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Severely Abscessed Tooth + Bone Graft + Conscious Sedation

A

Aurora

Junior member
Joined
Dec 8, 2015
Messages
6
Hi all. I'm not happy to be here, but doing my best to cope. I have to ask this wonderful community a few questions, hopefully to ease my fear.

I'm no stranger to dental procedures or medical procedures, but am very phobic. Currently I'm going my best to buck up and get ready but I know that as the day of my procedure approaches, I will become more and more afraid.

Situation:

I've been struggling since November with an infection in my tooth and surrounding gum. The tooth (#20) had a root canal about 7 years ago. When it first started hurting, I went to my dentist, he took an X-ray, and I got some antibiotics. Seemed to go fine. Then the pain came back a couple weeks later. One more round of antibiotics. The pain stayed away for like 2 months, but earlier this week came back with a vengeance. Now my tooth and surrounding tissue are throbbing constantly. My dentist referred me to an endodontist, who told me the tooth needed to be extracted and gave me a course of clindamycin. So I went back to my regular dentist, who scheduled me in for today. However, he flat refused to give me anything except 20 mg diazepam, which just didn't work last time I had it (needed a filling). I got slightly sleepy, but was still crying and losing my crap in the dentist chair. So this morning, I was feeling afraid after reading about sepsis from pulling infected teeth and also about how locals don't always work when infections are active. I called my dentist to ask questions about this, and he basically said he didn't want to deal with me and wanted to refer me to an oral surgeon. I found an oral surgeon who I liked (recommended by a friend) and went for a consultation today. He said that my infection was quite bad and that I had a lot of bone loss in the region. He said the infection had likely been brewing for two years (!!). He said I should have a bone graft. He also said that the tooth is not likely to come out nicely. The crown will probably break during the extraction, and the tooth itself might detach from the root. This means cutting and drilling into the gum to remove the root. Given all of this, I opted for conscious sedation (midazolam and fentanyl).

But here is the thing: I am so freaking nervous still. Stupidly enough, I'm afraid of the sedation. I had it once before when I had an upper GI endoscopy. It was unpleasant. Coming out of that state just felt like a struggle. I was in and out of being aware, and could not retain a memory for any measurable amount of time. I'm told that I asked the same question every 5 minutes for like an hour. I don't enjoy having gaps in my memory. To top things off, the sedation made me feel sick to my stomach, and I am emetaphobic.

Here is what I want to know.

So about the actual procedure:

Is it even okay to do a bone graft at the same time as pulling the tooth? Will that not seal the infection in so it can't drain?

What the heck does a bone graft entail? My oral surgeon made it sound like he would just pack some material into the socket that would eventually become my bone. Is it really that simple? If this is the case, will it reduce the risk of dry socket since there is something in the socket?

About the sedation:

So... I've always wondered if I was given too high a dosage of drugs when I was sedated for my endoscopy. This doctor legitimately thought I was a drug addict (I'm not entirely sure why. I'm really not) and I feel like she may have given me too much because she thought I would need a higher dose due to my supposed being a drug addict. When I talk to other people about their sedation experiences, they don't seem to have the ugly struggle of coming out of that state. When I had it, I only remember up to where the nurse pushed about half of the syringe into my IV. It wasn't even complete, and my memory is gone up to where I was struggling to become a human being again after the procedure. And boy was I high for the rest of the day. I dropped something on the floor later and tried to pick it up and missed like 3 times. It was just intense. And the nausea. Ugh, the nausea.

Sorry for rant. Question is: Did you experience this during sedation? Does it sound like I was given too much that time? Is there anything I should tell the oral surgeon before he gives me the drugs? Like, maybe I'm sensitive and don't need as much or something like that. Was this a normal sedation experience? I don't feel like sedation is supposed to be unpleasant, and I haven't hear of anyone getting so nauseas other than myself (although I admit I have stomach problems).

My procedure is on Tuesday. I just really want to talk to some people. My face hurts and I'm afraid.
 
A

Aurora

Junior member
Joined
Dec 8, 2015
Messages
6
Hmm, maybe I posted in the wrong forum since I didn't get any responses at all.

Oh well. I'll update this just in case any other poor anxious person reads it. I had my procedure this morning. I was so scared. I was crying and literally shaking in the chair while they hooked everything up to me. The nurses were trying to have idle chat with me but my responses were lame because I was just so scared.

The IV went in (slight pinch) and then we waited for the doctor to enter the room. He did, and I asked him to please inject the drugs slowly. When I was sedated previously, they went in really fast and it felt gross. He obliged, and gave me a little bit to start with. He had refused to give me zofran because it can be cause serotonin syndrome when combined with fentanyl. Fair. I asked (okay, begged) him to give me some promethazine after the procedure (I am emetephobic) and he said okay. Then the drugs kicked in and I felt quite strange. It was mildly uncomfortable at first, but not bad. I remember saying "whoa, I feel strange". I very vaguely remember getting the numbing shots which hurt a little but wasn't a big deal. I think I very vaguely remember some stuff going on, but mostly what I remember was them pulling the IV out and saying "you're done!" and I literally said, "that's it?!". I then struggled to put my jacket on (very drugged at this point) and got walked out to the car because I was very wobbly and had no balance. At one point, I felt very mildly queasy for a few minutes, but nothing I couldn't handle. Promethazine my savior!

Drive home was uneventful. Mostly just me stuffing gauze in my mouth, soaking it in drool, replacing it, dozing off once in a while and waking up, looking at the site where the tooth came out, stuffing fresh gauze in there, and dozing off again. Then I got home, and was much more stable. I was able to walk into the house by myself and lie down in bed, where I fell asleep for a while and woke up around now.

Now that I'm fully back in control of my cognitive functions, I'm really grossed out by the hole. It's sutured, which feels gross, and I feel the gap with my tongue even when I'm not doing anything. It'll take some getting used to. Oh, and it HURTS. Not trying to freak anyone out. But before the local even started wearing off, it started hurting. Once it did wear off, the pain was significant. I drank a nutrition shake and took a couple ibuprofen, took a nap, and I feel much better now. It still hurts a little, but no biggie.

I'm so happy it's over! Next time I need it, I'm not going to be afraid of the conscious sedation. The combination of the drugs being administered slowly and giving me some IV promethazine at the end made it a perfectly okay experience to me. A breeze, really.
 
Enarete

Enarete

Super Moderator
Staff member
Joined
Sep 18, 2017
Messages
2,780
Hi Aurora, thank you for updating us! Sorry that you didn't get any responses previously. It can be hard to reply to dentistry questions as a non-dentist, especially when the issue seems very complex and technical. In such cases non-replying might seem safer than guessing or assuming without any experience or knowledge. That might have been a reason for the lack on replies.

Happy to hear that the procedure is behind you and that your fears and worries about this didn't come true. Knowing what had helped if you ever needed sedation again is also a good thing, however I really wish you not to need any complex procedure in the future.

All the best, may you recover soon and hopefully your painkillers are working diligently.
 
D

Debdeenie

Junior member
Joined
Feb 28, 2018
Messages
2
O my goodness Aurora. You’ve got me petrified! I’m scared that I have an abscess! I had a temp crown put on wk before Christmas and it hurt for a wk and a half and then stopped. Had permanent crown put on last week in January and it hurt for two wks. Dentist doesn’t know why. Had referred pain too. More confusing to dentist. Anyway without knowing I had an abscess he put me on antibiotics. (Which I do not like taking. Not good for u) my pain stopped after I was on antibiotics for a wk and few days. I’ve been off of antibiotics for a wk now. I went to a periodontitis yesterday and she did some test. They came out negative. Afraid I wasted lots of money. Wish a specialist could read this too. Would the antibiotics hinder the periodontitis test? Will I more than likely have a abscess to happen later on? I’m desperate for answers. I don’t want pain and I don’t want to take more antibiotics!
 
E

electromagnetic

Junior member
Joined
Dec 4, 2017
Messages
7
Location
UK
A dentist in the dental hospital told me to gargle with lukewarm water ( not hot ) and salt.
That helps with the pain. I had a root canal tooth removed, now with partial denture I feel tension there.:hmm:

Just use a mouthwash corsodyl.
 
Last edited:
A

Aurora

Junior member
Joined
Dec 8, 2015
Messages
6
Thanks, Enarete! I know I had some very technical questions, so I understand why I didn't get replies. It's still pretty painful and swollen, but hoping it'll be better soon!

Debdeenie, I'm not sure if you have an infection or not. I understand why you don't like taking antibiotics. I hate taking them too! They really mess up my stomach. I'm not sure what test you are referring to, but my infection was diagnosed by xray. I tried two rounds of antibiotics (cephalexin) for my infection. Both times the pain went away temporarily. It came back with a vengeance about a month after the second round, and I knew I had to see a specialist at that point. He gave me clindamycin, which really really helped. And now I'm on penicillin to make sure the extraction site doesn't get infected. So in my case, I needed a lot of antibiotics. Looking back, I could have avoided taking so many if I had gone to the endodontist right away and had the procedure done sooner. I'm not a dentist, so I don't think I can give you advice on that.

Electromagnet, my oral surgeon told me to do that too. I haven't yet because I'm scared to spit in case of dry socket. But I'm going to try it tonight.
 
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