know what to do. It desperately needs to come out but the pain is just going to be horriffic and there's nothing I can do about it. It's going to be like last time.


To further complicate matters the consultant at Kings showed me on the Xray what the problem was - as well as being infected, the roots are actually sitting on the nerve in my jaw.


Oh god oh god oh god. I'm so scared. It's one in the morning and the sodding thing has woken me up again, I'm in pain and terrified about what's coming up on Tuesday *cries*

 

[zeke]

Re: Desperately need wisdom tooth extraction - UPDATE: It's done!

Well... I did it! I have now been minus one wisdom tooth for two days.


I'm amazed I went through with it, but I did and I lived to tell the tale.


I'm not going to say that the experience wasn't traumatic - it was, but only because of my fear of the drugs, which was extreme - I was crying hysterically before I even got to the chair. However... the procedure itself wasn't at *all* traumatic. I had it done at Kings Dental Institute and they were absolutely wonderful. The surgeon could see how terrified I was, and she did everything *so* slowly and explained everything she was doing and made me feel like I was in control of it. She put numbing cream on me first so I wouldn't feel the injection, and I really didn't feel it at all. The nurse held my hand all the way through it.


This time I was able to get properly numbed, although I did have to have several cartridges of the Citanest. About five or six, I think.


Because she did everything slowly in little stages, it took about 45 minutes from start to finish. I felt a tiny, tiny bit of pain just at the very last stages (after she'd 'wiggled' it loose, when she actually lifted it out) but it only lasted about two seconds and then bingo, it was out, job done. After it was out, I laughed hysterically for about ten minutes, and cried with relief.


There were a few sticky bits: I panicked when she went to inject me for the firs time and started crying 'no no no no' and all that stuff, and again when I swallowed some of the local anaesthetic and completely freaked out because I thought it would harm me but that passed quite quickly.


I couldn't believe how big the tooth was, and how angry looking (I didn't keep it, but I did take photos!) No wonder it had been giving me so much pain. The day before I had it done, I was down at A&E being pumped full of diclofenac, codeine and tramadol, it was that bad.


The thing that's amazed me most is that I've had NO pain at all, post-extraction. I was expecting to be in agony when the local wore off but literally, I have had zero pain. Not even a mild ache. I'm stunned. No swelling either, no bruising, not even a bit of stiffness. Nothing.


I feel a bit ropey - I've been feeling quite sick today and very tired, like I'm coming down with something, but I'm putting that down to either the stress or the after effects of the local (or the cocktail of drugs they gave me to try to stop the pain from the tooth on Monday, which made me *completely* stoned).


The best bit, although i feel a bit crap, is knowing I *never* have to worry about the infection again. It's gone. I never have to wake up again and think about how much pain I was going to be in that day. I don't have to wake up crying in the middle of the night from pain. I don't have to panic about the infection spreading and giving me septicaemia or something awful and worry that the only way to solve it is to go through an 'awful' experience. It's gone. It's such a relief.

 

[Dianne]

Re: Desperately need wisdom tooth extraction, but too afraid of the anaesthetic (med phobia)

Congratulations, Zeke! Well done! The "build up" before the appointment is always worse than the appointment itself. I just had 21 teeth extracted last Tuesday. I, too, had zero pain and no swelling! I and everyone else were so surprised. It went very, very well! I now have an upper and lower partial. I go today for my follow-up checkup and should receive my permanant partials in a couple months (I believe). I never thought I would get to this point, but here I am! Way to go for all of us who have taken that step!

Well, again, congratulations and good for you for taking a step to your better oral health!