Severe anxiety and gag reflex, tooth implant

[johnnycash]

Hi everyone.

So my situation is I've got alot of dental work to be done, I'm currently penciled in for general anaesthetic for the dental work, it included about 8 fillings, 4 teeth removed(3 wisdom teeth and 1 on the front.

However, 1 of the teeth at the front(central incisor) has to be removed. The dentist doing the work has said he thinks there's only a 30% chance he can save the tooth, and won't be able to know for sure until the day with further x rays and chipping away of the tooth.

This tooth removal has really set off my anxiety, and I've really been struggling, mainly because I have such anxiety and bad gag reflex that I'm terrified of not being able to get the tooth replaced. It's really set me off with major panic. Normally conscious sedation would be offered and I've had that in the past as a child, however I'm 25 stone in weight and been told that means I'm not eligible for conscious sedation.

I've been told the most obvious solution to the missing tooth would be a bridge, but that requires a near impossible to do teeth impression. It also may require the neighbouring 2 teeth to be affected, possibly causing bigger problems long term. The issue of having the work done itself is also a hurdle, as i believe it would take 2 appointments to be completed, and this being done on the NHS may not be possible under GA.

The other option is a tooth implant. I'm happy to pay for it, and long term its probably the best solution. but the work itself is again the main issue. My gag reflex and anxiety may make work almost impossible despite it being a front tooth.

So I really could do with some advice on how best to deal with this. Any help or advice would be appreciated.

 

[MountainMama]

Not a dentist, but I recently had my front central incisor removed under local and nitrous oxide. I also had extensive bone grafting and a bone wrap. An implant was put in at the time of surgery, so there was only one surgery. Maybe yours can be the same way, so there are not multiple surgeries? I have really bad anxiety as well, and can't afford GA, so I get nitrous to help with anxiety. I have also taken an oral sedative when nitrous was not available.

The impressions are awful...there is no way around that. I saw on here that someone mentioned that there are digital impressions available in some places. Maybe one of the dentists can help with that question.

 

[Gordon]

Your weight wouldn't prevent you having inhalation sedation, which also handily reduces the gag reflex, so that would seem to be the best way forward in the short term.
Another help would be to ask your GP for a referral for NLP or CBT sessions which also are a big help.

There's no way you can get a bridge prep and fit done under GA, at least in the UK, it would breach most of our guidelines, you're already a bigger risk than normal due to your size.

 

[johnnycash]

Your weight wouldn't prevent you having inhalation sedation, which also handily reduces the gag reflex, so that would seem to be the best way forward in the short term.
Another help would be to ask your GP for a referral for NLP or CBT sessions which also are a big help.

There's no way you can get a bridge prep and fit done under GA, at least in the UK, it would breach most of our guidelines, you're already a bigger risk than normal due to your size.

In regards to a tooth implant, would that be something that would be possible under GA privately instead?

In honesty I'm probably going to have to attempt to have it done and hope for the best, considering it's a front tooth I can't ask for an easier tooth, but my fear is half way through the procedure being unable to continue, or the dentist needing to use any tools that may make me gag(a dental dam perhaps)

 

[Gordon]

Nope. You can't easily get a dental GA done privately in the UK. The rules regarding acute recovery facilities rule out most private hospitals.
Dental dam quite often reduces gagging, paradoxically, it removes things from the potential "trigger zones".

 

[krlovesherkids777]

Johnnycash

As far as tooth implant. the actual implant procedure , I've had 2 of them, has been one of the least gaggy procedures I"ve had.. of course there is the impressions when it gets to that point, but now adays alot of offices to the digital impressions when they can and I've heard that is less gaggy than the impression good. I'm a gagger too. and have had awful luck usually with impressions.. I do concur with Gordon that the dental dam actually makes things easier and less gaggy somehow and I feel safer like nothing is going to drop down with that safety net implace.. .
HOpe you can figure out a good option. A good dentist who listens and cares to make you comfortable no matter what procedure will be a great factor too!

 

[johnnycash]

Johnnycash

As far as tooth implant. the actual implant procedure , I've had 2 of them, has been one of the least gaggy procedures I"ve had.. of course there is the impressions when it gets to that point, but now adays alot of offices to the digital impressions when they can and I've heard that is less gaggy than the impression good. I'm a gagger too. and have had awful luck usually with impressions.. I do concur with Gordon that the dental dam actually makes things easier and less gaggy somehow and I feel safer like nothing is going to drop down with that safety net implace.. .
HOpe you can figure out a good option. A good dentist who listens and cares to make you comfortable no matter what procedure will be a great factor too!

Did you have to use a dental dam for the implants? Much of the gag reflex is touch based, and as its a front tooth I should hopefully get away with minimal touching or hands inside the mouth, but I'm unsure of the equipment needed etc.

How long did the implant take to plant? I'm just hoping the dentist is extremely patient and allow a good few mins to settle any gagging issues, as once they start it's a slippery slope!

 

[krlovesherkids777]

Johnnycash,

I have not had a dental dam specifically for an implant. There were no parts where it was needed. Any dental dams I've had were for root canals, I have had a few on front teeth though... and back..

I really get the hands inside mouth thing being gaggy.. and I know it may sound strange, but I'm thankful that both my dentists previous and current have very small hands and thats not much of an issue party due to that they can move around in and out with out it being too gaggy.

The implant didn't take too long to plant. that part itself just a few minutes. My current dentist took a bit longer than the first being extra careful and meticulous on the placement, is mostly preparing the area and then stitching it up . But it really wasn't bad at all. I would do it all over again. I think you are very right that a patient dentist is extremely important , one that wants to make sure you are comfortable and is very careful with their work and balancing the two.

 

[Gordon]

Have you read our page on gagging here? https://www.dentalfearcentral.org/fears/gagging/

 

[MountainMama]

Did you have to use a dental dam for the implants? Much of the gag reflex is touch based, and as its a front tooth I should hopefully get away with minimal touching or hands inside the mouth, but I'm unsure of the equipment needed etc.

How long did the implant take to plant? I'm just hoping the dentist is extremely patient and allow a good few mins to settle any gagging issues, as once they start it's a slippery slope!

When I had my front tooth extraction and implant, there was no dental dam, nor were the oral surgeon's hands deep in my mouth. It did not trigger my gag reflex. The implant itself only took a few minutes. Then it took about five to six more minutes for the stitches.

 

[comfortdentist]

MountainMama story is typical. However I have had a few patients that you couldn't touch their mouths without triggering a gag reflex and a really strong one at that!

 

[johnnycash]

Johnnycash,

I have not had a dental dam specifically for an implant. There were no parts where it was needed. Any dental dams I've had were for root canals, I have had a few on front teeth though... and back..

I really get the hands inside mouth thing being gaggy.. and I know it may sound strange, but I'm thankful that both my dentists previous and current have very small hands and thats not much of an issue party due to that they can move around in and out with out it being too gaggy.

The implant didn't take too long to plant. that part itself just a few minutes. My current dentist took a bit longer than the first being extra careful and meticulous on the placement, is mostly preparing the area and then stitching it up . But it really wasn't bad at all. I would do it all over again. I think you are very right that a patient dentist is extremely important , one that wants to make sure you are comfortable and is very careful with their work and balancing the two.

Can you tell me a rough time line of the whole process? The procedure for time to finish? I'm mainly worried about the time it takes to open the gum, drill the hole, etc. The parts I'm almost certain to need to try and not gag(to not cause a mistake etc)

 

[johnnycash]

I just want to say to all the kind people who are commenting on here, thanks so much, anxiety for me is half the battle and having more information about the process and everything else really does help.

Im normally a "respond immediately" kind of guy, but with this I'm trying to check only occasionally as I don't want to over think it, as it usually ends up in a long Google session. It's best I take it slow and not be too focused on it, but the replies are absolutely helpful, and I can't thank you guys enough ?

 

[johnnycash]

Bump

Can anyone tell me a time line of their implant? How long did it take to fit the screw into your jaw? Is it quick of rather straightforward

 

[MountainMama]

The implant screw itself is very quick. It just takes a few seconds. It takes a little longer than that for the whole process, since they open the gums and have to stitch them up after. It is still quick and straightforward for a regular implant. Both of my molar implants were quick, even with one having to have bone grafting at the time of implant placement. My front tooth took longer, but it was mostly the cleaning out of infection that took the longest. My oral surgeon talks me through it, so when he said he was getting ready to do the implant, it felt like less than a minute from when he said he was putting it in to when he was starting the stitches.

 

[johnnycash]

The implant screw itself is very quick. It just takes a few seconds. It takes a little longer than that for the whole process, since they open the gums and have to stitch them up after. It is still quick and straightforward for a regular implant. Both of my molar implants were quick, even with one having to have bone grafting at the time of implant placement. My front tooth took longer, but it was mostly the cleaning out of infection that took the longest. My oral surgeon talks me through it, so when he said he was getting ready to do the implant, it felt like less than a minute from when he said he was putting it in to when he was starting the stitches.

Because of my gag reflex, I'm curious as to what the actual physical work time was, I'm gonna really struggle if I can't close my mouth or have a sip of water for long periods of time.

In truth I'm terrified of it becoming a nightmare

 

[MountainMama]

Because of my gag reflex, I'm curious as to what the actual physical work time was, I'm gonna really struggle if I can't close my mouth or have a sip of water for long periods of time.

In truth I'm terrified of it becoming a nightmare

It won't become a nightmare. It is really easy to worry about that (believe me, I did my share with mine), but in reality, it will be over way more quickly than you think. Afterwards, you will be thinking, "It's over?"

If you get the implant at the time of extraction, with bone grafting, like I did, it will be a little longer. If you get the tooth extracted, then get the implant done separately, it will be very quick. All surgeons and dentists work at different speeds, so I can't give you exact, but here is what mine was.
I had two surgeries scheduled together...front tooth extraction/grafting/clean out infection/implant, and an imolant put in on a lower molar, with bone grafting and shaving down a bone defect, with creating a gum flap. Total appointment time was one hour and twenty minutes. About a half hour of that time was getting prepped, getting shots and then waiting for them to take effect, and setting up nitrous oxide.

I was a little fuzzy from the nitrous, but I remember when my surgeon told me he was starting on the top tooth, and then it felt like only five minutes or so before he said he was putting in the implant. That only took a few seconds. Then he stitched me up. In between steps, he would step back and I had a moment to breathe and move/close my mouth.

I would bet that if you explained to the person doing the surgery that you need to rest your jaw (close mouth) periodically, they would accommodate you. Establish a stop signal, like raising your hand, so you can let them know.

 

[Birmanclaws]

I have two top front teeth implant, done at separate times. The longest part of the process was the application of the local anaesthetic, as the periodontist had a very good and slow technique which rendered the whole process painless.

The actual implant process, exposing the bone, drilling the implant, and suturing after was probably between 5 to 10 minutes.

There was no dental dam and no hands inside my mouth. Honestly, it was one of the easier dental procedures I have had.

 

[krlovesherkids777]

Johnnycash,

I have to acress with Birmanclaws in that it probably is one of the easiest procedures I've had as fell both during and after not too bad.. I say this getting ready for 5 bottom implants soon. I've already wrote a bit earlier but just had to agree with Birmanclaws and the rest.. its a very straightforward procedure .

 

[johnnycash]

Phew. This is sounding easier. I had a very out of character anxiety and panic attack when I was told the tooth would have to come out, and an implant is pretty much my only option to fix it.

Im going to have to go the expensive route, gas, digital print of my teeth, and the implant itself, but it's becoming more realistic and less scary the more I hear so thanks guys! 10minutes is possible as it's a front tooth, and with quite regular breaks I can no doubt push through it.

I suppose the worst that can happen is I vomit. Hopefully not causing any damage along the way.