Wisdom tooth cyst and anesthesia fear

[tinymouth]

I'm not sure if this is the right place for me...feel free to delete if you decide this isn't really dental phobia per se. After years of having dental work done with almost zero anxiety, I'm finally faced with something that scares me.

I'm in my late 20s and never got my wisdom teeth out. A week ago my dentist was looking over an old x-ray for an unrelated reason, and called me in right away. Turns out I have a cyst growing on a deeply impacted lower wisdom tooth, and I should have it taken out before it gets bigger and causes severe bone loss in my jaw. So far so good, except he's sending me to an oral surgeon who will probably insist on either deep sedation or GA, and I'm kind of terrified.

I've never had anything stronger than local anesthesia, so this is partly a fear of the unknown. But I also just don't want to be asleep for it unless it's absolutely necessary. I don't want the drugs in my system for hours afterwards. I will have a hard time arranging for a ride home, because my friends and family are all extremely busy. I'll have to inform my mother, who is a highly anxious person and will make everything worse before and after surgery. I'm scared of how I'll feel coming out of it (emotional reactions, panic attacks, nausea, etc). I have a very small mouth, and I'm scared they'll open up my jaw too wide while I'm under, and that I'll end up with TMJ damage and chronic pain. I already have some TMJ issues (grinding noises, clicking, occasional soreness), and I don't want this getting worse. I hate the idea of having something done to me while I'm unconscious, and having no memory of it. I hate not being in control. I'm scared of having gaps in my memory afterwards...I've heard of people not remembering the conversation with the nurses after, or their trip home. That freaks me out badly on a deep existential level. ? Overall, this will cause less trauma and disruption in my life if I can be awake.

I've read case reports and watched videos of surgeries for cysts similar to mine, and apparently it can be done with only local anesthetic. I've even seen it done that way for one that was bigger than mine (though of course, everyone's case is different). I can tolerate lengthy, uncomfortable procedures quite well, as long as I'm not in actual pain. Pressure, noises, drilling, blood, sharp things in my mouth, all good. I'm willing to try nitrous and maybe a mild oral sedative (enough to help me relax, but not enough to put me to sleep or affect my memory). If it's going to last longer than a couple of hours or if they'll have a hard time numbing everything properly due to the size and location of the cyst, then sure, knock me out. I still won't be happy about it, but it's better than the alternative.

When I shared my concerns with my dentist, he compared it to being rushed to the ER with appendicitis and said "in that situation you wouldn't have a choice, you'd just have to do it"...but that's emergency abdominal surgery that can't be done with local anesthetic. Different situation, different body part, and I would beg to be put to sleep. For this...if I can be awake, I would strongly prefer it.

I have a consult with the surgeon next month. I'm scared that he'll be condescending, that he won't listen, and that he'll get annoyed and tell me to leave if I ask too many questions. I don't want him to interpret it as me trying to tell him how to do his job...I just want to be taken seriously, and be given a thorough explanation of my anesthesia options. If he insists on doing it under GA, I'd want to know exactly why he thinks it's necessary, and I'd want to know what to expect if I did it under local. I'm planning to ask a gazillion questions. If I feel coerced in any way, I'll end up feeling like I'm being put to sleep against my will. That would be a crappy way to experience anesthesia for the first time, and I'm worried about the potential trauma it could cause. I need to feel like I am actually consenting to it.

I guess I'm looking for reassurance, as well as some advice for how to approach this with the surgeon without them thinking I'm an idiot. It's so intimidating. I'm aware that it's a little ridiculous. Most patients want the deepest level of anesthesia for invasive oral surgery, and then there's me, having a freaking anxiety crisis over NOT being awake to experience it. ? I think if it was any other part of my body being operated on while I'm unconscious, I wouldn't be reacting like this. But since it's my mouth, it just feels...invasive, I guess? Does that make sense? I'm imagining waking up and feeling violated almost.

Also, folks with TMJ issues: do you have any experience with it getting permanently worse after oral surgery? Is this going to ruin my life?

Again, feel free to delete if this doesn't belong here!

 

[FearfulInMA]

Hi and welcome! There are many of us who have fear about being sedated. I had my wisdom teeth out with local only. You may need to look around to find an oral surgeon who will feel comfortable with this. At the very least, an oral surgeon should answer all of your questions. Informed consent for treatment cannot happen without all of the information you’re looking for.

 

[v0latile]

Hey there. I had my wisdom teeth extracted under GA and I had the same fears about it (terror around not remembering, what it feels like to go under, etc.) but it ended up being completely fine. The worst part is definitely the worrying right beforehand.

The best approach with the surgeon might be to be up front and say you have some anxieties about GA and see if they'll walk you through the process so you know what to expect. It's important you feel confident going forward with whatever option you choose!

 

[Enarete]

Hi tinymouth,

It sounds like you have very clear preferences about how you wish to go about the treatment. You checked whether this is generally possible and you were even willig to change your mind if you were given a valid reason. It also sounds like you have very realistic image about what a surgical procedure would look and feel like if you were conscious and you‘re still fine with it so for me your preference in this is valid. Last but not least you are obviously ready to get the treatment done and all this is about is the „how“.

You wish your surgeon to take you seriously and handle you respectfully and answer your questions. This should be a pre-requisite of any encounter between a patient and a health care professional. Having all information you wish to have in order to make a decision is also perfectly fine and as FearfulInMA says, the base of informed consent.

It the surgeon makes you feel not taken seriously, just go and get another one. It is your body and your comfort which is a good reason to only work with a surgeon you feel comfortable with.

So putting it together, I just said what FearfulInMA already did and only used about four time more text for it

Keeping my fingers crossed for you to either feel comfortable with the surgeon or to feel confident enough to leave if that‘s not the case.

 

[krlovesherkids777]

Tinymouth,

It sounds like you are so self aware and have very valid concerns and points any dental provider should answer for you , I know for me, bedside manner is so important and if I feel they are sort of bypassing my concerns and just giong to their agenda or way of doing things.. it causes me to pause and not trust.. there is a reason for this.. listen to your gut. you have a very good one!

"It the surgeon makes you feel not taken seriously, just go and get another one. It is your body and your comfort which is a good reason to only work with a surgeon you feel comfortable with "

I sooo second this, very important.. I think so many times we just take who we get referred to or happens to be given us, but we do have a choice and we should be comfortable, and feel listened to and our choices and questions respected... so well said totally agree with Enarete..

 

[tinymouth]

Hi and welcome! There are many of us who have fear about being sedated. I had my wisdom teeth out with local only. You may need to look around to find an oral surgeon who will feel comfortable with this. At the very least, an oral surgeon should answer all of your questions. Informed consent for treatment cannot happen without all of the information you’re looking for.

Thank you so much for this! I think that's a good approach to take, and I'll be keeping it at the front of my mind as I go through this process.

Hey there. I had my wisdom teeth extracted under GA and I had the same fears about it (terror around not remembering, what it feels like to go under, etc.) but it ended up being completely fine. The worst part is definitely the worrying right beforehand.

I haven't even been to the consult or booked the surgery, and I've already spent the week worrying. Like, I want to cry just thinking about being in that chair, feeling my brain get switched off, and then waking up in a completely different room, confused and disoriented. I'm glad your experience went well! Hopefully mine does too, if that's what I end up doing.

It sounds like you have very clear preferences about how you wish to go about the treatment. You checked whether this is generally possible and you were even willig to change your mind if you were given a valid reason. It also sounds like you have very realistic image about what a surgical procedure would look and feel like if you were conscious and you‘re still fine with it so for me your preference in this is valid.

Validation! Yay! Thank you! I hope I'm being realistic about what I can handle. I know that if the cyst was growing in my upper jaw and into my sinus cavity instead, I would not want to be awake. But unless I'm given reasons to think otherwise, this seems doable. I can put up with some scary physical discomfort if it means I get to go home by myself after, wide awake and clear-headed.

You wish your surgeon to take you seriously and handle you respectfully and answer your questions. This should be a pre-requisite of any encounter between a patient and a health care professional. Having all information you wish to have in order to make a decision is also perfectly fine and as FearfulInMA says, the base of informed consent.

Thank you! I'm not expecting too much then? I feel stuck between not wanting to be an inconvenience or a bad patient, but also wanting to have some level of control over something that scares me. I was raised in an environment where standing up for myself was the worst thing I could do. Now I have all these issues when it comes to setting boundaries, especially for people I perceive as authority figures.

I will definitely ask for someone else if I'm not comfortable with him.

It sounds like you are so self aware and have very valid concerns and points any dental provider should answer for you , I know for me, bedside manner is so important and if I feel they are sort of bypassing my concerns and just giong to their agenda or way of doing things.. it causes me to pause and not trust.. there is a reason for this.. listen to your gut. you have a very good one!

Thank you! Bedside manner is important, especially if someone is going to put me to sleep and cut holes in my mouth. I don't want him to just be like "trust me, you wouldn't want to be awake for this" without explaining WHY.

I'm really taken aback by my intense reaction to all this. Out of all my anxieties (and I have many), doctors and dentists have not been one of them. I've worked myself up into a state of panic and haven't been able to focus on anything else, and I hate it so much. I'm trying to understand why this is so upsetting to me.

 

[Enarete]

Really sorry to read about the environment where you were raised in. Speaking up can be a nightmare anyway, but if you, as a child learned that having an opinion will bring you into serious trouble, then it's even harder. A dentist or a surgeon is an authority figure so having to speak up in their company can trigger the same feelings and fears you had as a child. You made it very clear that you prefer to have control over things and that you would like to avoid being sedated (and there are many other people who feel this way - me included - and that's ok). So putting these two things together I can see where the anxiety is coming from.

You don't have to please anyone, you are a customer. Again, wanting respect, information and being in charge of your health is ok. While there is not a simple way to get rid of anxiety and you very likely will be stressed out before and during the appointment, the only important thing is to find a way to voice your concerns and to chose a provider you would like to work with.