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Unable to numb lower wisdom tooth/have to return for possible IV sedation



Junior member
Jan 13, 2024
Hi there. I am beside myself with anxiety and have spent the last 24 hours going through most of the posts on this forum. I have a question about a recent experience and upcoming potential experience. I had a lower left fully erupted wisdom tooth that has had a sizable cavity for quite some time (with no pain). My regular dentist suggested I see an oral surgeon to have it extracted as it is hard for me to reach when brushing. I have pretty severe dental anxiety, but have had teeth extracted before as well as root canals with minimal pain/difficulty. For my appointment yesterday, I had my wife drive me and took some Xanax to manage the anxiety.

I was pretty proud of myself for getting to the office, going through the x-ray and dealing with the numbing injections. My face started to numb, but it didn't feel as strong as I usually have felt it and my teeth really didn't feel numb at all. The dentist began using the tool around the tooth that pushes the gum out of the way-- that was totally fine for me, but when he tried to lift the tooth I perceived pain and immediately told him to stop. He injected me in a few more locations to try to numb tooth, waited about ten minutes and started to use the lifting tool again. I felt a sensation (again, hard to describe, but not as sharp as nerve pain, but still pain) and he stopped and noted some inflammation at the root and suggested that this is why it might not be numbing. He prescribed an antibiotic and has me coming back Monday for IV sedation. He hurriedly said this ("gonna have to come back Monday for IV sedation, you have a hot tooth" and then quickly left). I have never NOT gotten numb enough in the past and not sure why it didn't work this time. I'm currently on the antibiotic and am going back Monday. Besides gum pain from the injections and his prodding, the tooth does not hurt at all.

Here's my dilemma. I am TERRIFIED of sedation. I am considered obese 5'7" 235lbs. I also have moderate positional sleep apnea (AHI of 22/zero apneas while on my side). I do not use a CPAP and instead manage with a wedge pillow/side sleeping. My apple watch (while not completely scientific) shows that I never have O2 drops below 92 while sleeping and I'm not waking suddenly or having large increases in heart rate during sleep. ENT noted an mallampati score of 3-4. Just had a physical and bloodwork and BP are all great. I have been sedated for major surgeries before with not complications upon waking or during surgery while under general anesthesia (one surgery lasted almost 6 hours). I was also 20 pounds heavier than I am now. My fears are:

1. I will stop breathing during IV sedation
2. My obesity, apnea, and grade 3-4 mallampati score will make #1 more likely
3. I will die
4. I will have a hard time breathing during recovery

Based on the x-ray and doctor's comments, this tooth is not a complicated extraction. It is not close to the main nerve of the jaw, it is fully erupted, and the roots are not splayed (look conical). Not sure what to do. I plan on brining all of this up with oral surgeon Monday, but cannot handle sitting with this right now. Not sure of the right approach. General anesthesia at a hospital seems like overkill, but willing to do that. Wow- that was long, thanks for reading if you made it this far!
IV sedation would be a lot safer for you than a GA.
1) You will be reminded to keep breathing. You'll be able to co-operate
2) What's your BMI? Can't really give you a good answer without that, but presumably the OS thinks you're within safe limits.
3) From what?
4) You'll be able to sit fairly upright, you'll be monitored for the hour or so you'll take to recover
Thanks for the response. My BMI is 36.5. And my more specific fears are that I will die from lack of oxygen or having a laryngospasm during the procedure due to obesity and moderate OSA. I am not super morbidly obese and have no troubles with activity/breathlessness during activity (can climb several floors without stopping). My OS did not talk about anything re: the sedation. He seemed a bit annoyed with me b/c I didn't numb enough. I did fill out paperwork and indicated my weight/height, diagnosed sleep apnea. I plan on using tomorrow to ask questions/bring up these concerns. He just seemed rushed-- not rude, just matter of fact.