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IV with oral premedication

G

Guest

Former Member
Hello all. I will be getting 11 teeth pulled, the remaining teeth laser cleaned, then temp partials, and eventually in time, bridged replacements.

The one concern I have with this procedure is the combination of Oral Sedation (Halcion 0.50) then IV Sedation (Versed and Fentanyl). I have been trying to research cases of both methods being used, and cannot find any cases of both methods being used at once.

To be honest, this scares me a bit as I feel this might be overdone here in my case as I have a slight dental phobia, but hardly a huge Phobia issue. My issues are mainly general anxiety, which I am sure most people have at varying degrees.

I have more of an issue with being over sedated and having my body over drugged to be honest.

Anyways, is there anyone here who has this sedation procedure as I describe?

Or, are there any Dentists here that are willing to chime in for an opinion here?

Would be greatly appreciated, thanks;


[UK dentists, FYI - Versed = midazolam]
 
Have you told your dentist of your concern and if so what did (s)he say?

It's really hard to comment without knowing you or seeing how complex/difficult the treatment is likely to be.

I've used oral sedation with IV in the past, sometimes it's necessary just to get the patient in the front door :)
There's no particular problem with mixing the two.
 
Thanks for your answer;

Yes I was there today to get the fitting mold for my temp partials. He showed me the machine hookups they have, the monitors, heart rate. Explained to me that the IV is basically for the pain relief/dream type state so that we can get the work done in this one visit.

The work is somewhat complex having to pull 11 teeth and laser clean as well and fit the partials in all in the same visit. Itmight be best for both the patient and dentist. I am really not that afraid of the work per say but to be honest, Id rather be out of it to a degree.

I suppose my concern is to the safety side but it appears to me, even a person with a heart condition, iv with oral sedation looks plenty safe as I cannot find any known cases of anyone ever having anything really go badly wrong.

So I take it you woujld say this is a rather safe procedure as well correct?

Thanks for your response;
Scott
 
What I'd say is this: it's safe (because a reversal agent can easily be given once you get the IV, and 0.5 halcion is a safe dose), but if you feel you don't need oral sedation, discuss not taking it with your dentist beforehand. It's your decision, not your dentist's. If on the other hand you think the oral sedation would help you, take it.

I don't see any point in taking oral sedation if you don't think it's necessary for pre-appointment nerves, but if you feel it would help, it's not dangerous.
 
My concern really is that I really do need the IV Sedation?

I dont mind just being numbed up and slightly sedated, what Id mind and am concerned is potentional respitory and possible allergic reactions to the combo of an opiate and 2 seperate benzos, I am not terrified of the dentist, i have normal fears like anyone else. I ma losing sleep over the greater fear of having something going wrong under iv sedation.

So The Oral Sedation is good enuff for me. I am concerned I am being pressured, whether real or imagined, into receiving IV SEDATION.. why?

we are talking 11 teeth to be pulled. I have Perio so The teeth are not exactly deep in the bone because there is not a ton of bone left. most are loose ,and hell, i could pull them if i really tried.

I have had teeth pulled before, I was never hurt by it, The needle dont really bug me, sure it hurts so what? I am not afraid of needles.

My point is really this. My understanding is that IV sedation is for people who basically cannot cope with a dentist, I can so why do i need to take a combo of something that is potentionally DANGEROUS, when it is not needed?

Now if I had to undergo a serious operation, sure Id take GA and I would be afraid, but because it would be necassary, I would do it.

I mean I have read that Oral Sedation if enuff, that even with Oral, people basically forget allot of the procedures.

I am more stressed, way more stressed about iv sedation mixing benzos with opiates.

Also i am a former drug abuser,(coke, crack, 4 years clean) these days I am just flat out weary about putting ANY drugs into my body.

I am just trying to find out a way to communicate this to my dentist the right way.

with my prior drug use to be honest, im am flat out afraid of DYING FROM MORE DRUGS, dosing off here and not waking up.all for a procedure where RTHIS IS NOT NEEDED.

I dont mean to sound like a baby, but am I relating my issues ok here?

Thanks for your time;
Scott
 
Hi Scott,

can you phone/write/speak to your dentist and tell him that you'd prefer the treatment to be done without IV sedation - and then see what he says?

The dentist may just not know you very well. In which case he may just work on the assumption that a lot of people want to be "out of it", and that you would want that as well.

About 5 years ago, I had three implants placed. My dentist at the time also said she'd use oral sedation combined with IV sedation (just assuming I'd like that).

However, when I explained that I definitely didn't like IV sedation and didn't want it, she had no problem with that.

The oral sedation (one pill as I left home to go to the dentist) was enough for me (but my body isn't used to mind altering substances in any form). I remember very little from the procedure - so little in fact that until about 18 months ago when I saw a panoramic x-ray of my mouth, I thought I only had two implants; I'd forgotten about the 3rd one.

Anyway, I've rambled on a bit. My point is: talk to your dentist about it; don't just go along with it.

G.
 
Here is what they wrote back;

Hello Scott,

"Because of its safety and effectiveness reasons, DR Gonzales does not perform only oral sedation. Due to your height and weight and the fact that you were a heavy drug user in the past, Halcion alone will not be enough to sedate you. We have treated many patients with heart related issues and have never had any problems. In fact, by only using Halcion we are not able to control your heart rate. For example, Halcion lowers your heart rate, if your heart rate was to go too low and you did not have an IV, we would not be able to give to the medication you would need to boost your heart rate to a safe level. Also, the other medication with give you through IV help alleviate swelling, discomfort and nausea after the procedure. There are Drs. out there who do only oral sedation and who have not attended the many courses DR Gonzales has to perform IV sedation, if you would feel more comfortable having only the oral sedation, please let me know and I will get you a consultation set up with one of them. Thanks!"

any opinions anyone? Thanks;

Scott
 
The situation is like this: if you go with oral sedation only, you run the risk that it won't do anything for you at a safe dose - no sedation, no memory loss for the procedure. With IV sedation, it is a lot easier to achieve the desired level of sedation, and a reversal level can be readily given.

It is rumoured that some dentists who use Halcion oral sedation will give doses that are dangerous and may have you tip over into general anaesthesia. This is especially true where titration (giving incremental doses) is concerned. IV sedation is the safest choice. The letter is correct on that score.

Regarding the fentanyl though - I don't think it's a great idea. What age is the dentist?

So - if you don't mind that oral sedation might have no effect, and the extractions are very straightforward and easy, you could go with that option (or local anaesthesia alone).

More generally, I would say that if you can't relate to Dr Gonzales, I might consider changing dentists. From your description, it sounds like he's not willing to discuss the pros and cons of various options. How do you find him as a person?
 
I'd say the dentist is in his mid 50's. I would say he is ok pretty much. I mean with my problems, pulling the bad teeth are probably the best option. I've seen the ex-rays. Even my teeth that really are not that loose, one can see the bone under it is below the root, which he informed me those teeth could last for a few years, but eventually because of the bone loss that has gone below the root, they will have to come out eventually.

Concerning fentanyl, why do you think its a bad idea?, because of the mixing of this opiate with the Benzos?

My game plan is to eventaully get bridges attached to the healthy teeth, which will be about, heh, 5 in front lower and 7 in the front upper.

then bridged implants rather than single crowns per implant which would cost most likely well over 50 grand. I suppose I can deal with the IV sedation. My main concern is safety here, which perhaps I am over reacting. I do not have any known heart issues, but I might re do my procedure appointment if my blood work has not come back before my appointment which is next thursday.

I suppose I can dump the Oral Sedation or perhaps request a lower dose. It is just the mixing of all the stuff togetherthat scares me.
thanks for your answers, I appreciate it;

Scott
 
The reasons why I said I wasn't too keen on fentanyl:

(1) because of your history, and it feels to me like you're worried about taking an opiate (understandably so);

(2) because the trend at present is towards using only one agent (usually midazolam) - to the best of my knowledge, that's what the "experts in the field" recommend nowadays. But older dentists trained in IV sedation were taught to use combos, esp. in the US.

Personally, I feel - taking into account what you've mentioned and the fact that you'd like some sort of sedation - the best idea might be IV midazolam on its own. Maybe discuss this option with your dentist?
 
Ya.. There is no dicussion here with this dentist. He does what He does, and I might have to lose a bit of money if i decide to switch. Personally, I'm not happy into being "forced into something"

I already tried to request only Oral Sedation, you can see that was denied. I feel it would almost be pointless to attempt to request less Iv Sedation.

Just allot of anxiety here to be honest. On one hand, the idea of getting this all done in one visit is appealing; On the other, I have a greater fear of being "under" than of the actaul procedure. I have had teeth pulled before, it's no big deal once they get you numb, heck, they could pull all my teeth with me being fully awake and it would not upset me emotionally all that much.

So I'd say I have slight dental anxiety like anyone else and MAJOR FEAR OF DEATH PHOBIA.

Yes I do not feel this dentist cares about my concerns at all to be honest.

Since I have already paid upfront and they might have made the partial temps already.

I might be in a world of money loss.

I went to another dentist a few months ago and almost had a similar procedure done, but did not go thru with it because the dentist, while a cool guy (Iranian)wanted to first do a scaling cleaning, then afterwards determine which teeth where to be pulled. I felt he should know this my looking at the x-ray. However looking back, I might have been a bit hasty

However, this guy was not trying to force me into anything and I actaully personally liked him as we did some personal talking so to speak. I do not beleive he uses sedation iv at all or oral, which personally I do not need.

Also he said that 8 teeth looked pretty much gone, not 11 and said after cleaning he could get a better idea. I would like a dentist here to chime in if possible to give an opinion on whether or not that was an honest evaluation.. Thanks;

Scott
 
I went to another dentist a few months ago and almost had a similar procedure done, but did not go thru with it because the dentist, while a cool guy (Iranian)wanted to first do a scaling cleaning, then afterwards determine which teeth where to be pulled. I felt he should know this my looking at the x-ray. However looking back, I might have been a bit hasty

However, this guy was not trying to force me into anything and I actaully personally liked him as we did some personal talking so to speak. I do not beleive he uses sedation iv at all or oral, which personally I do not need.

Also he said that 8 teeth looked pretty much gone, not 11 and said after cleaning he could get a better idea. I would like a dentist here to chime in if possible to give an opinion on whether or not that was an honest evaluation.

If you ask 3 different dentists you'll probably get 5 different treatment plans :) dentistry isn't an exact science.
It seems odd that Dr Gonzales is being so inflexible about your treatment plan, I think your best route here would be to arrange a one to one consult with him and discuss your concerns. Perhaps writing yourself down a list of questions for him as an aide memoire would be a good idea.
After that you should have a better idea of what you want to do next.

Sorry not to be more helpful.
 
Thanks for your advice Gordon;

I cancelled the procedure. There were other things that happened that just indicated to me that this guy was not the right Dentist for me. When I went to get the mold for my partials, I told the assistant beforehand that my back molars have their roots exposed, and to be careful about the mold being too cold.

She said "Do not worry it will be fine" Well she stuck it up in there and I went flying thru the roof, and she continued to keep it in there, My legs were flying away, in horrendus pain, I almost hit her.

The Dentist came over, no apology, nothing. That was my final "sign" to back out of this. I should of walked out right then. I am an agreeable person so I was cool about it but at home, this incident bugged me.

I doubt they made the temp partial already since it has been only a day and if they did, I will pay for it and take it somewhere else.

I fully understand Dentists are in Business to make money, I do not begrudge them for it.

But when a Dentist simply does not give a krap about a patient at all, and I can clearly saee this guy does not, time to look elsewhere.

Nitros would be just fine with me along with a local. I have had teeth pulled before, it is no big deal, I did not feel a thing.

As well on their intro CD, they claim to offer other sedation, like Nitros, but I was told "The doctor only give that to severly ill and children.. Then why advertise it? This guy want to do what is only good for him and not me.

So I guess he does not care he lost about 5 grand this time, and int the future probably 50k in future dental work. I will give my Business to someone else who will actaully work with me for it.

That's how I have to look at it, because it is more than just a business, and I firmly beleive a good dentist should be rewarded financially, if he/she is good and CARES ABOUT THEIR PATIENTS, rather only their moneyand just "another mouth"

I'd take that attitude if I was only getting minor work done. I need a dentist to fully understand this is a huge deal for me, not just financially but emotionally as well.

That is how I see it. Thanks everyone for all your help, I will report back here when I find the right dentist.

Scott
 
I think you made the right decision (nitrous for the severely ill and children only?? Gimme a break... :rolleyes:)

I absolutely agree with your take on the dentist-patient relationship.

Best of luck with your dentist search :thumbsup: !!
 
Attn Gordon, Nitrous, can it be used for

Can nitrous be used for procedures with multiple tooth extractions?
I might need up to 11 teeth extracted, and I was wondering, since it is said here you have a great deal of experience with it, if a combo of nitrous and a local can be used in my case here. I did find one dentist where I live locally who offers it but before I go in for a consult, I'd like to know it what I ask is doable. As you know from my other post, I just do not want to be IV Sedated.

I have had years ago n20 applied in a procedure and I actaully liked it. Also when I was a kid we used to have "whip its" that we sucked on before.

The effects of n20 seem to put me in a state of "I have no idea what the hell is going on" but still kind of knowing what was going on, but just in a kind of silly hi.

Thanks for your response in advance;

Scott
 
Yes that's possible. Most patients would want something a bit "stronger" than N2O for that many extractions, but I'd be happy to use it if the patient wanted it.
 
Stronger as in?

I guess I meant n20 with a local. what do you mean by "stronger"?

Thanks;

Scott
 
I think what Gordon meant was that the phobic patients he gets to work with as a community dentist (see explanation below) usually want something that makes them less aware of their surroundings than nitrous oxide could, for multiple extractions. With IV sedation, a deeper level of sedation can be achieved compared to nitrous. As far as I'm aware, multiple extractions with local only are by no means unusual where non-fearful patients are concerned, especially where the extractions are not anticipated to be difficult.

(The community dental service (CDS) in the UK provides care for adults and children with special needs and phobic patients, who are not able to see a General Dental Practitioner due to extreme fear.)
 
Anyone ever have 10 or more teeth pulled

Anyone ever have 10 or more teeth pulled at once using a local anathesia? meaning a caine only?

do dentists do this at all anymore?
 
Depends on where the teeth are in the mouth and how many would be left, but I've certainly removed more than 10 at once with LA alone.
 

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