IV sedation does not work...what next :(

[helenmelons]

oh blimey I do not know where to start....

dental phobic from a child due to numerous bad experiences, finally had IV sedation at 15 yrs of age which worked fantastically well.

then the phobia kicked in bad and I didnt have anyone to take me or support me and did not go for years.

when I was mid 20's I tried valium tablets..did not touch me.

few years later i tried IV sedation, whilst it sent me to sleep and I cant recall anything and thought the work had been done they apparently could not knock out my reflexes and everytime they touched me I freaked and fought them (I dreamt of juggling green balls and apparently the had green gauze lol)

tried IV sedation again a few years later in my early 30's and had the same effect although I remembered more, they finally managed to calm me enough to get the half extracted tooth out (he was actually going to leave it half hanging out).

I need desperately to go again, found a nhs dentist that said they did laughing gas (figured it got me through 4 births maybe what i need is to be relaxed but not out of it) explained all the receptionist, said i wanted to see a certain dentist that website said dealt with nervous people but i saw some doctor dentist of death...ended up in tears again, but got an appt with the other one, he is a nice enough bloke, we decided to try tablets to calm me and see if we can get over the phobia.

tablets didnt do anything for me, (2 x 2mg) but i sat there and let him numb me up, but my legs were banging in fear and the room was boiling hot according to my man and what i felt but i was in major shock, shivering and feezing and needed to be covered, he then did some molds and the coldness went into a broken tooth and set off awful pain including the tooth that was about to have a root canal, so i didnt have any faith in the numbness and he agreed it may not have worked so we left it.

he says IV sedation is pointless, because i am overweight my body will just soak up the sedation, although one time before when it didnt work i was not that overweight and 2 dentists have told me it is because i am so so so scared my body just fights it all.

so I have tried tablets, IV sedation and hypnotherapy..
what next I can't really afford to go privately and pay for treatment and gas to try that. I am on maternity leave having had a baby hence i am entitled to nhs treatment, when i had my last baby i had an awful time, almost lost him and had a code red crash c section and to be honest being in the dentist chair bought that all back to me and has set off nightmares.
I feel that i could not bear to have the feeling in my mouth of the drill etc, his fingers were bad enough.

I want to get the work done, i need to get it done, i want to smile i want to be pain free but i feel so limited

I need an extraction maybe but he says he thinks it is savable but a couple of root canals at least, one of them is a front tooth at the top that was damaged in a bike accident and has decayed, it is verging on having to come but one he says he thinks he could save...

I am debating having a general to have them all out as the only way to deal with the fear as i figure no teeth = no fear but i am only 39 do i really want false teeth?

I have been told in the uk that you can only have GA for extractions, and even if you need extractions and fillings or root canal they wont do any other work whilst under GA only extractions...is this my only option?

many many thanks

 

[Gordon]

In some areas you can have a GA for fillings as well as just extractions, but you can't have root canals.

Best thing would be to ask for a referral to a specialist in Special Care dentistry who would have the appropriate skills to help you.

 

[Camisa]

Have you inquired about "deep sedation?" It's IV sedation that is deeper than the usual conscious sedation.... they usually use a heavier sedative.... it would be done by an Anesthesiologist to monitor your level of consciousness while the dentist works on you..

 

[helenmelons]

many thanks, would special care dentistry be at my local hospital or an area dental hospital? I ask because i had an awful experience with an extremely rude dentist there, according the the hospitals websites he is actually a consultant and is still there.

I have never heard of deep sedation, i just dont know where to go or what to do, would a dental hospital be able to help me? I am on the outskirts of london would one of the london ones be able to offer gas and air and maybe help that way or offer other options?

 

[Wyrd]

I went under deep sedation, you might want to learn more about it on this site or on dental sites. It went all well

I live in Canada, so cant help you in regards of your area. But look for a dental specialist and the services they offer. If they offer sedation, they should write about the ones they used. Plus, in your area they must be like an Association of dentists or something that you may call to get names.

Good luck!

 

[Gordon]

You've never heard of deep sedation because it's a US centric expression and doesn't exist anywhere else in the world

One of the London teaching hospitals like Guys will certainly have the appropriate specialists on the staff, if you can get a referral for there.

 

[Altari]

Hi Helen!

I, too, have a very HARD TIME going along with sedatives. During my wisdom tooth removal, I was told I needed to be "resedated" because I began to come out of it much sooner than I should have. Ditto on two medical procedures I had for my gallbladder. I became combative going down and coming up.

A few things you said jumped out to me in sympathy.

tablets didnt do anything for me, (2 x 2mg) but i sat there and let him numb me up, but my legs were banging in fear and the room was boiling hot according to my man and what i felt but i was in major shock, shivering and feezing and needed to be covered

If you are panicking, local can make it worse. I found this out the hard way during my root canal on Tuesday. Everything seemed OK, I'd survived, then the local set in and I was shaking uncontrollably. From what I've been told and read, many local injections contain a form of adrenaline to make it work faster. If your dentist didn't warn you about this, he should have. Mine talked me through the false panic attack I had when the adrenaline set in. If you're prone to panic attacks, or having one from the situation, you'll be incredibly sensitive to adrenaline rushes.

he says IV sedation is pointless, because i am overweight my body will just soak up the sedation, although one time before when it didnt work i was not that overweight and 2 dentists have told me it is because i am so so so scared my body just fights it all.

What the other two dentists said. They can adjust your dosage to your weight, but if you're already panicking, your body will quickly metabolize any drugs put in. Fear isn't "all in your head." It affects every part of your body, but many "professionals" don't accept that it's a real complication and tell patients to just "wait it out."

I am debating having a general to have them all out as the only way to deal with the fear as i figure no teeth = no fear but i am only 39 do i really want false teeth?

I would highly suggest undergoing phobia therapy. There are some threads about it around the forum. I was always the type of person who would get a local injection and metabolize it in minutes. It made dental work impossible. Phobia therapy can help you understand the reasons why you're becoming frightened and equip you to mentally work through the panic. It won't necessarily go away, but it won't control your body. It sounds especially important in your case because of your experiences during childbirth.

 

[Camisa]

Helen,
It really sounds to me like your dentists are making it harder than it has to be. When I say "deep sedation" I mean employing medications which can render you more sedated than just benzodiazepines alone (Versed, Halcion, etc are benzodiazepines). Benzodiazepines can be unpredictable at times because some people have a tolerance to them. Tolerance meaning your body may not respond to them the same way someone else's does. Tolerance can be affected by your body weight and moreso affected by other medications you are on, and other reasons.

When I said deep sedation I did not mean to confuse you with "centric US" jargon.. I honestly did not know that deep sedation was only an American term, and I also assumed most people knew what it was because it is explained in detail, on the dental fear central main website, but basically if I can clarify, what I meant by deep sedation is, like I said above, a sedation which renders you more deeply sedated than conscious sedation. This is usually done with a drug called Propofol, which is actually classified as a general anesthetic but in smaller boluses (doses) or controlled infusions (like a drip) it can be used as a deep sedative which may be stronger than the benzodiazepines. In the US, Propofol must be administered by the proper professionals and should not be involved with the procedure itself, only the IV administration of drugs, it also has to be done in an equipped facility that will enable the Anesthetist to intubate you in the event that the deep sedation accidently gets too deep and tips over into the General Anesthesia category. I personally have had Propofol in small amounts administered with and without other IV sedatives and have never needed to be intubated, I was just very "deeply" sedated. It was as if I were sleeping. and I was breathing on my own.

Also in addition to Propofol and benzodiazepines, a small amount of other IV drugs with sedative properties may be administered along with the beforementioned drugs, such as Fentanyl. In the US, this is common because very little of each drug is used to produce a synergistic effect - basically meaning the small doses of each drug can produce a more controlled and relaxed state than just relying on one mega dose of of only one of the three IV drugs. For example you would need less Propofol if you also had small amounts of Fentanyl and Versed. An example would be 2mg Versed along with the small amount of other drugs. But if the other drugs were not administered, then you would probably need a higher dose of the Versed, and if your body is tolerant to benzodiazepines such as Versed, it might be a good idea to talk with your doctor about a deeper IV sedation with the use of other IV administered drugs. It's very common in the US but I don't know how things go in the UK.

I personally think dentists should broaden their horizons from use of "just" benzodiazepines for sedation because so many people react so differently to them and there is a huge amount of people who are tolerant to them because they are dependent on taking them every day for some other reason.

 

[comfortdentist]

Benzodiazopines absolutely don't work well on everyone. If you have taken any benzodiazepine drugs or drugs that act on the same receptor then versed just won't be adequate. I have used low dose ketamine in conjunction with versed and profound local anesthesia with great success for 25 years, however the state board is passing a resolution to ban the future use of ketamine.

 

[Camisa]

Ketamine - i dunno - I heard that stuff can have some nasty side effects and a big hangover. and something called "k holes" or out of body experiences. eeeek.

I prefer Propofol... but understand, that, like benzos, it's not right for everyone... e.g., someone allergic to eggs or something. I wish they would have more options than benzos which are just as mild as benzos to be taken for IV sedation procedures.

Now benzodiazepine dependence/addiction is a whole different story - talk about hellish adverse effects - this is my current situation and also why I am tolerant to benzos in my i.v. - I'm not an addict but I became dependent on them a few years ago and cold turkeyed off - got real sick - now tapering..it's been rough!

 

[helenmelons]

thank you everyone. I am going to go back and attempt to get refered to guys. I have only 1 mth left to have the work done. Does anyone know if you get refered to guys do you still have to pay for treatment or is it covered as would normal hospital surgery etc? Just wondering for when my mat cert runs out.

Talking with my partner who was with me on the day we both agree he didnt really want to treat me, he took so long and really wasnt the best for my fear despite his website boasting about being great with nervous patients. I only chose him because he said gas was available and i figured if i could have 4 babies with gas then maybe it would work for teeth. Stupid thing is i want to have it done..something takes over

 

[amandah]

Hi I am amandah, and live near Guildford. I too have awful problems here with my teeth, and now have to go into have all my back teeth out in a private hospital as I am so scared of the NHS as I cry and would rather have TLC. But there is a refferal clinic in Frimley in Surrey. As your in London why not try Guys dental hospital? The have a special care unit. I am exactly like you nothing works on me as I am fighting it as well and cant relax properly at all. Also as I gag I will not be having implants afterwards. So its soups and scambled eggs pasta etc all the way. anyway good luck and dont be rushed into anything. regards amandah