Terrified of extensive oral surgery under GA

[MaryLand007]

Hi, thankyou for this forum.
All done under GA because of very severe PTSD and phobia.
I have had previous procedures done under GA on the 25 May, these included ultrasonic cleaning, scaling, a splint over the four upper front teeth to stabilise for now, the two front (very mobile) upper teeth and digital impressions were done.
I have an upcoming surgery under GA, 29 June. This is for extractions of two front upper adult teeth and a left retained Lower baby molar, also a deeper cleaning and any fillings needed And the placement of the upper two front teeth replacement, maryland bridge.
A few questions please...
1/ It will be an immediate fitting after extractions. Is this ok, safe and does it impact on any longer term outcome? (I will have dissoclavable stitches and dentist will use disssolvable packing to prevent dry socket, is this safe and to what degree is dry socket lessened?)
2/ I have been warned there is a possibility that the longer term maryland bridge may not fit and that a temporary one will need to be fitted immediately post extraction, then another GA for the adjusted maryland bridge. Is this a common occurance with a tech created bridge not fitting and another needs to be immediately fitted? The surgeon has said I will not be leaving the operating theatre with no front teeth.
3/ I have also been warned as the gums settle with healing there will be a gap of mere mm between the bridge and gums. Is this a concern re food getting stuck in there, risks of further dental issues with healthy teethand or will it be seen when smiling?
4/ Is it difficult to get used to an artificial maryland bridge in the mouth, with talking, eating etc?
5/ How much pain will I be in, how long? And length of time for healing?
6/ I have been told a maryland bridge is only a longer term temporary measure, its mostly cosmetic and am concerned about this, being it could debond? And still needing to be careful? with eating, like curently with this splint.

*Note before oral surgeon does her work, a gynaecologist surgeon is firstly going to remove a lesion in an intimate area, both surgeries under the same GA.
*After the surgeries, I will be admitted to a mental health acute care unit for a few days due to the very traumatic nature of surgeries.
Thankyou kindly for any answers or any other thoughts, please?

 

[Gordon]

1/ It will be an immediate fitting after extractions. Is this ok, safe and does it impact on any longer term outcome? (I will have dissoclavable stitches and dentist will use disssolvable packing to prevent dry socket, is this safe and to what degree is dry socket lessened?)

It's a good idea. There's not much chance of dry socket under these circumstances. Assuming your aftercare is reasonable. Don't smoke being the main thing.

2/ I have been warned there is a possibility that the longer term maryland bridge may not fit and that a temporary one will need to be fitted immediately post extraction, then another GA for the adjusted maryland bridge. Is this a common occurance with a tech created bridge not fitting and another needs to be immediately fitted? The surgeon has said I will not be leaving the operating theatre with no front teeth.

Nope, pretty rare in my experience, just some sensible pre-surgery warning from the surgeon.

3/ I have also been warned as the gums settle with healing there will be a gap of mere mm between the bridge and gums. Is this a concern re food getting stuck in there, risks of further dental issues with healthy teethand or will it be seen when smiling?

It can happen. Less a concern with food getting stuck but it might get to the stage where it's noticeable. Equally though, it might not happen. Again just sensible of the dentist to give you warnings of problems in advance.

4/ Is it difficult to get used to an artificial maryland bridge in the mouth, with talking, eating etc?

Nope. It'll feel a bit different to your tongue for a day or two but that's about it.

5/ How much pain will I be in, how long? And length of time for healing?

Not much. Worst pain is the first few hours after treatment, but the GA will include some strong pain relief and by the time that wears off you should be over the worst. Initial healing? A week or two at worst.

6/ I have been told a maryland bridge is only a longer term temporary measure, its mostly cosmetic and am concerned about this, being it could debond? And still needing to be careful? with eating, like curently with this splint.

With modern cements they seem to be pretty permanent, but applying sufficient force in the wrong direction could make it fail. No reason to be super careful of it when eating, but opening beer bottles with one is a bad idea

I had a cerebral palsy patient with one to replace his front tooth, he had a bad habit of falling over and hitting his mouth and had KO'd the front tooth a couple of times, I was able to reimplant it twice, but the 3rd time I had to remove it and put in the bridge.
That lasted about 4 years, then he fell over again and KO'd the tooth which was holding on the bridge. The bridge was still attached to the KO'd tooth! A 2 unit Maryland was then fitted which (last I heard 15 years on) is still going fine.

 

[MaryLand007]

Thankyou for your replies, there is reassurance.

It's a good idea. There's not much chance of dry socket under these circumstances. Assuming your aftercare is reasonable. Don't smoke being the main thing.

I do smoke, this will be traumatic surgery (given nature of PTSD traumas), quitting smoking is not an option yet have access to NRT patches, which may or may not work, in the case they do not and I am distressed etc what is the Bare Minimum amount of time to not smoke afterwards, is it hours or days?

Nope, pretty rare in my experience, just some sensible pre-surgery warning from the surgeon.


It can happen. Less a concern with food getting stuck but it might get to the stage where it's noticeable. Equally though, it might not happen. Again just sensible of the dentist to give you warnings of problems in advance.

With it possibly showing, will this be obvious with any opening of my mouth? or more so if someone had a "gummy smile", which I dont.

Nope. It'll feel a bit different to your tongue for a day or two but that's about it.


Not much. Worst pain is the first few hours after treatment, but the GA will include some strong pain relief and by the time that wears off you should be over the worst. Initial healing? A week or two at worst.


With modern cements they seem to be pretty permanent, but applying sufficient force in the wrong direction could make it fail. No reason to be super careful of it when eating, but opening beer bottles with one is a bad idea

I had a cerebral palsy patient with one to replace his front tooth, he had a bad habit of falling over and hitting his mouth and had KO'd the front tooth a couple of times, I was able to reimplant it twice, but the 3rd time I had to remove it and put in the bridge.
That lasted about 4 years, then he fell over again and KO'd the tooth which was holding on the bridge. The bridge was still attached to the KO'd tooth! A 2 unit Maryland was then fitted which (last I heard 15 years on) is still going fine.

Thankyou for the reassurances as it challenging enough with this composite ribbond splint, hypervigilant 24/7, (very tiring) it may fall and the loose teeth are worse and fall and good to know maryland bridges are more longer term, than what has been read about, "up to five years" "often debonding" etc.
Not at all looking forward to any of this but no alternatives and the teeth will fall organically bringing about an even more distressing situation.
Thankyou for your thoughtful replies.

 

[Gordon]

I do smoke, this will be traumatic surgery (given nature of PTSD traumas), quitting smoking is not an option yet have access to NRT patches, which may or may not work, in the case they do not and I am distressed etc what is the Bare Minimum amount of time to not smoke afterwards, is it hours or days?

12 hrs is bare minimum, 24 hrs is fine, 48 would be better.

With it possibly showing, will this be obvious with any opening of my mouth? or more so if someone had a "gummy smile", which I dont.

It would tend to appear around the "gum margin" area of the false teeth, how visible that would be is debatable, IF it happened at all.

 

[MaryLand007]

Thankyou for your info and reassurances, appreciated.

 

[MaryLand007]

@Gordon Would like to update you...and any thoughts?
Back at home and surgery went well physically. Managed no smoking for four days and have significantly cut down on cigarettes (from 20/25 for 33 years to 5/6 now; last two and a bit days), hoping this continues but will not beat myself up if increased due to ongoing stresses etc, yet a limit of 10 per day is preferable.
Its feeling very surreal what has happened, people have said the maryland bridge looks very natural as upper front teeth, the colour blends well, a clean white. They are porcelain and I can see thevery slight grey bit and translucent white bands but likely more obvious to me, as said feeling very surreal.
1/ The disolvable stitches are also still in two extraction sites, up the top right front and where the bottom retained baby molar was, almost six days later okay?
2/ Used a waterpik on gentle and that got the top gums bleeding so will stop that that for a day or two?
It is Very tricky using superfloss, first time, couple of days ago felt like papercuts times 1000 up on top front gums.
3/ Unsure how to use superfloss? Or maybe the waterpik will be okay by itself?
4/ Still being extra extra cautious with the brushing (ultrasonic toothbrush on sensitive setting Not the polishing setting) of the natural teeth beside the maryland bridge and the two artificial ones. Does this fear of knocking the bridge out ease??
Trusting the healing continues without complications etc. 5/ How long does full healing take with gums and with the bone?
Thankyou for your help and support.

(maybe of interest, as an update, no complications with the dental but have complications with the gynae surgery, a stitch came out, not enough for it to be redone under GA, to observe for any further isssues, for now it should heal, albeit much slower and its very very painful, its alot to go through both dental and gynae under same GA)

 

[Gordon]

Thanks so much for the update, I'm glad things went smoothly for you. (I was impressed by the way your dentist went about warning you about potentially poor outcomes in advance, btw, that was good practice on their part).

1/ The disolvable stitches are also still in two extraction sites, up the top right front and where the bottom retained baby molar was, almost six days later okay?

Yes fine, they take their sweet time occasionally. Non-dissolvable stitches are traditionally removed after 7 days, so you're not outside the normal range there anyway.

2/ Used a waterpik on gentle and that got the top gums bleeding so will stop that that for a day or two?

Yeah, give yourself a couple more days.

It is Very tricky using superfloss, first time, couple of days ago felt like papercuts times 1000 up on top front gums.

Practice makes perfect I'm afraid. Can you get an appointment with a dental hygienist for some 1:1 lessons?

3/ Unsure how to use superfloss? Or maybe the waterpik will be okay by itself?

No, you need to learn to use the floss.

4/ Still being extra extra cautious with the brushing (ultrasonic toothbrush on sensitive setting Not the polishing setting) of the natural teeth beside the maryland bridge and the two artificial ones. Does this fear of knocking the bridge out ease??

I daresay it does. There is no way on this earth you'll knock out a Maryland with an electric toothbrush though! Unless you get hit in the face with the back end of one!

Trusting the healing continues without complications etc. 5/ How long does full healing take with gums and with the bone?

Several months if you're talking about bone healing.

Thankyou for your help and support.

Well done again for getting through it. And an extra well done for cutting back on the cigarettes!

(maybe of interest, as an update, no complications with the dental but have complications with the gynae surgery, a stitch came out, not enough for it to be redone under GA, to observe for any further isssues, for now it should heal, albeit much slower and its very very painful, its alot to go through both dental and gynae under same GA)

One of the more peculiar cases I did was doing a full mouth clearance (all teeth, insert upper and lower dentures) at the same time as the gynaecologist was doing a sterilisation procedure at the <ahem> other end of the patient... the gynaecologist finished before me.

 

[MaryLand007]

Thanks so much for the update, I'm glad things went smoothly for you. (I was impressed by the way your dentist went about warning you about potentially poor outcomes in advance, btw, that was good practice on their part).

Thankyou Gordon, you have very much helped from afar with reassurances, always appreciated.

Yes fine, they take their sweet time occasionally. Non-dissolvable stitches are traditionally removed after 7 days, so you're not outside the normal range there anyway good to know.

Okay, will let them be.

Yeah, give yourself a couple more days.

Nodding.

Practice makes perfect I'm afraid. Can you get an appointment with a dental hygienist for some 1:1 lessons?

The surgery was done within the public system so no access to a "general" appointment even with hygienist, due to long waitlist and other patients much higher needs. An alternative is to watch youtube dentist showing or google can help.
Its been almost a week now, without flossing but have used the toothbrush, rinsing often with both salt water and reintroduced mouthwash yesterday. @Gordon are the tiniest interdental brushes a good idea as another option until getting the knack of the superfloss?

No, you need to learn to use the floss.

Hear you, as above.

I daresay it does. There is no way on this earth you'll knock out a Maryland with an electric toothbrush though! Unless you get hit in the face with the back end of one!

Thank goodness, its adrenaline moments when cleaning them, will try to take on board that it would take a shiteload to knock them, thankyou.

Several months if you're talking about bone healing.

Ok and @Gordon and the gums healing time, approx?

Well done again for getting through it. And an extra well done for cutting back on the cigarettes!

@Gordon Thankyou kindly Forward thinking here, are vapes (or e-cigs) better for oral health? vs cigarettes.

One of the more peculiar cases I did was doing a full mouth clearance (all teeth, insert upper and lower dentures) at the same time as the gynaecologist was doing a sterilisation procedure at the <ahem> other end of the patient... the gynaecologist finished before me.

Thank goodness to hear of someone else who has experienced both, not alone! Due to the nature of severe PTSD, I had a great surgical team, an all female team was organised (dentist, dental assistant, gynae, anaesthetist and her assistant and other theatre staff). The gynae did her bit then the dentist did hers, under for about two hours or so.
Must be very very odd as a dentist that these are both happening at the same time, can only imagine Thank goodness for GA!

 

[Natzuk]

@MaryLand007 I’m so glad I came across this thread .
I’m from the UK and am waiting too have two teeth out under general anaesthetic as like yourself surgery is very traumatic for me even having local anaesthetic or needles . I’m autistic also which I know you don’t need to be but makes things harder .
I need two upper back teeth removed so am waiting for a general anaesthetic, I tried too have them done under local it was horrible and I just wish people listened.
It’s good too hear all went well for you .
I’m dreading it but I know my mouth will be clear of constant infections and making myself worried am going too die .
I’m just worried I’ll be waiting a long time which I hope not because it’s mentally affecting me and I feel worried.
Hope you’re recovering well
X

 

[Gordon]

The surgery was done within the public system so no access to a "general" appointment even with hygienist, due to long waitlist and other patients much higher needs. An alternative is to watch youtube dentist showing or google can help.
Its been almost a week now, without flossing but have used the toothbrush, rinsing often with both salt water and reintroduced mouthwash yesterday. @Gordon are the tiniest interdental brushes a good idea as another option until getting the knack of the superfloss?

There's plenty of videos out there, the main thing is to take your time, don't panic and try to get good visibility of the area as best you can.
Small TePe brushes are great for between natural teeth but won't clean under your pontic (the false teeth on the bridge) so you'd do better with super floss for that if you can.

Ok and @Gordon and the gums healing time, approx?

2-3 weeks on a healthy individual.

@Gordon Thankyou kindly Forward thinking here, are vapes (or e-cigs) better for oral health? vs cigarettes.

Yes, apparently they are. Trouble with vapes is that there are so many different concoctions it's hard to be sure what's actually being tested.

Thank goodness to hear of someone else who has experienced both, not alone! Due to the nature of severe PTSD, I had a great surgical team, an all female team was organised (dentist, dental assistant, gynae, anaesthetist and her assistant and other theatre staff). The gynae did her bit then the dentist did hers, under for about two hours or so.
Must be very very odd as a dentist that these are both happening at the same time, can only imagine Thank goodness for GA!

It's just good practice to try to get the most out of any one GA at a time. I often shared theatre time with other disciplines, especially ENT. Orthopaedic surgeons were not keen though, they were too worried about infection getting into their operation sites.
I was busy doing the dentistry, with my back turned to the gynaecologist, but my dental nurse got an excellent view of both procedures.

 

[MaryLand007]

@Natzuk Hi
The waiting and the fear is very hard, cant deny this.
I can type out a list of things that did not help or added to further distress and things that Helped; they may be things for you (and other people) to consider, each situation is unique and very personal. The biggest thing is to Know you are Not alone, sounds very cliche, but it is Truth (so many of us on here are battling and or in fear and phobia).

Things that didnt help me...
*Googling for months, days and hours on oral health
*Not physically resting jaw when needed
*Not reaching out (and unassertive with this) for "wrap around" supports for so so long when it was desperately needed
*Living in fear and panic 24/7, in mostly isolation
*Oral health was a 24/7 "job" meaning it took over and above anything else in my life

Things that Have Helped...
*Asking for psychiatric medications to be increased very, very slightly, during the more intense waiting and the now healing (knowing the increased doses are temporary and taken as needed)
*Going to my doctor and asking for food supplementary drinks like fortisip
*A bit of very very gentle self discipline with doing the best to come back to Now, in other words taking each half moment as it goes, as best as able
*Asking and being more assertive with the need for intense support
*Resting the jaw physically and having absolute quiet time with reading on the bed, curling up under duvet listening to the radio etc.
*Putting it all into perspective, in other words reminding myself sometimes that any person would find all this very challenging yet balanced with (the extra challenges of severe PTSD) and knowing I am actually "normal" and doing okish, all things considered
*Having the courage joining up on here and being able to type freely about any concerns and this site is a safe compassionate space and educational with gentle (feedback/answers) guidance is extremely helpful and lessens the isolation of healing
*Reminding myself and again, being real, that the physical healing will take a bit more time, yet each and every hour is towards this more fuller physical healing balanced with the more personal mental and emotional healing will take longer And this Is ok
*Sitting in the sun with a cup of tea, simple yet helps to rebuild mental energy (with the waves in barely ups and severe downs with this whole journey) and no doubt good physically

Just a few thoughts that may help you and others on here.
And thankyou @Natzuk, I hadnt even thought of the no longer infections, you have helped me.
Take good gentle care and each half moment as it goes, as best x

 

[MaryLand007]

@Gordon Thankyou for your immense support, help and guidance. Knowing I can type here is so very helpful with any concerns and questions. Thankyou kindly.

 

[Natzuk]

@MaryLand007 thanks so much for this .
I’m finding it so difficult as I can’t even find a dentist too treat this infection which I suspect it is as my jaw hurts .
I can’t afford too pay and there’s no NHS spaces available.
I’m scared , don’t know what too do .
I’ve left lots of emails too some other dentists, too see if they will see me tomorrow and treat me .
I just keep thinking I’ll die if no one will help me .

With no support it’s hard .
Just feel lost .

Hope you’re resting and recovering well x

 

[MaryLand007]

@Natzuk There will be solutions and trust the dentists on here will have some positive helpful thoughts and possible guidance for you. I hear your fear and anxiety, dental infections are rare to affect the whole body with spreading yet they make you feel very unwell, which adds to the anxiety that occurs, death is very very very rare from dental infections. Keep typing on here if you need to, better to express than not.

 

[MaryLand007]

@Gordon Hi, tonight a bit concerned. Would you please offer advice...and its Friday night here so no access to dental dept at hospital unless "dire emergency" with on call dentist.
1/ The site where the lower left baby molar was extracted, the tooth next to it (left side, closest to stitches) is swollen and has bleed, is this normal reaction or something to worry about please? Have increased salt mouthwashes again and increased vitamin C.
2/ Have tried using the superfloss under the false two upper fronts, to no ability, had a few tears. Am able to do the other bits where it attaches to natural teeth. Used the waterpik on gentle underside of false teeth and gums bleed. Very worried the more time that no thorough cleaning happens in this area (underside) the more chance gum and or healthy natural teeth next to it may occur? Just over a week today, last thorough clean (gums with natural teeth before surgery). Stiches in all extraction sites remain.

(side note body is physically struggling as glands with other procedure are up in groin tonight, have emailed the gynae for advice) *likely immune system battling overtime with both procedures and their healings
Very tired and exhausted mentally.

 

[MaryLand007]

Adding in the last hour have had to take panadol And codeine, pain. The codeine had been lessened in last day or so until tonight. Bit worried. Will be checking any replies when able, need to go to bed, unwell.

 

[Gordon]

1/ The site where the lower left baby molar was extracted, the tooth next to it (left side, closest to stitches) is swollen and has bleed, is this normal reaction or something to worry about please? Have increased salt mouthwashes again and increased vitamin C.

The tooth has swollen??? Did you mean the gum? Let's go with that theory...it's probably a reaction to the stitches (is that where they still are?) Dissolving stitches basically work by causing enough irritation to the host that the immune system kicks in and attacks them...

2/ Have tried using the superfloss under the false two upper fronts, to no ability, had a few tears. Am able to do the other bits where it attaches to natural teeth. Used the waterpik on gentle underside of false teeth and gums bleed. Very worried the more time that no thorough cleaning happens in this area (underside) the more chance gum and or healthy natural teeth next to it may occur? Just over a week today, last thorough clean (gums with natural teeth before surgery). Stiches in all extraction sites remain.

Err, you don't want to put anything between the top of the false tooth and your gum if that's what you're trying to do? The floss goes in through the gap between your tooth and the false one. Does that make sense? Don't try to jam it under where the root would be if it was a real tooth. Does that make sense?

 

[MaryLand007]

@Gordon Apologies yes its the gum and can see stitch in the same area, the other stitches are in the hole. That makes sense with them now extra irritation, body trying to remove them. Too worried to do this (remove) myself, so will let them be. The top ones are also still there.
Re superflossing, didnt dare further try under the false ones. Its all new and crashing mentally, emotionally isnt helping adding to confusion with the how to. Just to confirm please @Gordon I am flossing all natural teeth with usual floss, then superflossing the natural teeth incl the sides of the false ones. Is it okay for oral health to only gently brush the top and underside of the false incl gums, as tolerated along with occasional water pik on gentle in those areas, on right track?
Thankyou, its very overwhelming as reality begins out of the fog of surrealness with this all.

 

[Gordon]

Apologies yes its the gum and can see stitch in the same area, the other stitches are in the hole. That makes sense with them now extra irritation, body trying to remove them. Too worried to do this (remove) myself, so will let them be. The top ones are also still there.

It's the biggest drawback with self-dissolving stitches, they either self destruct too quickly or late enough to be annoying They will fall out eventually, don't fret.

Re superflossing, didnt dare further try under the false ones. Its all new and crashing mentally, emotionally isnt helping adding to confusion with the how to. Just to confirm please @Gordon I am flossing all natural teeth with usual floss, then superflossing the natural teeth incl the sides of the false ones. Is it okay for oral health to only gently brush the top and underside of the false incl gums, as tolerated along with occasional water pik on gentle in those areas, on right track?

That sounds right, yes, floss your natural teeth as usual then use super floss between your natural teeth and the false ones. It's fine to just brush round the false teeth, wouldn't bother with the water pik unless it makes you happy.

 

[MaryLand007]

@Gordon Thankyou kindly, I am on the right track.