Help with IV Sedation - SCARED

[Guest]

Hi everyone - glad i found this site!
I have an urgent problem than i can't seem to go forward with.
I'll try to make this brief as it is decades now!
Always 'hated' dental work (actually the dentist not the work!) - but a long story. Live in small rural town, no choices, bad advice, lack of 'lots of money' for certain treatment, etc.
anyway, i decided to get a bunch of dental work done i have needed - wear a partial that i wanted replaced with something permanent. But first, my problem.
Almost 3 weeks ago i lost a filling in a bottom wisdom tooth. The 'tooth' was mostly filling, and there's not much tooth left, and down to the gum line. Dentist said it must be extracted. I've had teeth extracted before and swore i'd never do it again (though i had no problems - well, not much).

The first were down 20 or so years ago. i was young, and not suffering from panic attacks and severe anxiety now. The oral surgeon gave me a pill (don't remember what) for the night before - which knocked me right out, and take one in the morning before the appointment. I was pretty calm, just a feeling of dread (plus not wanting to lose a tooth!). i was 'put out'. The surgeon had to carry me from the chair to the recovery room where i stayed about an hour because i wouldn't wake up. Eventually i was 'awake' enough for my mom to get me to the car and go home. I was pretty much out until the next day. - all i have is brief rememberances of being hungry but my tooth kept bleeding for hours and i hate that gauze in my mouth. I was hungry but couldn't eat due to the tooth (and because i really hadn't eaten the day before due to anxiety). The next day i was 'fine'. A few years later i needed another extracted. I got no pill to take, but wasn't overly nervous. I woke up after and went home and was generally alert. However, the dentist called me the next day to see if i was 'all right'. 'Why?' i asked. He said i was so agitated, he thought he would have to sit on my lap to pull the tooth out. Hm...I do remember waking up at one point, but only a split second. But hate the blood and the gauze for hours and hours. (i got a little partial to wear). Years later yet another had to be pulled out. (apparently all my roots are u-shaped, and i seem to lose fillings or teeth break down to the gum line).

A few years later, a third trip. Same oral surgeon. Really didn't want this done - a valium and i was on a few other drugs for things. When i got there he told me he could not put me 'out' due to the drugs. Might have been the steroids or the potassium tablets, i'm not sure. I travelled several towns, was under stress and i just said 'pull them out then'. 20 shots of novocaine later he did it. It was nothing really. I felt nothing (had nitrous), didn't 'hear' anything, wasn't aware of stitches (i'm needle phobic). However, i burst into tears after - relief tears. But the bleeding and gauze was worse for me and i hated it. First time also that a tooth hurt so bad after - needed pain medication, and my face swelled up. Still, i thought i was better than being 'out'.

Well, here i am with my current dilemma. No, i don't want the tooth extracted, but he says i have no choice. One reason the appointment isn't made yet, is i have no one to bring me there and back yet.

But i'm so terrified, i have nightmares about it, and i wake up and the first thing on my mind is "Am i getting it pulled out today"? and i'm in a very horrid mood for hours. Every day i'm obsessing over all the negatives.

Finally i called one oral surgeon (wow! my town now has 2 different ones!) - first said the doctor would use 'iv sedation' - but i got no clear answer on 'what kind' (sodium pentathol? sp?) or what??? She said
i would be able to respond. She just said 'things have changed over the years. they are much improved'. But that is all i got. I gave her a list of the drugs i take, a pill for anxiety and antidepressants (which don't stop the panic attacks or the Awful General Anxiety) - and she said those would be fine. She just said to let them know if take something like valium or ativan before i go. She also said no food or drink after 8pm the evening before, even if my appointment is at 11:00AM. Why?

The next oral surgeon i talked to (receptionist) basically said the same thing (ie - no details on what the iv sedation is) - and said no food or drink after midnight.

Why the difference in food or drink?

I'd be so nervous i probably wouldn't eat the whole day before.

I'm also a very tiny person at only 93lbs.

So, i'm very worried about the whole IV sedation thing. Is it really different from 20 years ago?

Will the wisdom tooth cause even more bleeding and gross gauze way at the back of my mouth? (i don't think i could stand it!).

I need to know these things because if i find a ride i want to get there so i stop dwelling and obsessing over all the horrid things i imagine.

I'm really looking forward to 'fixing my whole mouth' (well, the outcome, not the work!).

I wish i could find a dentist who uses a 'water laser' or air abrasion but we don't have any around where i live.

but first, the extraction. I really can't seem to face it right now. Can someone help me?????

Sorry this is long, but some background info i thought would help.

Thanks *anyone*.
AnneTerese

 

[Guest]

Hi AnneTerese, thanks for posting here ! I can't really contribute much on this one, except the spelling (Sodium Pentothal aka Thiopental sodium), and that it's an ultrashort-acting barbiturate. As far as I know, benzodiazepines are usually favoured over barbiturates these days.
Did the first receptionist actually say they're using sodium pentothal, or did that refer to a previous IV sedation you had?

I'm sure our dentists will have more to add

 

[Guest]

Thanks for responding!

That 'sodium -what-ever' - well, that is what i was told i got years ago. but these days, i don't know.

is there a reason the office didn't say WHAT it would be i would be getting?

As for the IV sedation, will i really be awake but unaware of what's going on? or really 'quite out of it'???

I was really hoping dental-things would have come 'leaps and bound' since i was a kid. Guess not, huh? (i do hope a dentist responds!).

I'm so stressing over it - and wish i could stop that. (my thoughts about it - all negative!).

Maybe i could take one of those 'amnesia drugs' until i actually get there and get it over with????

thanks!
Anne Terese

 

[Guest]

Well - dentistry has come a long way - I was just suprised at your mention of pentothal, because its use in IV sedation has been superceded by benzodiazepines! In all likelihood, you will be receiving a benzodizepine such as midazolam.

Benzos are very safe, targeted anti-anxiety drugs, unlike barbiturates (sodium thingy), which are sleep-inducing drugs with many disadvantages (for example, they can make a person more sensitive to noxious stimuli, and are generally a lot less safe to use).

So you will be awake and able to respond, but because benzos can induce partial memory loss for the period from when they kick in until they wear off, you may not remember very much about it afterwards.

I'd say the reason why the receptionists wouldn't tell you what drug you'll receive is simply that they didn't know and didn't want to look uninformed by admitting this to you... that would be the most plausible explanation . I wouldn't read too much into it. You could ring again and ask for a dentist or nurse to give you a quick call when they have the time, and ask them.

I'm not 100% sure why you're not allowed to drink or eat after 8pm the night before if the appointment is at 11am- if one of the dentists could comment, I'll add the explanation to the IV page mentioned above .

 

[Guest]

I don't understand the no eating requirement either. Sorry.

I usually prefer the patient to have a light meal about an hour before their appointment, I don't like them to be fasted. I'm assuming that the dentist is only going to do IV sedation, not general anaesthesia/deep sedation.

 

[Guest]

I'm not 100% sure why you're not allowed to drink or eat after 8pm the night before if the appointment is at 11am.

The standard procedure is NPO (nothing to eat or drink) after midnight the night before. My guess the 8pm deadline is just extra insurance. They want nothing in the bowels or the bladder for obvious reasons.

the reason why the receptionists wouldn't tell you what drug you'll receive

They are never sure because the decision is often made when you get there. Many different factors are considered: allergies, previous experiences, interactions with other drugs you are taking, your level of anxiety. etc.

Midazolam (Versed in the US and Canada) can induce partial memory loss. I just had this drug for a spinal procedure this past week and I don't remember anything at all! The most important thing is to have a driver with you. Don't make any important decisions for a day or two afterwards. There is no nausea or sickness afterwards - just a little confusion and lots of naps.

 

[Guest]

A few years later, a third trip. Same oral surgeon. Really didn't want this done - a valium and i was on a few other drugs for things. When i got there he told me he could not put me 'out' due to the drugs. Might have been the steroids or the potassium tablets, i'm not sure. I travelled several towns, was under stress and i just said 'pull them out then'. 20 shots of novocaine later he did it. It was nothing really. I felt nothing (had nitrous), didn't 'hear' anything, wasn't aware of stitches (i'm needle phobic). However, i burst into tears after - relief tears. But the bleeding and gauze was worse for me and i hated it. First time also that a tooth hurt so bad after - needed pain medication, and my face swelled up. Still, i thought i was better than being 'out'.

Just wondering - what did you prefer about the nitrous, and were you agitated that time? And, if they expect the extraction to be difficult, would general anaesthesia be an alternative? Have all the available options been discussed yet?

 

[Guest]

I think that they are just keeping all options open in the event that they may want/need to use general anesthesia. If the patient does eat then general anesthesia is not an option.

 

[Guest]

I think that they are just keeping all options open in the event that they may want/need to use general anesthesia. If the patient does eat then general anesthesia is not an option.

But surely, something like that would not be decided on the spot, but discussed beforehand?

 

[Guest]

Given the history here, all avenues must be kept open. There is no knowing how much premedication the patient will decide to take on her own beforehand.

 

[Guest]

I don't really know how the system in the US works, but I'd like to think that "the patient" (let's call her Anne Terese) should have the opportunity to mentally prepare herself and be informed about what's going to happen.

So my thinking as a layperson would be: if IV is the big problem for Anne Terese and she did much better with RA (nitrous) in the past, why not use that ?
And if the extraction was expected to be very complicated, why not go straight for general anaesthesia and discuss it with her beforehand, given her history with IV?