Wizzies out with locals and nitrous - can it be done?

[Cassiopeia]

Hello,

I've posted a few times over in Support about my wisdom teeth extraction drama. It was supposed to be done on July 14th, but got there and found out that the sedation they use is not right for me. At least the breakdown I had in the chair (mostly over fear of the drugs they were going to give me due to a terrifying reaction I had to a fentanyl/Ketamine combo given for a nerve block before foot surgery a few years back) showed me that their entire staff is incredibly compassionate and patient.

Since my consult with the oral surgeon, I'd been wondering if two upper fully-erupted teeth and two lower barely soft tissue impacted teeth (fully erupted on one side and a tiny soft tissue impaction on the other) are worth the knock-out meds at all. After going over the "deeper" anesthesia options with the oral surgeon and his staff, I've been rethinking things even more. The procedure will be so quick that it doesn't seem necessary to be deeply anesthetized.

I also have a connective tissue disorder called Ehlers-Danlos syndrome, which makes my joints dislocate very, very easily. If I was deeply asleep with muscles paralyzed, my jaw could easily dislocate. This happens to me all the time when I'm sleeping normally. I feel that it's better to be conscious so I can tell if my jaw is slipping out of place.

I do have some anxiety over the procedure itself, but most of my anxiety is related to aftercare and pain afterward. There's some anxiety about what actually happens because this is a big unknown for me. When I ask myself: Why would I want to be asleep? the only answer I can confidently come up with is: Because if something were to go wrong, I wouldn't be awake for it. When I think about being put to sleep, I have even more anxiety about being out of control and how this would go over with my deteriorated health (the EDS and a very severe and progressive case of dysautonomia).

I'm scheduled to have my right two wisdom teeth extracted with local anesthesia and, maybe, nitrous next Thursday. During my consult, the oral surgeon specifically said that he could do one side at a time "with just local anesthesia, if you want."

The scheduling lady said they have nitrous if I decide I want it. What difference would it make? Financially, I'm all paid up, so doing one side at a time is not a financially-based decision. If I had nitrous, could he do both sides?

Is this reasonable? Or am I setting myself up for disaster? I just don't want to get in the chair AGAIN and find that there's some reason why it can't be done. I'm confident in my ability to withstand the procedure, and the surgeon already said he could do it, so it should be ok.

Ever since making this decision to have it done awake, I've felt a lot less stressed out and anxious about the procedure. I know it sounds counter-intuitive, but it's true! I'm one of those patients who gets really upset about the prospect of being out of control, especially since that medication reaction I had 7 years ago.

Sorry for such a long post. I'm looking for feedback and I want to make sure everyone understands as much of my situation as possible.

 

[Dr. Daniel]

Hey

According to what you write, it seems to be that there is no real reason for sedation. I am not a big fan of sedation (when it comes to anxiety) and in your case, it does not sound like the right thing. By the way, nitrous is not sedative but it helps with the anxiety so that's a good thing to use, but not other sedative drugs.

What you oral surgeon has suggested sounds like a good solution. If you want to go on a safer and moor gradual path, you can ask to extract the right teeth in two appointments (one tooth at a time) and a third appointment to get the two left ones. This way you will open your mouth even for a shorter period, and what's more important, you will have a much more confidence and ease.

 

[Cassiopeia]

Dr. Daniel,

Thank you for your reply. Your response was honest and level-headed, which is exactly what I was looking for.

The thought of having sedatives, especially IV sedatives, was making me a lot more anxious because of my previous scary experience with being sedated before my foot surgery. I'm fine if I know I'm going under deep-sleep anesthesia with amnesia, but have no desire to be under twilight sedation. I see no reason to be deeply asleep for what I have to have done.

There is no plan to use oral sedatives or anti-anxiety pills like Valium or Xanax. I take long-acting morphine for chronic pain related to the EDS, and I know that mixing that with sedatives or anti-anxiety meds is not smart.

I am comfortable having both teeth on the right side extracted at the same time. I have been having excruciating pain all across the right side of my face, all upper right teeth (and sometimes into the back-most lower teeth), deep inside my ear, around the back of my ear and head, and when it gets really bad, the bridge of my nose and around my eye. When this is at its worst, I can't touch my face at all on the right and inside my mouth, tongue, lip, and nose goes numb. The pain feels like lightning, burning, being smacked in the face with a hammer, and bee stings. I am at the point where I can't sleep on my right side or touch the right side of my face with anything at all without causing an attack of severe pain. We are unclear if it is tooth-related or a true nerve problem. I have some nerve dysfunction due to dysautonomia, so there is a question as to whether this could represent something like trigeminal neuralgia (I really, really hope not!). Both the dentist and oral surgeon can't guarantee that having the teeth removed will eliminate the pain and, if it doesn't, a neurologist will be my next step. I really hope it does not have to come to that.

The teeth came in relatively normally, but they have all developed large cavities that can't be fixed, so I know they have to come out.

I'm sort of looking forward to having the right side done because it could get rid of my pain and the upper right wisdom tooth is about 1/4 the size of the others (the dentist and hygienist were laughing about it in the hallway).

I am not looking forward to having to do advanced algebra when I'm back home, though! I'm working ahead, so I won't have to work math problems for about 4 days after the extractions.

It won't be as bad as I'm imagining...