Suppressing the wince / is sedation necessary?

[maxwellc]

Hi all, apologies if you feel this message shouldn't be on this board, I just thought some people might have had experience with requiring sedation here.

A bit of my far back right tooth broke off after a punch to the face years ago, only a little fell out and it wasn't causing me any difficulty so I left it. This was about 6 years ago. A couple of times over the years it got a bit sore, I brushed it and the gums bled a little, but both times the next morning it was fine.

About 6 months ago I was eating a granary baguette and the tooth broke. Around this time I noticed that the tooth smelled pretty bad. Therefore I thought I'd better see the dentist. This was probably the first time I'd been in 7-8 years. She thought she might be able to put
a filling in that one, and I needed another filling.

I had orthodontic treatment (I had them off around the same time I last went to the dentist) and the retaining wire on the inside of my bottom teeth is still there. There was quite a lot of build up on this, so I visited the hygenist who scraped off 7-8 years worth of the build up. It was uncomfortable and there was quite a bit of blood, but my teeth felt good.

Anyway, I went to have my fillings done. She gave me injections and started on my broken tooth, but soon saw that the decay went under the gum line and just put a temporary filling in there. She said I could either have it out or they could attempt root canal.
For the other filling, she started drilling, and it felt pretty sharp. Sometimes she'd be drilling and I wouldn't feel a thing, sometimes it would be sharp. So I relaxed as best I could and thought of other things, but she'd still sometimes hit a sharp bit and make me wince. I was trying hard to ignore it so sometimes I'd just blink or squint a little and she'd back off. She turned the water off which seemed to help at first, but then it'd hurt again.

She said the anaesthetic wouldn't prevent it being sensitive. I don't really understand what she meant by this. It wasn't really bad pain but it was a nasty feeling. She kept saying if I couldn't cope with the pain she'd have to refer me to someone for sedation. I said I was OK to continue. She said to raise my hand if it hurt, but I wanted her to just do it. In the end she said she could see I wasn't comfortable, and that made her uncomfortable, so she was going to refer me to a community dentist for the filling and extraction under sedation.

I'm not a great fan of dental treatment but I didn't go there feeling anxious. I've had two teeth out under local anaesthetic before and it was fine. I admit I was quite tense, but I did relax myself when it started causing me discomfort.

Although having my teeth crushed is probably my Room 101, I didn't think I had a problem with dental treatment, and I didn't think I had a low pain threshold either. Am I a bad patient, because that's how I felt? Are you supposed to suppress the wince?

 

[brit]

Hi Maxwell


I have good news: no, there shouldn't be any need to wince at all if you have been properly anaesthetised.

Fear of Painful Dental Treatment

Do you avoid the dentist because you are afraid of pain? Find out how dental treatment can be made painless.

www.dentalfearcentral.org

The bad news: there are still a few dentists out there who don't give patient comfort during treatment a high priority.

To say local aneasthetic will not remove sensitivity is complete nonsense, she is not very good at local anaesthetic technique and you need a new dentist rather than sedation i.m.h.o.

Can't Get Numb

Find out why you may not get numb enough, what dentists can do to get you numb, and how to ensure your treatment is painless.

www.dentalfearcentral.org

There is no need to have a high pain threshold to have dental work done with just local anaesthetic. Guess what many dentists can give dental injections without making you wince too.

Painful Injections and Needle Phobia

Are you terrified of dental injections? Find out why shots may be painful, how to make them comfortable, and what to do if you have needle phobia.

www.dentalfearcentral.org

If your tooth were infected, that is still no reason to not get you properly numb, even if it meant your taking some antibiotics first. Not all dentists are familiar with the advanced local anaesthetic techniques to get 'hot' teeth numb.

I have had a lot of dental treatment over the last few years and none of it has been painful. In fact my dentist makes a point of saying that it is not supposed to hurt so if anything does to let him know.
Was she a newly-qualified dentist by any chance?
You are not a bad patient, she may well be a bad dentist however.

 

[TimidLady]

In the last few years I have had root canals under local, including ones with infections, on an emergency basis. I have recently had a broken tooth which could not be saved extracted under local, and I have had an implant post put in my jaw. All without pain. When possible when there is an infection antibiotics should be started before the tooth is treated. Around here the common thing is to give the patient 2 antibiotic pills before any surgery like root canal or extraction even if there is not an active infection, as a preventative measure.

Did she cold test these teeth? Was there a pulp exposure when she was trying to fill the one tooth?

If you are not having much pain at the moment, you have enough time to get a second opinion. It sounds like you did not have a good experience with this dentist, so you might not want her to be the one referring you to someone else if you have a choice.

Please do not endure unnecessary pain. You do not have to be tough at the dentist. The more you suffer at the dentist, the harder it is to go back. Been there.

It sounds like you'd rather not be sedated. If you've had teeth out under local before, you should be able to do this under local if you wish. I don't know what went wrong during your appointment, but whatever it was, it clearly wasn't anything you did.

Some people here have various reasons we prefer not to be sedated. There are other posters here who need to be sedated for root canals and extractions because it's the only way they're going to get into that chair. Nothing you've said in your post makes me think you absolutely need to be sedated. Many people prefer to be sedated and remember nothing, and that's fine, but if you're not one of them, that's fine too. Don't be afraid to say you'd rather not be sedated if that is the case. It is quite common to do both those procedures under local *without* pain. By the way, the extraction of my broken tooth took about 10 minutes. Root canals took longer but it's worth it to save a tooth if it can be saved. You can get many years of use out of a tooth with a root canal.

 

[maxwellc]

Thank you - both of you - for your compassionate responses.

I did not have any cold testing as far as I know; she did poke around with a scraper-type tool which still caused a sharp feeling in certain places. There was not pulp exposure as far as I know - on the x-ray, the decay did not appear to go down to the pulp. On the broken tooth, she said the decay went below the gum line and after a little drilling she put a temporary filling on and stopped work on that one.

The injections weren't pleasant but were relatively minor compared to the drill. The thing is, my mouth felt completely numb! And my lip felt fairly numb too. She asked me what was numb, so I expect she was going off this. She was quite good with asking me about the pain, and she said she could use more anaesthetic but it would just be numb for longer.

I have nothing against sedation and I can certainly see the appeal of it. I can see how bad dentistry experiences could lead to considerable anxiety, and how sedation could be a wonderful option to avoid all that trauma. It's just that, while I don't like visiting the dentist, I've had good experiences in the past, so I feel that sedation may just be an unnecessary expense!

I am not in any pain at the moment; so I will now look for a second opinion and seek out my root canal options. brit, TimidLady, you may have just saved me a tooth!

I'd just like to add that I'm glad this site exists. It looks like a really valuable support network; I can imagine it's provided comfort for a lot of people.

 

[brit]

The thing is, my mouth felt completely numb! And my lip felt fairly numb too. She asked me what was numb, so I expect she was going off this. She was quite good with asking me about the pain, and she said she could use more anaesthetic but it would just be numb for longer.

So why didn't she top you up rather than suggest you should endure pain or be sedated? Just because it feels numb, doesn't mean it absolutely is. Some dentists also test gently with an
explorer before starting to drill and ask if you feel anything sharp, then stop once they have started drilling to ensure you are still painfree....numbing is an art and a science and just because a dose of LA has been given does not mean the patient is sufficiently numb.
There are also different LA types, some stronger than others eg articaine rather than lidocaine.

If you were avoiding another injection because of the potential pain of that - that is the reason why a dentist who gives the local comfortably is an excellent choice, since you never have to do the 'is the pain of the local worse than the pain of the drill' weighing-up.

If you change dentists look for one with computer-controlled LA delivery such as the Wand/STA. As slowly as possible (believe it or not) is the way to give a comfortable injection whether or not topical is used.
There's also a new buffering solution for local anaesthetic to reduce the sting called Onpharma which some dentists are now using, just as there is an agent which can be injected after treatment to make the numbing wear off faster(not my cup of tea lol) called Oraverse.

 

[norwegianchick]

I think she just didn't manage to make you properly numb.

I usually need top ups, but the good dentists I've been to always managed to make me comfortable.

See if you can get articaine, it's more effective.

Good luck!