Is 7 hours of IV sedation safe?

[CaribbeanSail]

I went to the dentist yesterday for the first time in 20 years, due to unbearable tooth ache that wouldnt go away. By the way a HUGE thank you to this site, in my sleepless nights due to the tooth ache and my relisation that I must finally break down and go to a dentist, I did some googling and found this site. I spent many hours reading through it and learning about all these new ways to cope with dental anxiety with sedation. This site went a long way to giving me the courage, but also allowed me to research some dentists first to find the right one who can handle a major dental phobic like me who has not been in a very long time.

Well I found the perfect dentist it seems, he actually specializes in IV sedation and patients with highly neglected teeth and dental phobia, with a firm rule on no lecturing.

So it turns out the source of my tooth pain is a wisdom tooth. But of course that is not the only problem I have. I have 7 cavities that need filling, bad tartar buildup, and my 3 other wisdom teeth while not causing pain, do need removing. I figure, given my dental phobia, and the fact IV sedation will make me not know the difference, why not just do everything that needs doing, rather then just the bare minimum of removing the one wisdom tooth.

This however would be an all day affair due to the amount of work, arrive at office to begin sedation at 8am and be done at about 4pm. The dentist said its fine and no additional risk due to the length of time. However reading about IV sedation on this site, it sounds like its normally limited to less then 2 hours at a time. So that has me worried a bit. I know I could split the procedures up into multiple visits, but sedation or not, going to the dentist once is bad enough, several times? No way, I can guarantee that once the pain is gone I would just opt not to go back again (knowing this about myself I am also opting to pay a high premium for 7 porcelain fillings rather then silver or composite, since they are supposed to last longer).

Has anyone else done IV sedation for such an extended period of time? Or know of the ins and outs of it enough to tell me if this is normal or okay?

Thank you! I keep switching back in forth between sheer terror for my upcoming appointment to do all this and absolute delight at the idea of being able to smile without embarrassment again.

 

[CaribbeanSail]

I actually want to ad a different follow up question to my origonal question. I understand you are basicly awake with IV sedation, but you wont remember most or all of the experience. One thing that keeps popping into my mind though, while under this sedation, are you less inhibited (like while very drunk)? For instance, is it likely one might say something highly inappropriate or embarrassing to the attractive assistant? Could someone lose control of or not care about their bodily functions (ie let out horrid flatulence or worse?).

 

[Gordon]

I've done cases of 4-5 hrs before, it really doesn't matter how long the sedation lasts, it doesn't get any less safe over longer durations

It's possible that you might say something to the assistant, but she's a professional, she'll be used to it and won't be the slightest bit bothered by it.

You'll still have control over your bodily functions!

 

[Wyrd]

Someone already answered your questions in regard of the lenght... I wanted to just let you know how my 1st experience under sedation went on October 8. i was scared and wanted all to be done like you in one visit. My dentist made a treatment plan: 2 visits under sedation & 3rd one with laughing gaz (well we will try).

I was under deep sedation... but was breathing on my own. A nurse was watching me all the time. I didnt feel pain or anything when they put me "to sleep". I remember at one point hearing the dentist (coudnt understand a word he was saying) and him doing something in my mouth (i didnt care and only wanted to sleep more). That is the only memory that I have... I did ask my dentist why I remembered that, he told me that he had at some point to wake me slowly.

Then in the recovery room, I felt ok, in control of all my thoughts, so that really made me feel good. I was ready to go home, so I sat instead of lying down. I looked in the window outside, nice trees, little birds and sunshine. The medical nurse that was watching over me was very nice. I had to wait 1 hour. Once home, I helped my mom do my bed, sat with her and talked and even ate some soup. Then I went to relax and fell asleep for a little. My thoughts were more dramatic and out of proportiongs and honestly it wasnt bad at all. I am going under sedation again on November 29. Of course, I am still scared... but less, so that is such a happy thought for me.

Dont give up. You will be so happy once it is done. Before going I did a lot of relaxation with visual thoughts (the things I feared the most to expose myself to those scenarios). I dont know if it helped but I did practice them anyway.

Let us know how it goes!

 

[ButterfliesInHerEyes]

If you think about it, doctors do surgeries that last much longer than 7 hours, with GA which is much stronger with more possible complications, and people are fine with it. So it would stand to reason that 7 hours of IV sedation is fine.

 

[CaribbeanSail]

Thanks for the responses.

Gordon, when you say I might say something inappropriate, is that to verify that I might be uninhibited like i might be when I am drunk? There is where the "control" issue comes in I guess. In a way I wouldnt mind doing or saying things while on the sedation, IF I could remember it, but the idea of being an idiot and not remembering so I could apologize after, bothers me to no end. Also, you say you have done cases of 4-5 hours before, I am confused if that means you have done them as a dentist, or as a patient? If as a dentist is it possible you could explain why longer durrations does not make it more risky?

Butterflies, the fact people do GA for far longer doesnt really help with my fears. GA does last far longer sometimes, but is also MUCH more dangerous, and has a docter who has spent years training and specializing in it. As I understand a dentist has to go through about 20 hours of training to do IV sedation, big difference. I have a lot of confidence in a couple hours of IV sedation, I just cant find anything anywhere that tells me 7 hours of it is safe.

I dont just have a fear of dentists, I have a fear of doctors, I have a fear of needles, etc... A fear if put into a sedative state I may not come out the other end. When you look at the list of possible fears of dentists listed on this site, I can checkmark "all of the above", control, embarasment, etc.. The sedation thing helps with so many of those, but invokes an entirely seperate fear, I am a hypocondriac, which is part of my fears of MDs and dentists. Like, "I know I must be dying of something, so I will be happier in life not knowing". Pumping me full of medication makes me think, "Oh, I know I must have liver issues, and this will kill me", and of course, 2 hours of drugs is less strain on a liver then 7 hours. I know I could go to a MD and get my liver and kidney function checked before hand, but well, that freaks me out too, its a catch-22 there.

I keep trying to think of ways to shorten to threatment, to reduce my fear. But its all work that pretty much needs to be done. The best option I can think of is remove 2 wisdom teeth instead of all 4. But the more reading I do about wisdom teeth and the long term problems they cause with infections and such, I get freaked out by that too.

But then I read about dry sockets and the week or so after extraction, I want to minimize portenial issues. I mean, if you have 2 wisdom teeth out rather then 4, it stands to reason you cut in half the risk for dry socket? I have had my wisdom teeth for about 12 years, they all came in with room in my mouth for them. As the dentist explained it to me, the issue is due to how far back they are, and the gums behind them, keeping them clean was an issue and they decayed far beyond the rest of my teeth. Years ago the wisdom teeth on the top and both sides decayed to the point they broke, I remember years ago peices of tooth breaking off of them.The back half of them are broken at the gum, the forward half of them are intact. But that forward half is basicly just a hollow tooth, I can stick my tongue inside the tooth and touch the gum that has grown over the inside of the tooth (or more often then not, the food gunk that has gotten stuck in there). They cause me no direct pain though. Oddly, the wisdom tooth that is causing me the pain that sent me to the dentist for the first time in 20 years was one of the bottom ones that is still a full tooth (though with a very bad cavity that makes it beyond saving). Anyway, I am tempted to leave those broken teeth where they are.

In general I think I would lean more towards doing the multi session issue, do the most dire issues first session and do the rest in later sessions. That way I reduce the length of sedation and if I inevidably dont go to the additional session, I at least took care of the worst problems. But I have a logistical issue in that I live on a yacht and I am already extending the time I can possibly stay in the area before heading south safely to do just the on session. So multipule sessions would mean doing the rest with another dentist in the Caribbean where options are far fewer and newest technology is not available. So, its all or none for more then one reason, but the whole 7 hour thing freaks me out (on top of the million other things that freak me out).

I left my initial consultation with a prescription for painkillers, and I only had to take them for 1 day, the toothache is gone now and I havnt had to take the painkillers since. You have no idea how tempted I am (well, most of you probably do) to just not go through with it, I have no pain now, all is "good", haha. I know I need to do it though and will be happier after the fact (except for my bank balance being $10K less then it was before). I am sure I will go through it, I already lined up a friend to "watch" me for the 24hours after the procedure, and as fearful as I am of the dentist, I am even more hung up about making a friend drive 2 hours to pick me up, stay in a hotel with me (staying on my boat is too dangerous I think post IV sedation), babysit me and drive home. So enlisting this friend pretty much commited me more then my fears might make me want to back down. But I desperately need assurance on the 7 hours of IV sedation that I can feel confident in.

I fully realize I am irrational in many many ways, but I think most of us who come here for help are. Must of my posting is venting, so happy to have found a support group full of people who understand. The 7 hour thing though is still a very big issue that I just need some actual documentation that its actually okay. To quote this very website... "A typical IV session takes up to 1 1/2 hours. If it takes longer, it's done in multiple visits, or depending on the case, under General Anaesthesia.", this does not instill confidence and offers little explanation, considering in my case I am looking at a session 4 to 5 times longer then typical and not with multipule sessions or GA.

Thank you, really, this site is a godsend.

 

[Gordon]

I'll try to answer your questions as well as I can, I might have missed something in your post so if I do get back to me please.

1) I do them as a dentist, never personally experienced IV sedation, my longest treatment was about 5 hrs, that was a very complex restorative case and I was just doing the sedation, another dentist was doing the treatment.

2) There's no extra risk involved in the extra time, just very few dentists want to set aside 7hrs for 1 patient, it's not cost effective for us

3) Please don't worry about saying anything inappropriate, honestly, nobody cares what patients say under IV, it's truly not worth bothering about.

If it's such an issue for you though, then I'm sure that the staff will be happy to tell you if you said something stupid and you could then apologise. Failing that I don't mind having relatives in the surgery watching what goes on, they could tell you what you did or didn't do..

 

[Camisa]

You will probably be so relaxed that you won't want to start talking. Plus your mouth will be being worked on, so you probably wouldn't talk anyway. That being said, a lot of people talk about stuff in conscious sedation - stuff that often, doesn't even make any sense, and medical professionals know this, and know that whatever you're saying may not even be how you really feel. Being drunk is different.... you say stuff you don't mean when you're drunk but you can still think about what you're saying.

Please don't fret....

 

[CaribbeanSail]

Thank you everyone for the replies.

Gordon thanks for clarifying that you are a dentist, that puts a lot more weight behind your words that you are a trained professional yourself. I think it is terrific that dentists also contribute to this forum, one would think after dealing with us phobics all day at work, the last thing many if you would want to do is come deal with us in your spare time! You have my deepest gratitude for taking the time to answer mine and others questions.

I stopped by my dentists office the other day to pay for my upcoming procedure. I took that time to voice my concerns and ask more questions that I had not thought of on my first visit (where I was in pain and severely stressed as it was my first visit in 20 years).

2 more days till my procedures, I am terribly nervous but looking forward to having it over and done with. I think I really lucked out finding a very special dentist, I will be their only patient for the entire day, with the entire staff devoted only to me for the whole day. Since I dont have someone to drive me to the appointment, one of them is even coming in an hour early so I can take my ativan at the office, rather then take the ativan then jump into a cab and trust a cabbie.

 

[Gordon]

That's really nice of them, it's the little things that make a big difference.

Please let us all know how it goes.

 

[CaribbeanSail]

Well, I did it. 7 hours of dental work in one shot. 4 wisdom teeth removed, 7 cavities filled and scaling on all my teeth. The IV sedation worked well, I had taken an adivan an hour before, and they hit me with some nitrious before putting the IV in (I am needle phobic as well). I vagluey remember them starting and messing around in my mouth in the begining. I also remember a few times in the middle, them waking me up to ask me something, but very hazy. I remember waking up in the end, and asking them if they still had to do the wisdom teeth and they said they already did and I am all done.

A friend picked me up and is staying with me tonight. I can see why this is required, I was totally zonked out of it the first several hours after I left the office. I am feeling pretty normal now 7 hours later. I had a bit of a dull throbbing pain, which I took vicatin for and it went away with ease, its well past when that should have worn off now though and I am pain free. Just a mouth full of bloody gauze and an intense hunger (jello just isnt fillig me up!), hopefully pasta tommorow.

All i all, I cannot imagine a dental visit being more pain free. I am sure I will remain highly phobic, but this was a positive experience and as long as I continue to visit this same dentist, I think I can keep on top of things from now on.

Now just phobic about getting dry socket!

 

[CaribbeanSail]

Now its the day after my procedures. My wisdom teeth didnt stop bleeding until late this morning. I woke up at 3am with a mouth full of blood, it was not pleasent and a bit scary. It was a huge releive when the bleeding stopped. Pain is pretty much gone, took a pain killer this morning (about 6 hours ago) and as its worn off I have not felt the need for another one. I am still insanely hungry, living off chocolate milk and pudding for now. Tommorow I will try soup. The work done looks terrific, my teeth look the best they have in about 18 years.

I honestly cant beleive how well it all went. IV sedation is a godsend! After the amount of work I had done and how easy it was, I can honestly say I think I may be able to get over my dental phobia entirely. To all other phobics out there: when people say technology and attitudes in dentisry have changed, they mean it! its night and day, find a good dentist who is up to date in both attitude, technology and training, its all the difference!

 

[Gordon]

Thanks for posting an update on here, it's good to know how things have worked out!

 

[amandah]

Hi I am a total nervous wreck. I have to have all my molars taken out 9 in all. And as a sufferer of chronic Anxiety, I am wondering if IV is for me or if I would be better with GA, again I am terrified to have GA.But it will be done privatly not NHS !! Yes I am terrified of the NHS . Please please help Thanks regards amandah

 

[brit]

Hi I am a total nervous wreck. I have to have all my molars taken out 9 in all. And as a sufferer of chronic Anxiety, I am wondering if IV is for me or if I would be better with GA, again I am terrified to have GA.But it will be done privatly not NHS !! Yes I am terrified of the NHS . Please please help Thanks regards amandah

Privately i/v sedation is probably a lot cheaper than GA in UK since i/v can be done outside a hospital whereas GA cannot. On NHS i/v sedation would cost a small amount unless you were exempt from fees whereas GA in NHS hospital would be 'free at point of use'.

In my experience having GA in an NHS hospital is a pretty safe undertaking!

Private i/v dental care would allow root canals to be done and teeth to be saved which would not likely happen under GA in NHS hospital, you would more likely be looking at extractions only.

Both are safe options, read more here:

Is dental sedation right for me?

What sedation options are available for dental treatment? Which is the right one for me? Find out about oral, inhalation, and IV sedation.

www.dentalfearcentral.org

 

[amandah]

Hi well here goes, I am an extreme anxiety sufferer. And at last have made it too see a Dentist !! But I have got to have all my molars out. Decay or chipped.I am getting a referral to the ( Cedars over at Frimley, surrey. But I am scared in case I hear whats going on !! As I take a long time to relax. I am also a mouth breather , with anxiety. I am also looking into a possible op through the Nuffield but this would be a GA again HELP !! I have got to have 9 teeth out !! But surely they will not do them in one hit. Anyway, please can you advise me? I am a total nervous.wreck regards amandah

 

[Di]

amandah, first of all you need to be sure you need these 9 teeth removed. You mention decay or chipped, but is it really necessary to remove them, can't they be treated? It's never a good idea to have teeth removed if they can possibly be saved. Once a tooth has gone, it's gone for good, and you need to put something in the gap, be it implant or some sort of denture. Can I ask what you're thinking of getting if you go ahead and have these teeth removed?

Personally I'd get a second opinion from another dentist before agreeing to have so many teeth extracted. Most dentists nowadays aren't keen to extract teeth that can be saved, not like in days gone by when they seemed happy to reach for the pliers at the drop of a hat.

 

[Wyrd]

I was wondering how your appointmen went?

I'm going under sedation again this Monday, November 29th and like you, I am afraid. But since I went once, I am a little less afraid, not much but a little.

The last time I went, I was very nervous, talking fast, being hypersensitive to anything... and I did say a few things and ask a few questions, that some might "think" they are inappropriate... well I dont. For one, I said to the dentist who put me under sedation that she was beautifull (I'm a girl), well I meant it... its not because I am a nervous wreck, that I cant compliment someone), I even ask my dentist at what time he got up that morning, cause my appointment was at 7 am and told him that he was weird doing procedures at this hour. Usually I am still in bed! In fact, it can sound weird, but to me I was just trying to be nice and have a sense of humor.

So, dont worry too much about what you will say... pretty sure you wont talk under procedure.

You might as well be surprise, your procedure might take less time. In my case it didnt, but a tooth that needed to be extracted took less time, the dentist pulled it out in 5 min, he didnt cut me or anything. It was half there, since it broke and the roots were still in my gums. Now, I have a missing tooth, but no more infection and feel already better. Like my overall health is much better. I dont regret going, actually am pretty proud.

I know its hard to "let go" and to "trust" them, but they showed you little signs to make you feel better.

Keeping you in my thoughts.

*** I just saw that you went, congrats! You must be proud of yourself. Thanks for the update.