Stuck between a rock and a hard place

S

Sawaway

Junior member
Joined
Apr 27, 2021
Messages
3
Hey there,

I have Ehler's Danlos Syndrome hypermobility type, which means I have trouble getting numb and my jaw is EXTREMELY unstable and I experience frequent subluxations. The subluxations, if extreme, cause me to nearly lose consciousness because of anxiety associated with them.

So...I started out having a filling that needed to be replaced in my far back tooth. My dentist tried at two different appointments to get me numb to no avail. I waited because of the pandemic to see another dentist and now the tooth needs to be pulled (a bit of a long story, but not relevant to the problem).

Mind you, every visit to the dentist causes high anxiety because of my jaw issue! MAJOR guarding, inability to open wide or for a long periods. It helps to be not tilted back too much, but dentists don't like when I request that accommodation.

Sedation/general anesthesia is a not really a viable possibility because I need to be very attentive to my jaw and maintain some muscle tension to prevent subluxations and possible dislocation (God forbid!). Can't imagine what would happen otherwise!

What do I do? I JUST HAVE to be able to get numb! But even if that works out, how do I tolerate the tugging and wide opening I'll have to do for the extraction? How will it not seriously damage my delicate jaw? Is there an instrument they can use or some way to do the extraction that would require less tugging and require my mouth not to have to open so wide and for so long? I'm plagued with anxiety to the point that I feel like avoiding the whole scene!

Any advice?!

Thanks in advance!
 
Gordon

Gordon

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Oct 25, 2005
Messages
7,210
I'd be looking at topping up the conventional local anaesthetic with something like a Wand doing intraligamental. Then section the tooth into smaller pieces before removing it. That should avoid most of the force needed for the extraction and should be more doable without your jaw being open too wide, but it will take a bit longer, so you'll need to make sure they schedule extra time to let you rest up for a bit between stages.

Nitrous oxide would help, the muscle relaxing properties would be useful and so would the slight anaesthetic effect.

In future I'd be making sure you have a high level of fluoride, use a high fluoride toothpaste if you can get one there such as Duraphat and use fluoride tablets, you really want to make sure you don't have to do this again :) There's a good section here on avoiding dental decay...
 
letsconnect

letsconnect

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Here’s the link to the page that Gordon mentioned:

 
S

Sawaway

Junior member
Joined
Apr 27, 2021
Messages
3
I'd be looking at topping up the conventional local anaesthetic with something like a Wand doing intraligamental. Then section the tooth into smaller pieces before removing it. That should avoid most of the force needed for the extraction and should be more doable without your jaw being open too wide, but it will take a bit longer, so you'll need to make sure they schedule extra time to let you rest up for a bit between stages.

Nitrous oxide would help, the muscle relaxing properties would be useful and so would the slight anaesthetic effect.

In future I'd be making sure you have a high level of fluoride, use a high fluoride toothpaste if you can get one there such as Duraphat and use fluoride tablets, you really want to make sure you don't have to do this again :) There's a good section here on avoiding dental decay...
Wow! I really appreciate the quick, thoughtful, and thorough response! THANK YOU!! Unfortunately, i think the wand did not work when trying to address the problem earlier. Is sectioning the tooth the same as a coronectomy? I also have a nerve that's close to the root, apparently. So sounds good to reduce force and protect the jaw, but sends my anxiety levels up thinking about breaking the tooth up!!! Haven't seen the oral surgeon yet, but just so nervous about what's to come... Thanks again for the info which helps me prepare mentally for all this.
 
Gordon

Gordon

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You'd not be using the Wand as the primary anaesthetic, just a secondary top up. It's a bit tricky to use for the main local in my experience.

No, sectioning is different from a coronectomy. In the latter you're basically slicing the top off and leaving the roots. This is a good strategy if the roots are very close to the nerve. In both cases the sensation for the patient is pretty much the same as getting a filling, I've had sectioning done :)
 
S

Sawaway

Junior member
Joined
Apr 27, 2021
Messages
3
Thank you so much! The wand was used after trying lots of injections that didn't work -- all in the same visit! Well, I'll just cross my fingers something will get me numb and try not to have a panic attack before and during the procedure. I am hoping the surgeon will recommend a coronectomy or sectioning or whatever will be less likely to exacerbate the jaw issue. I will let the forum know the outcome. Thanks again!
 
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