What to expect when you're extracting
June 23, 2011 5:37 PM Subscribe
Wisdom tooth extraction tomorrow. Definitely want sedation, but I have a few specific questions about how to minimize the unpleasantness of the procedure. Help me figure out what I'm looking for and how to express this to the oral surgeon!
I've read two previous sedation AskMefis: the fear-of-sedation thread and the local-or-general anesthesia thread. I'm still a bit confused.
My favorite extraction stories are the ones where the people were given some sort of memory-robbing sedative just before the nasty bits began, then came to after it was all over with no memory of the procedure. I've had nitrous oxide before (during a root canal), and that was a decently pleasant high, but the drilling noises and the pressure were still unpleasant. From what I've heard about wisdom tooth extractions, the noise and pressure are worse. I'm fairly certain I don't want to know what's going on.
So, my questions:
* Is what I'm describing general anesthesia? If so, one or two comments mentioned a bad recovery time after general anesthesia. What's involved in that?
* This post is about an oral surgeon who only does local anesthesia. I don't want that! But it's too late to call the dentist's office to confirm there are other options. How common is it to encounter oral surgeons who won't do anything but local anesthesia? Or, conversely, how standard (at this point) are the delightful magic drugs that make you forget everything till it's over? At the very minimum, there will be serious nitrous, right? Right?
* My very, very sweet partner got tomorrow off work at the last minute so he can accompany me, so I don't have any fears about getting home afterwards. But how do you get home afterwards if you don't have a guardian angel?
Thanks as always, Wonder-People!
I've read two previous sedation AskMefis: the fear-of-sedation thread and the local-or-general anesthesia thread. I'm still a bit confused.
My favorite extraction stories are the ones where the people were given some sort of memory-robbing sedative just before the nasty bits began, then came to after it was all over with no memory of the procedure. I've had nitrous oxide before (during a root canal), and that was a decently pleasant high, but the drilling noises and the pressure were still unpleasant. From what I've heard about wisdom tooth extractions, the noise and pressure are worse. I'm fairly certain I don't want to know what's going on.
So, my questions:
* Is what I'm describing general anesthesia? If so, one or two comments mentioned a bad recovery time after general anesthesia. What's involved in that?
* This post is about an oral surgeon who only does local anesthesia. I don't want that! But it's too late to call the dentist's office to confirm there are other options. How common is it to encounter oral surgeons who won't do anything but local anesthesia? Or, conversely, how standard (at this point) are the delightful magic drugs that make you forget everything till it's over? At the very minimum, there will be serious nitrous, right? Right?
* My very, very sweet partner got tomorrow off work at the last minute so he can accompany me, so I don't have any fears about getting home afterwards. But how do you get home afterwards if you don't have a guardian angel?
Thanks as always, Wonder-People!
You dont actually need sedation for wisdom tooth extraction, I wasn't sedated, just had the local anesthetic in my gums. While it was fairly unpleasant, it wasn't particularly painful, neither during nor afterward.
posted by moorooka at 5:42 PM on June 23, 2011
posted by moorooka at 5:42 PM on June 23, 2011
I was sedated via iv, not gas, for wisdom tooth extraction.
It was not true general anesthesia -- i.e., no breathing tube. But I was out like a light -- counted backwards from 5 and next thing I knew I woke up and the surgery was over. It was actually pretty awesome.
I don't think most doctors do full-on general anesthesia for wisdom tooth extraction, but whatever milder version they gave me was great.
posted by eugenen at 5:46 PM on June 23, 2011 [8 favorites]
It was not true general anesthesia -- i.e., no breathing tube. But I was out like a light -- counted backwards from 5 and next thing I knew I woke up and the surgery was over. It was actually pretty awesome.
I don't think most doctors do full-on general anesthesia for wisdom tooth extraction, but whatever milder version they gave me was great.
posted by eugenen at 5:46 PM on June 23, 2011 [8 favorites]
The memory-rubbing sedative you mention, is called "twilight sedation" and is an IV that just sort of makes you forget. It's technically a general anesthetic but different because you're not unconscious.
Did you discuss this at all with your oral surgeon? Did you have any sort of pre-extraction consult? If not, you're probably out of luck because stuff like twilight sedation requires an anesthesiologist to be present (or at least it did when I had my wisdom teeth extracted). Also you aren't supposed to eat or drink for a certain amount of time before receiving twilight sedation which, again, would have been covered in your pre-appointment consult.
Unfortunately, it's just not something you can ask for the day of your surgery. You might want to reschedule.
posted by joan_holloway at 5:49 PM on June 23, 2011
Did you discuss this at all with your oral surgeon? Did you have any sort of pre-extraction consult? If not, you're probably out of luck because stuff like twilight sedation requires an anesthesiologist to be present (or at least it did when I had my wisdom teeth extracted). Also you aren't supposed to eat or drink for a certain amount of time before receiving twilight sedation which, again, would have been covered in your pre-appointment consult.
Unfortunately, it's just not something you can ask for the day of your surgery. You might want to reschedule.
posted by joan_holloway at 5:49 PM on June 23, 2011
I had local. The worst part was the actual injection into the gums - nasty. You will drool afterwards.
posted by fire&wings at 5:58 PM on June 23, 2011
posted by fire&wings at 5:58 PM on June 23, 2011
Best answer: I don't think twilight sedation requires an anesthesiologist to be present. I had it recently and it was just the oral surgeon and a nurse.
I think you should make it CLEAR you insist on twilight sedation. Don't let them start without it. When I've had it done it involves gas mask (nitrous) and an IV, and I'm out ... Very next instant, they're "waking" me and telling me it's over. Tell them that's the experience you want.
posted by jayder at 5:58 PM on June 23, 2011
I think you should make it CLEAR you insist on twilight sedation. Don't let them start without it. When I've had it done it involves gas mask (nitrous) and an IV, and I'm out ... Very next instant, they're "waking" me and telling me it's over. Tell them that's the experience you want.
posted by jayder at 5:58 PM on June 23, 2011
Best answer: I think you should make it CLEAR you insist on twilight sedation. Don't let them start without it. When I've had it done it involves gas mask (nitrous) and an IV, and I'm out ... Very next instant, they're "waking" me and telling me it's over. Tell them that's the experience you want.
That's what I got too, and it was awesome. I didn't believe them when they told me they were done.
I think you should probably say something like "gas me up good, I'm super nervous".
posted by gjc at 6:09 PM on June 23, 2011
That's what I got too, and it was awesome. I didn't believe them when they told me they were done.
I think you should probably say something like "gas me up good, I'm super nervous".
posted by gjc at 6:09 PM on June 23, 2011
Best answer: I've experienced things both ways: wisdom teeth removed with sedation; oral surgery (lots of sawing & gum rearranging to deal w/impacted canines) with local anesthesia. There wasn't any pain with the local, but there was a pretty massive headache afterwards (because, you know, somebody taking a bone saw to your upper jaw) and, as fire&wings says, a fair amount of drooling. And, of course, you know what's going on. I definitely preferred being sedated: out like the proverbial light (bang!) and then suddenly awake after everything was over.
posted by thomas j wise at 6:11 PM on June 23, 2011
posted by thomas j wise at 6:11 PM on June 23, 2011
I had twilight sedation when I had my wisdom teeth extracted and there was not an anesthesiologist present for it. I have had very unpleasant reactions to general anesthesia and did not experience anything close to that with twilight. I did, however, wake up crying. Not as in "I woke up and then started crying," more like, "I was sobbing hysterically and that's what woke me up." Apparently that's not at all uncommon.
You want the twilight. I, too, get very anxious at the sound of dental work and I would want twilight again if I had to do anything more than a filling.
posted by cooker girl at 6:12 PM on June 23, 2011
You want the twilight. I, too, get very anxious at the sound of dental work and I would want twilight again if I had to do anything more than a filling.
posted by cooker girl at 6:12 PM on June 23, 2011
Best answer: I had my wisdom teeth out in January and I made it VERY clear that I did not want to be aware for ANY of it because I'm still trying to work my way out of some severe dental phobia.
I got to the office, they took me into a room, sat me in a chair, covered me with a heated blanket, and handed me a tiny cup of Versed. I drank it, tried to talk to the assistant about gastric bypass (she asked), and then after a few sentences said, "I'll tell you more about it later, I think I'm..."
Then I woke up. I was not in pain, but I had a mouth full of gauze and blood. My mom led me out to her car, buckled me in, and covered me with a blanket - onto which I immediately sneezed blood. Fun!
They put the IV in after I was knocked out from the Versed - which I really appreciated as I have issues with needles, too. I have absolutely no memory of any of it.
The socket pain wasn't too bad, but the jaw pain was really unpleasant. After a few days of suffering with Vicodin, I gave in and took some ibuprofen and that knocked it out really quickly.
All in all, it wasn't NEARLY as bad as I was expecting. The swelling that happens on day two or three is sort of hilarious. Take photos! And have a lot of soups and mushy food on hand, and ice packs. You'll be good as new in a week or less!
posted by elsietheeel at 6:12 PM on June 23, 2011
I got to the office, they took me into a room, sat me in a chair, covered me with a heated blanket, and handed me a tiny cup of Versed. I drank it, tried to talk to the assistant about gastric bypass (she asked), and then after a few sentences said, "I'll tell you more about it later, I think I'm..."
Then I woke up. I was not in pain, but I had a mouth full of gauze and blood. My mom led me out to her car, buckled me in, and covered me with a blanket - onto which I immediately sneezed blood. Fun!
They put the IV in after I was knocked out from the Versed - which I really appreciated as I have issues with needles, too. I have absolutely no memory of any of it.
The socket pain wasn't too bad, but the jaw pain was really unpleasant. After a few days of suffering with Vicodin, I gave in and took some ibuprofen and that knocked it out really quickly.
All in all, it wasn't NEARLY as bad as I was expecting. The swelling that happens on day two or three is sort of hilarious. Take photos! And have a lot of soups and mushy food on hand, and ice packs. You'll be good as new in a week or less!
posted by elsietheeel at 6:12 PM on June 23, 2011
Best answer: I had twilight sedation (all four teeth out at once; I wasn't afraid of the pain - I just didn't want to be present for any of it), and it was great. When they "woke" me up, I started to ask why they hadn't started yet, but I couldn't really talk because I had gums full of gauze. A friend had to drive me home and hang out with me for a while, to make sure I didn't keel over from dizziness, or accidentally take too much pain medication. I was fine the next day - my jaw was a little achy and swollen, but that was it.
posted by rtha at 6:12 PM on June 23, 2011
posted by rtha at 6:12 PM on June 23, 2011
I had general anesthesia for my extraction, but that was because my wisdom teeth were impacted and needed to be surgically removed (as opposed to being pulled out, for which I think you'd have local anesthesia). I don't actually remember being consulted on what method the oral surgeon would use, but I probably would have chosen to go under like I did. I didn't remember anything from the surgery, had some mild pain a day or two after and was grossly fascinated by having to clean out the mouth holes for the next few weeks.
Honestly, the worst part of the procedure for me was having to talk to the two really cute nurses (really? there had to be two?) afterward who were supervising me/keeping me awake? and kept insisting they could understand what I was saying through all the gauze, puffiness, and blood. And drool.
I took care to present myself nicely when I returned for a follow-up in case I ran into the nurses again, but alas, no redemption.
I know it's good to feel prepared but don't psych yourself out over this, it won't be that bad and you have someone who is willing to deal with your drool immediately after you come out of a dental procedure. That's love.
posted by therewolf at 6:22 PM on June 23, 2011
Honestly, the worst part of the procedure for me was having to talk to the two really cute nurses (really? there had to be two?) afterward who were supervising me/keeping me awake? and kept insisting they could understand what I was saying through all the gauze, puffiness, and blood. And drool.
I took care to present myself nicely when I returned for a follow-up in case I ran into the nurses again, but alas, no redemption.
I know it's good to feel prepared but don't psych yourself out over this, it won't be that bad and you have someone who is willing to deal with your drool immediately after you come out of a dental procedure. That's love.
posted by therewolf at 6:22 PM on June 23, 2011
I was about 3/4 of the way to unconscious for wisdom tooth extraction (done in two sessions; one to remove a wisdom tooth with an inflamed socket from biting down on it, and a later one to remove the remaining three teeth which could have become problematic). Each time, I was on an IV drip and a few seconds of inhaling gas. I had no pain despite being awake enough to give a thumbs-up to the surgeon and being cognizant of the particulars of the procedure. I definitely could not have made it home by myself, just given the volume of congealed blood that exited my mouth on the trip home; I was too knocked out to walk, I was in no shape to drive, and public transporation while looking like an extra from 28 Days Later was certainly not an option.
I didn't have any loss of memory, as I remember most of each procedure, but I just didn't give a fuck about the instruments in my mouth and whatnot and was completely relaxed.
I've also had general for a bunch of non-dental things and it's been fine; I lose 5-6 hours but generally don't have any other trouble. IMO it's overkill for commonplace wisdom tooth extraction (and my teeth were anchored but good - the roots had little curves on them that got stuck way down into my jaw - as they showed me later).
If you are on opiates or analogues for pain relief afterward (typically Vicodin or something else similar), get some stool softener and begin taking it with the first dose of the pain killers. You will be ingesting drugs that produce constipation, will have swallowed some amount of blood, will be eating lightly and irregularly and missing fiber, and not stimulating your GI tract in the normal way. Take care that you don't end up with more discomfort in your ass than in your face.
posted by Inspector.Gadget at 6:31 PM on June 23, 2011
I didn't have any loss of memory, as I remember most of each procedure, but I just didn't give a fuck about the instruments in my mouth and whatnot and was completely relaxed.
I've also had general for a bunch of non-dental things and it's been fine; I lose 5-6 hours but generally don't have any other trouble. IMO it's overkill for commonplace wisdom tooth extraction (and my teeth were anchored but good - the roots had little curves on them that got stuck way down into my jaw - as they showed me later).
If you are on opiates or analogues for pain relief afterward (typically Vicodin or something else similar), get some stool softener and begin taking it with the first dose of the pain killers. You will be ingesting drugs that produce constipation, will have swallowed some amount of blood, will be eating lightly and irregularly and missing fiber, and not stimulating your GI tract in the normal way. Take care that you don't end up with more discomfort in your ass than in your face.
posted by Inspector.Gadget at 6:31 PM on June 23, 2011
Best answer: Just to clarify: Twilight sedation is not the same as general anesthesia. That Wikipedia article gives a pretty good description of what it's like, and as you can see from the responses here, it's a rather effective mind-eraser. (It certainly was for me when I had my wisdom teeth out.) General anesthesia is something that's almost always going to be performed only in a hospital - but that's okay, because it's definitely not needed for wisdom teeth removal. Twilight works like a charm.
Your surgeon may (probably? I'm not sure) also inject novocaine into your gums to help deaden the pain for the time after you regain alertness. It's likely they'll also give you nitrous before they start the twilight anesthetic.
As others have said, though, you generally need to make it clear you want twilight before you schedule your surgery. Obviously you can survive without it, but it's not an experience I'd want to have.
As for getting home afterwards, surgeons' offices are pretty adamant about you having company. I suppose if you were truly, truly, truly hard up, they might insist you spend several hours in their waiting room (not fun) before letting you go. But I've never heard of anyone doing this. I would also emphatically not recommend it. After I thought I had regained full consciousness, I kept having blackouts - something I was unaware of until my wife told me all the ridiculous things I said to her during that liminal stage. (I told her I got interrogated by JFK! Apparently I was not referring to a dream!) So, I'd do everything you can to ensure someone is there to take you home.
posted by Conrad Cornelius o'Donald o'Dell at 6:31 PM on June 23, 2011
Your surgeon may (probably? I'm not sure) also inject novocaine into your gums to help deaden the pain for the time after you regain alertness. It's likely they'll also give you nitrous before they start the twilight anesthetic.
As others have said, though, you generally need to make it clear you want twilight before you schedule your surgery. Obviously you can survive without it, but it's not an experience I'd want to have.
As for getting home afterwards, surgeons' offices are pretty adamant about you having company. I suppose if you were truly, truly, truly hard up, they might insist you spend several hours in their waiting room (not fun) before letting you go. But I've never heard of anyone doing this. I would also emphatically not recommend it. After I thought I had regained full consciousness, I kept having blackouts - something I was unaware of until my wife told me all the ridiculous things I said to her during that liminal stage. (I told her I got interrogated by JFK! Apparently I was not referring to a dream!) So, I'd do everything you can to ensure someone is there to take you home.
posted by Conrad Cornelius o'Donald o'Dell at 6:31 PM on June 23, 2011
Best answer: First: if you're anxious about your upcoming procedure, perhaps this will help: I have pretty severe dental panic, complete with occasional hyperventilation, and I found my recent wisdom tooth extraction to be a breeze, almost pleasant. No, really!
For my extraction, I had general anesthetic through (what I assume was) an IV in my arm. It involved no face mask or gas or other injection, but the oral surgeon described it as "general anesthetic" and on the bill (which I'm looking at right now) it's listed as "gen anes."
This general anesthetic provided me with the magical missing-time experience you're seeking. I remember directing the oral surgeon to the big vein in my right arm, and then BAM I was in the recovery room clamping a no-longer-cold ice pack to my cheek and nodding earnestly at the instructions a nurse was issuing to my husband. Clearly I'd been there some time, but I have no clear memory of it.
(I feel like there's a hazy memory of the recovery room buried in my head somewhere, and I do vaguely recall urgently trying to crack a joke while the surgeon's hand was in my mouth. I suppose that means I was aware of the sounds, too, but I don't actually remember any of that and I'm not going to go excavating any of those memories anytime soon. The few things I do remember are pretty cheerful. I remember that I found myself pretty hilarious, and that I thought the Vicodin had no dopey effect on me. But, uh, it did.)
Though my oral surgeon informed me about other anesthetic choices, he didn't recommend any of them and we both assumed I'd be having the general --- though perhaps that's partly because I had told him I'm irrationally terrified of dental work and he wanted to make it easy on me.
And it was easy. Really. I wouldn't hesitate at all if I needed to have another oral surgery procedure: it was easy. (I know not everyone finds it so easy, but I wish I hadn't listened to the relatively uncommon painful or scary experiences that some people had.) The aftercare was a bit of a drag, but mostly because of the boredom.
When I told friends and family about my anxiety ahead of time, they all reassured me that I wouldn't even remember the experience. This suggests to me that the general/twilight/forgetting drug is pretty widely used.
But still, don't hesitate to call your oral surgeon's office first thing in the morning and ask about the anesthetic. They do this every single day; they can make you feel safe and cared-for.
posted by Elsa at 6:32 PM on June 23, 2011
For my extraction, I had general anesthetic through (what I assume was) an IV in my arm. It involved no face mask or gas or other injection, but the oral surgeon described it as "general anesthetic" and on the bill (which I'm looking at right now) it's listed as "gen anes."
This general anesthetic provided me with the magical missing-time experience you're seeking. I remember directing the oral surgeon to the big vein in my right arm, and then BAM I was in the recovery room clamping a no-longer-cold ice pack to my cheek and nodding earnestly at the instructions a nurse was issuing to my husband. Clearly I'd been there some time, but I have no clear memory of it.
(I feel like there's a hazy memory of the recovery room buried in my head somewhere, and I do vaguely recall urgently trying to crack a joke while the surgeon's hand was in my mouth. I suppose that means I was aware of the sounds, too, but I don't actually remember any of that and I'm not going to go excavating any of those memories anytime soon. The few things I do remember are pretty cheerful. I remember that I found myself pretty hilarious, and that I thought the Vicodin had no dopey effect on me. But, uh, it did.)
Though my oral surgeon informed me about other anesthetic choices, he didn't recommend any of them and we both assumed I'd be having the general --- though perhaps that's partly because I had told him I'm irrationally terrified of dental work and he wanted to make it easy on me.
And it was easy. Really. I wouldn't hesitate at all if I needed to have another oral surgery procedure: it was easy. (I know not everyone finds it so easy, but I wish I hadn't listened to the relatively uncommon painful or scary experiences that some people had.) The aftercare was a bit of a drag, but mostly because of the boredom.
When I told friends and family about my anxiety ahead of time, they all reassured me that I wouldn't even remember the experience. This suggests to me that the general/twilight/forgetting drug is pretty widely used.
But still, don't hesitate to call your oral surgeon's office first thing in the morning and ask about the anesthetic. They do this every single day; they can make you feel safe and cared-for.
posted by Elsa at 6:32 PM on June 23, 2011
Best answer: My oral surgeon said: "If I give you local (an injection), you'll be playing basketball this afternoon. If I give you the IV drip (like a "twilight sedation"), you'll be loopy for the rest of the afternoon but you won't remember a thing." Then, he said -- "You don't get extra points for suffering. It's way less unpleasant with the IV drip." I had the IV drip. And it's the same as everyone describes. Countdown. Then, I have a vague memory of someone hovering over me for 2 seconds. Then, I'm being helped to the recovery room. The whole thing seemed to last 30 seconds.
posted by Buffaload at 6:32 PM on June 23, 2011
posted by Buffaload at 6:32 PM on June 23, 2011
IANADentist. But from my personal experience, a lot of the trauma of wisdom tooth extractions depends on the particular placement, root structure and the orientation of tooth. My upper wisdom teeth (#1 and #16) were uncomplicated, nearly straight down extractions of somewhat misplaced, undamaged, undecayed, strong teeth with simple roots. They each popped out in under 3 minutes of fiddling by the dentist, under local anesthetic, with a day or so each of "aftercare" including cotton wads and Tylenol to control the residual bleeding and minor pain. My bottom wisdom teeth were both fully horizontally impacted.
I should have had an oral surgeon take them out, but for cost reasons, I elected to have the dentist that took out my uppers give it a try under local anesthetic, starting with #32. The tooth broke into pieces during the extraction, which took 30 minutes, and some damage was done to my jawbone, but the dentist got it all. During aftercare, I developed a dry socket, that took a couple weeks to heal (in fairness, I was still smoking at that time, which probably exacerbated the problem), and was pretty painful and nasty most of that time. That dentist refused to try to extract #17 on the basis of his experience with #32, and I still carry #17, fully submerged below the gum line, and generally asymptomatic, more than 35 years after having #32 out.
Some years later, I had other work done by an oral surgeon, under full general anesthesia, and the after experience of general anesthesia was not pleasant, including major headaches for several days, strong after tastes, and some major constipation, along with all the other post-operative mouth issues and care. I've also been under general anesthesia for three hip replacement surgeries, and a couple of colonoscopy procedures, and each time, have had very poor after care experiences. But some people simply have different reactions to the commonly used anesthetic agents; my experience is not unusual, but not necessarily indicative of your possible results.
So, based on my own experience, I think a lot of what you can expect is dependent on things you may already know about your wisdom teeth, from xrays, and pre-extraction consults. If the teeth to be extracted are emerged, and there is no serious decay or damage to complicate matters, the risk of general anesthesia isn't likely warranted by the avoidance of trauma you want. With only a local, your uncomplicated extractions will be done in minutes, and you'll not need any pre-procedure prep, or post-procedure care, beyond simple clotting and minor pain.
On the other hand, for fully impacted wisdom teeth, where an oral surgeon may have to open the gum deeply, and break the tooth while extracting it, sedation or general anesthesia may be warranted, despite its greater risks to your overall health compared to local anesthesia. If that is the case, as others have said, you should have been advised of such, and done a pre-procedure prep according to instructions by the oral surgeon. Moreover, most likely, your procedure will be attended by additional personnel (nurse practitioners, technicians, or anesthesiologists) whose major role is to administer and monitor the general anesthesia, depending on the method and drugs chosen for your case.
posted by paulsc at 6:41 PM on June 23, 2011
I should have had an oral surgeon take them out, but for cost reasons, I elected to have the dentist that took out my uppers give it a try under local anesthetic, starting with #32. The tooth broke into pieces during the extraction, which took 30 minutes, and some damage was done to my jawbone, but the dentist got it all. During aftercare, I developed a dry socket, that took a couple weeks to heal (in fairness, I was still smoking at that time, which probably exacerbated the problem), and was pretty painful and nasty most of that time. That dentist refused to try to extract #17 on the basis of his experience with #32, and I still carry #17, fully submerged below the gum line, and generally asymptomatic, more than 35 years after having #32 out.
Some years later, I had other work done by an oral surgeon, under full general anesthesia, and the after experience of general anesthesia was not pleasant, including major headaches for several days, strong after tastes, and some major constipation, along with all the other post-operative mouth issues and care. I've also been under general anesthesia for three hip replacement surgeries, and a couple of colonoscopy procedures, and each time, have had very poor after care experiences. But some people simply have different reactions to the commonly used anesthetic agents; my experience is not unusual, but not necessarily indicative of your possible results.
So, based on my own experience, I think a lot of what you can expect is dependent on things you may already know about your wisdom teeth, from xrays, and pre-extraction consults. If the teeth to be extracted are emerged, and there is no serious decay or damage to complicate matters, the risk of general anesthesia isn't likely warranted by the avoidance of trauma you want. With only a local, your uncomplicated extractions will be done in minutes, and you'll not need any pre-procedure prep, or post-procedure care, beyond simple clotting and minor pain.
On the other hand, for fully impacted wisdom teeth, where an oral surgeon may have to open the gum deeply, and break the tooth while extracting it, sedation or general anesthesia may be warranted, despite its greater risks to your overall health compared to local anesthesia. If that is the case, as others have said, you should have been advised of such, and done a pre-procedure prep according to instructions by the oral surgeon. Moreover, most likely, your procedure will be attended by additional personnel (nurse practitioners, technicians, or anesthesiologists) whose major role is to administer and monitor the general anesthesia, depending on the method and drugs chosen for your case.
posted by paulsc at 6:41 PM on June 23, 2011
Best answer: When I got my wisdom teeth taken out, they were all impacted and infected. My dentist referred me to an oral surgeon, who showed me clearly what the problem was (my wisdom teeth were coming in sideways under the gums. Fun!) and explained what they were going to do. I had to take antibiotics for a week to clear up the infection and was on massive doses of painkillers.
When the time came for the surgery, I had twilight sedation, and it was GREAT. I remember trying to tell the nurse something just after they put in the IV. The next thing I knew the oral surgeon and nurses were waking me up. I said, "Did you already take my teeth out?" and they smiled and said yes. Then, because it just seemed so unbelievable (I had absolutely no memory of it at all) I said, "Did you take ALL of them out?" and they reassured me that they had. I healed really quickly with very little swelling and didn't feel sick from the sedation at all.
The pain I was in BEFORE the surgery was bad. The pain afterward was negligible. If I had to do it again, I'd choose twilight sedation.
Good luck with your surgery tomorrow!
posted by hurdy gurdy girl at 6:51 PM on June 23, 2011
When the time came for the surgery, I had twilight sedation, and it was GREAT. I remember trying to tell the nurse something just after they put in the IV. The next thing I knew the oral surgeon and nurses were waking me up. I said, "Did you already take my teeth out?" and they smiled and said yes. Then, because it just seemed so unbelievable (I had absolutely no memory of it at all) I said, "Did you take ALL of them out?" and they reassured me that they had. I healed really quickly with very little swelling and didn't feel sick from the sedation at all.
The pain I was in BEFORE the surgery was bad. The pain afterward was negligible. If I had to do it again, I'd choose twilight sedation.
Good luck with your surgery tomorrow!
posted by hurdy gurdy girl at 6:51 PM on June 23, 2011
Best answer: One unfortunate aspect of my recent twilight sedation was that my FIRST memory of waking up was that I was in the middle of a conversation about my divorce. I asked the nurse how she knew I was divorced, and she said "oh you've been talking about it" ... *cringe*
posted by jayder at 6:59 PM on June 23, 2011
posted by jayder at 6:59 PM on June 23, 2011
Didn't you have a consult with the oral surgeon to talk about this?
posted by radioamy at 7:12 PM on June 23, 2011
posted by radioamy at 7:12 PM on June 23, 2011
Best answer: As I remember it, they gave me the nitrous mask, and I breathed that for a few minutes and got a bit high; I remember giggling to the nurse at a joke I made that probably made no sense. Then the dentist came in, they put in an IV, told me to count to 5, and I was out. Next think I remember is the dentist saying "Ok, zardoz, you can close your mouth and sit up now." I don't know what the knockout drug was, but apparently you can respond to orders and requests even though you're out. Kinda creepy.
The operation itself was painless, though kind of a Big Deal. I remember being really stoned the whole rest of the day, and had to eat mashed potatoes and jello for a few days after that. But I've been through a lot worse.
posted by zardoz at 7:17 PM on June 23, 2011
The operation itself was painless, though kind of a Big Deal. I remember being really stoned the whole rest of the day, and had to eat mashed potatoes and jello for a few days after that. But I've been through a lot worse.
posted by zardoz at 7:17 PM on June 23, 2011
Best answer: I don't even know how my impacted wisdom teeth came out, but I tell you what, I knew nothing about it at the time and it was awesome (Drugs! Woot!). There was nitrous, and then me saying "Ow, that needle in my hand hurt!" and then bleargh.....Just wanted to tell you to put a big fat absorbent towel over your pillow before you pass out in a drug-addled snooze. I woke up to a huge wash of blood and it was rather disturbing. And don't let the cavities get infected (rinse them thoroughly with the syringe they'll give you). Mine did and I lost so much wight you could see the outlines of my teeth through my cheeks.
posted by Go Banana at 7:42 PM on June 23, 2011
posted by Go Banana at 7:42 PM on June 23, 2011
Best answer: Yet another twilight sedation success story. I vaguely remember them laying my chair back and having me count down, then woke I up with mouthful of gauze and was shoveled into a wheelchair for my mother to take me home. It's definitely the way to go if there are no medical contraindications. And do make sure to follow the directions they give you (including Go Banana's excellent advice re: towel on the pillow), even if it seems like overkill. I did the whole ice pack/gauze/soft foods thing as directed and was almost back to normal within a few days.
posted by katemonster at 7:59 PM on June 23, 2011
posted by katemonster at 7:59 PM on June 23, 2011
Best answer: Ive had a couple different types of sedation, and really you have nothing to worry about.
For wisdom teeth, make sure you are getting that oh so lovely IV with some oxygen/nitrous mix. Seriously, its great, you wont give a shit about having drills and what not in your mouth. Really easy, and as soon as you get home enjoy some lovely pain medication (meaning take it before you start to feel the pain, it is an uphill climb if you wait too long). In general, it isn't bad at all. If you feel like you need someone around have a friend/loved one around, and take your medication. Again, don't wait for the pain, just take it. If you do find yourself in pain, even after taking vicodin (I am assuming that's what they will script you as it is most common) take another one, just be sure you stay under 4 grams of acetametphen a day ( about 8 vicodin 7.5 mg w/ tylenol). As long as you are not allergic, you will quite fine. If you are, you will know pretty quickly as your face will swell.
Have fun, or as much as you can at an oral surgeons (which really is pretty fun fwiw).
posted by handbanana at 8:22 PM on June 23, 2011
For wisdom teeth, make sure you are getting that oh so lovely IV with some oxygen/nitrous mix. Seriously, its great, you wont give a shit about having drills and what not in your mouth. Really easy, and as soon as you get home enjoy some lovely pain medication (meaning take it before you start to feel the pain, it is an uphill climb if you wait too long). In general, it isn't bad at all. If you feel like you need someone around have a friend/loved one around, and take your medication. Again, don't wait for the pain, just take it. If you do find yourself in pain, even after taking vicodin (I am assuming that's what they will script you as it is most common) take another one, just be sure you stay under 4 grams of acetametphen a day ( about 8 vicodin 7.5 mg w/ tylenol). As long as you are not allergic, you will quite fine. If you are, you will know pretty quickly as your face will swell.
Have fun, or as much as you can at an oral surgeons (which really is pretty fun fwiw).
posted by handbanana at 8:22 PM on June 23, 2011
I got completely put under. It was magical, elevate your pulse and they will give you the magical gas. Very magical.
Tell them how afraid you are and look doe eyed and cute.
posted by ibakecake at 8:25 PM on June 23, 2011
Tell them how afraid you are and look doe eyed and cute.
posted by ibakecake at 8:25 PM on June 23, 2011
Also, just wanted to add after seeing jaydars comment.
After I had my last two wisdom teeth out a couple years ago, apparently when I woke up I was asking for some pot (which funny enough embarassed my mother) but I really have zero recollection of asking a stranger @ an oral surgeons office to find a joint I rolled.
posted by handbanana at 8:26 PM on June 23, 2011
After I had my last two wisdom teeth out a couple years ago, apparently when I woke up I was asking for some pot (which funny enough embarassed my mother) but I really have zero recollection of asking a stranger @ an oral surgeons office to find a joint I rolled.
posted by handbanana at 8:26 PM on June 23, 2011
If you do find yourself in pain, even after taking vicodin (I am assuming that's what they will script you as it is most common) take another one, just be sure you stay under 4 grams of acetametphen a day ( about 8 vicodin 7.5 mg w/ tylenol).
Whoa, whoa. Obviously I Am Not Your Doctor, but do check with your doctor to find out what OTC drugs you can use to augment your prescription drugs. I was told (by my doctor, who is not your doctor, for my situation, which is not your situation) to absolutely avoid any acetaminophen with Vicodin, because the Vicodin already has acetaminophen in it. He allowed me to alternate ibuprofen and Vicodin. This does NOT mean you can take ibuprofen; check and see what your doctor allows you. Don't hesitate to call the office with any questions, or to depute your partner to do so for you.
I got so groggy and doped out that I ended up handing over my Vicodin to my partner so he could dole them out; I simply could not keep track of my dosage.
take it before you start to feel the pain, it is an uphill climb if you wait too long
I heartily echo this: take it on your schedule even if you think you don't need it. 24 hours or so after the procedure, I felt pretty good and I decided to try skipping a dose of Vicodin. That was a bad idea: it takes quite a while to kick in once you decide you need it. It's the only part of the whole experience that was really, truly awful and it was completely avoidable.
My genius bonus wisdom-tooth-extraction tip: if you're buying bags of frozen veggies to use as makeshift ice packs, buy one bag of corn and one bag of peas. (Peas and corn are traditional because they're small and granular, so they conform nicely to your face.) That way, you always have one cold in the freezer and you can tell which is which, no matter how drug addled you get. (This tip is courtesy of my genius husband.) Also, put them in zip-top bags in case they spring a leak, then wrap 'em in a kitchen towel.
posted by Elsa at 8:38 PM on June 23, 2011 [1 favorite]
Whoa, whoa. Obviously I Am Not Your Doctor, but do check with your doctor to find out what OTC drugs you can use to augment your prescription drugs. I was told (by my doctor, who is not your doctor, for my situation, which is not your situation) to absolutely avoid any acetaminophen with Vicodin, because the Vicodin already has acetaminophen in it. He allowed me to alternate ibuprofen and Vicodin. This does NOT mean you can take ibuprofen; check and see what your doctor allows you. Don't hesitate to call the office with any questions, or to depute your partner to do so for you.
I got so groggy and doped out that I ended up handing over my Vicodin to my partner so he could dole them out; I simply could not keep track of my dosage.
take it before you start to feel the pain, it is an uphill climb if you wait too long
I heartily echo this: take it on your schedule even if you think you don't need it. 24 hours or so after the procedure, I felt pretty good and I decided to try skipping a dose of Vicodin. That was a bad idea: it takes quite a while to kick in once you decide you need it. It's the only part of the whole experience that was really, truly awful and it was completely avoidable.
My genius bonus wisdom-tooth-extraction tip: if you're buying bags of frozen veggies to use as makeshift ice packs, buy one bag of corn and one bag of peas. (Peas and corn are traditional because they're small and granular, so they conform nicely to your face.) That way, you always have one cold in the freezer and you can tell which is which, no matter how drug addled you get. (This tip is courtesy of my genius husband.) Also, put them in zip-top bags in case they spring a leak, then wrap 'em in a kitchen towel.
posted by Elsa at 8:38 PM on June 23, 2011 [1 favorite]
When my wisdom teeth were extracted (eight, I think), I was given nitrous oxide and an IV. I remember seeing the needle go in, and being completely out of it within 20 seconds. I remember nothing between that point and waking up on a bench in another room, disoriented.
I was given an Rx for some pain medicine (can't even remember which one!) that kept my jaw from hurting too badly; it recovered within a week of the surgery, as well. The sockets were a little sore. I do remember going to IHOP and having to eat teensy tiny bites because my jaw hurt.
posted by cp311 at 8:41 PM on June 23, 2011
I was given an Rx for some pain medicine (can't even remember which one!) that kept my jaw from hurting too badly; it recovered within a week of the surgery, as well. The sockets were a little sore. I do remember going to IHOP and having to eat teensy tiny bites because my jaw hurt.
posted by cp311 at 8:41 PM on June 23, 2011
Elsa,
You are right about OTC medications. I am assuming OP is a rational, educated individual who knows what they put into their body. It would be a terrible idea to take additional acetaminophen in addition to pain medication. Generally, vicodin (hydrocodone) is made into a preparation combined with acetaminophen, hence the warning from your doctor, or anyones responsible doctor for that matter. I was simply stating the FDAs advisory concerning the daily maximum intake of acetaminophen. Granted this is changing with new guidelines concerning acetaminophen combined with narcotic pain killers, but this should not be an issue concerning OPs procedure. Typical acetaminophen preparations in narotic medications are 350 or 500mg/pill, but some can be up to 650.
/I am not your doctor or anyone elses for that matter, I just know narcotic pain medication.
posted by handbanana at 9:20 PM on June 23, 2011
You are right about OTC medications. I am assuming OP is a rational, educated individual who knows what they put into their body. It would be a terrible idea to take additional acetaminophen in addition to pain medication. Generally, vicodin (hydrocodone) is made into a preparation combined with acetaminophen, hence the warning from your doctor, or anyones responsible doctor for that matter. I was simply stating the FDAs advisory concerning the daily maximum intake of acetaminophen. Granted this is changing with new guidelines concerning acetaminophen combined with narcotic pain killers, but this should not be an issue concerning OPs procedure. Typical acetaminophen preparations in narotic medications are 350 or 500mg/pill, but some can be up to 650.
/I am not your doctor or anyone elses for that matter, I just know narcotic pain medication.
posted by handbanana at 9:20 PM on June 23, 2011
Thanks much, y'all. I may be losing a wisdom tooth tomorrow, but y'all have given me plenty of wisdom tonight.
I feel like I have a pretty solid handle on the twilight sedation concept. Sounds like a marvel of modern medicine. I'll make sure that's what's going to happen to me. IV, check.
I'll start on my medication schedule as soon as I hit the pharmacy, and I'll stick to it, even if I don't yet feel I need it.
I'll prepare for blood-soaked pillows. Ew.
I'll try not to ask for pot. But no promises.
posted by grrarrgh00 at 11:13 PM on June 23, 2011
I feel like I have a pretty solid handle on the twilight sedation concept. Sounds like a marvel of modern medicine. I'll make sure that's what's going to happen to me. IV, check.
I'll start on my medication schedule as soon as I hit the pharmacy, and I'll stick to it, even if I don't yet feel I need it.
I'll prepare for blood-soaked pillows. Ew.
I'll try not to ask for pot. But no promises.
posted by grrarrgh00 at 11:13 PM on June 23, 2011
I had a kind of crappy experience with twilight sedation and wisdom tooth extraction. After I woke up I threw up multiple times in the car home and at home. I was dizzy and uncomfortable for a good few days even though I did not have any major pain (and my surgeon didn't even give me any prescriptions for any drugs).
However, I did also have another experience with sedation, for an endoscopy (I was gagging just with the throat numbing stuff and so they went "whelp, we're drugging you"), and that time the recovery was mostly fine. The major differences that I can think of were that I didn't swallow a bunch of blood during the endoscopy (for vomiting), and I was given what felt like significantly more recovery time for the endoscopy (they just had a room where you could sleep it off until you felt ready, whereas for the extraction they seemed to want me out within 20 minutes).
posted by that girl at 3:49 AM on June 24, 2011
However, I did also have another experience with sedation, for an endoscopy (I was gagging just with the throat numbing stuff and so they went "whelp, we're drugging you"), and that time the recovery was mostly fine. The major differences that I can think of were that I didn't swallow a bunch of blood during the endoscopy (for vomiting), and I was given what felt like significantly more recovery time for the endoscopy (they just had a room where you could sleep it off until you felt ready, whereas for the extraction they seemed to want me out within 20 minutes).
posted by that girl at 3:49 AM on June 24, 2011
I had twilight for wisdom tooth and to re-set a badly dislocated shoulder. Both times, I "woke up" not remembering any of the procedure or pain involved. I also apparently said some really dirty stuff to the nurses while I was blacked out.
posted by PSB at 5:44 AM on June 24, 2011
posted by PSB at 5:44 AM on June 24, 2011
Best answer: handbanana, on rereading I see that you weren't even talking about augmenting Vicodin with OTC drugs, but about a maximum safe dosage of acetaminophen already in the prescription drug, which is a different issue. I'm sorry, I misread your remark.
OP, you should ask your doctor whether you can use OTC painkillers (and what kind) with your prescription drugs for aftercare. It can make your recovery a bit easier to have alternating doses, but it's crucial to use only what the surgeon (or his office) allows.
And let me offer one more reassuring note. While it's good to be prepared for all the possible icky aftermath like bloody pillows and gauze pads, it's absolutely possible that you won't have any of that mess. I used an old pillow and pillowcase and stocked up on gauze, but as it turned out, I stopped bleeding quickly after the extraction and healed up beautifully with no mess at all. You might, too.
Follow your aftercare instructions scrupulously and don't worry if they're slightly different from what others report here. (For example, I panicked when I realized they hadn't provided me with a syringe for rinsing. Turns out, the doc knew I wouldn't need one and didn't want me using one.)
Something that helped calm me down before the procedure: your oral surgeon and support team do this every day. It's totally routine for them, and they will do everything they can to make it safe and as comfortable as possible for you.
Good luck today!
posted by Elsa at 6:05 AM on June 24, 2011 [3 favorites]
OP, you should ask your doctor whether you can use OTC painkillers (and what kind) with your prescription drugs for aftercare. It can make your recovery a bit easier to have alternating doses, but it's crucial to use only what the surgeon (or his office) allows.
And let me offer one more reassuring note. While it's good to be prepared for all the possible icky aftermath like bloody pillows and gauze pads, it's absolutely possible that you won't have any of that mess. I used an old pillow and pillowcase and stocked up on gauze, but as it turned out, I stopped bleeding quickly after the extraction and healed up beautifully with no mess at all. You might, too.
Follow your aftercare instructions scrupulously and don't worry if they're slightly different from what others report here. (For example, I panicked when I realized they hadn't provided me with a syringe for rinsing. Turns out, the doc knew I wouldn't need one and didn't want me using one.)
Something that helped calm me down before the procedure: your oral surgeon and support team do this every day. It's totally routine for them, and they will do everything they can to make it safe and as comfortable as possible for you.
Good luck today!
posted by Elsa at 6:05 AM on June 24, 2011 [3 favorites]
This thread had some good information about wisdom teeth extraction.
posted by TedW at 6:16 AM on June 24, 2011
posted by TedW at 6:16 AM on June 24, 2011
The no food or drink thing before anesthesia: If they didn't tell you not to eat or drink you're probably not getting IV anesthesia.
If you think you're not signed up for anesthesia but are willing to make a fuss at the office just in case you can get it: If you can say that you haven't had anything to eat or drink in 12 hours then you're much likelier to get it. Some places have more relaxed rules and a few places are more strict, but 12 hours covers most without being too onerous.
posted by anaelith at 9:16 AM on June 24, 2011
If you think you're not signed up for anesthesia but are willing to make a fuss at the office just in case you can get it: If you can say that you haven't had anything to eat or drink in 12 hours then you're much likelier to get it. Some places have more relaxed rules and a few places are more strict, but 12 hours covers most without being too onerous.
posted by anaelith at 9:16 AM on June 24, 2011
Surgery complete. I explained to my dentist that I wanted conscious IV sedation, and that's what I got. Insurance didn't cover it for less than 3 teeth, but I was totally happy to pay for it. I didn't remember a bit of it. Total magic-juice.
Elsa, I didn't get your message till afterwards. I noted to my surgeon that Vicodin had been less-than-effective in the run-up to my root canal (was supplementing it with lots of ibuprofen), so he switched my scrip to Percocet. I'm now in bed, in my comfiest pjs, gently nibbling on gauze. Thanks for the note about the bloody pillow and whatnot. My doctor also didn't give me a syringe; I'll try not to panic.
To my knowledge, I didn't ask for pot.
posted by grrarrgh00 at 9:53 AM on June 24, 2011
Elsa, I didn't get your message till afterwards. I noted to my surgeon that Vicodin had been less-than-effective in the run-up to my root canal (was supplementing it with lots of ibuprofen), so he switched my scrip to Percocet. I'm now in bed, in my comfiest pjs, gently nibbling on gauze. Thanks for the note about the bloody pillow and whatnot. My doctor also didn't give me a syringe; I'll try not to panic.
To my knowledge, I didn't ask for pot.
posted by grrarrgh00 at 9:53 AM on June 24, 2011
Response by poster: ^ That's my sockpuppet, sorry. I created this secondary account because I found myself not posting out of fear that I'd need AskMeFi after I'd already used my weekly quota.
posted by mthomps00 at 9:57 AM on June 24, 2011
posted by mthomps00 at 9:57 AM on June 24, 2011
Yay, you're done! I hope it was as easy as mine. In any case, it's over now and you'll be good as new soon. Relax and let your partner lavish you with care!
posted by Elsa at 10:45 AM on June 24, 2011
posted by Elsa at 10:45 AM on June 24, 2011
I had some wisdom teeth out after watching this movie. (go to teh 30 second mark) wasn't quite that bad
posted by Iax at 2:49 AM on June 25, 2011
posted by Iax at 2:49 AM on June 25, 2011
I;m gonna chime in here because you guys scared the hell out of me with thos thread.
I did not have anesthesia. And I am a HUGE BABY about dental work. Really, truly, honestly I swear to you- It's not that bad. There is weird pressure but then all of a sudden the dentist is holding your tooth and it's over. It took like 2 minutes. If you're really worried, do this: Take a finger nail and poke yourself in the gums. Done? Okay, that hurt about 10 times worse than any part of the tooth removal will.
Recovery, I'm like 8 hours in. It hurts! But it's not umbearable. The worst part is the blood. It's like having a headache in your mouth. You'll live!
Anyway, worry warts of the world (like me): You'll be okay and you don't need a full on IV/knockout think going on.
posted by GilloD at 4:40 AM on July 23, 2011
I did not have anesthesia. And I am a HUGE BABY about dental work. Really, truly, honestly I swear to you- It's not that bad. There is weird pressure but then all of a sudden the dentist is holding your tooth and it's over. It took like 2 minutes. If you're really worried, do this: Take a finger nail and poke yourself in the gums. Done? Okay, that hurt about 10 times worse than any part of the tooth removal will.
Recovery, I'm like 8 hours in. It hurts! But it's not umbearable. The worst part is the blood. It's like having a headache in your mouth. You'll live!
Anyway, worry warts of the world (like me): You'll be okay and you don't need a full on IV/knockout think going on.
posted by GilloD at 4:40 AM on July 23, 2011
This thread is closed to new comments.
posted by maxim0512 at 5:39 PM on June 23, 2011