Dental sedation anxiety.

April 27, 2006 2:34 PM

Help me allay my specific dental fear: sedation.

I'm getting my wisdom teeth out tomorrow, and I'm scared. Not of the part where it hurts, though that will not be so rad either, but the sedation part. They're giving me a prescription sedative, the kind where I'll be awake but not remember after, and I'm taking a cab home.

I have some problems in general with anxiety, which partly stem from some bad experiences with psychedelic drugs back in the ol' misspent youth (that is, a couple years ago). As a result, the idea of being awake but not really aware of what I'm saying or doing, and not remembering, really scares me.

I've read the previous AskMe threads on dentist fears, but those mostly seem to propose sedation as the answer, whereas for me it's the problem. Does anyone have any advice on:

1) How to calm down before the appointment so I'm not a complete stressball, which I know would make everything worse.
2) What's it feel like when this stuff kicks in?
2) What should I tell my dentist?
3) How do I deal with worries about the loss of memory after I "come to", and how is it going to feel?

Thanks!

posted by ITheCosmos to health & fitness (26 comments total)

1) I'm not too sure on, but
2) It doesn't feel like anything. You're awake in the dentist's chair waiting to be sedated, and then BAM you're being helped out of the chair and are very groggy and everything's over and there's a lot of cotton in your mouth.
3) Dentists are used to patients having anxiety problems. Tell them exactly what's freaking you out.
4) For me, there wasn't a loss-of-memory issue at all. It literally felt like I had blinked and it was over. It wasn't like falling asleep, or substance-induced memory loss at all.
posted by Jairus at 2:47 PM on April 27, 2006

I had not experienced any psychedelics before my experience with sedation (also wisdom teeth), but:
2a)It feels sleepy I think, but really I can't remember exactly what it felt like as it was taking effect (I can't remember because of the drug, not because it was a long time ago).
3)To me, afterward it just felt like I had been asleep or unconscious. It wasn't really a sensation of "loss of memory". It was not even similar to any hallucinogic feelings.
posted by unknowncommand at 2:50 PM on April 27, 2006

Whoops, sorry about the numbering on the last points. You get the idea.
posted by ITheCosmos at 2:52 PM on April 27, 2006

I have been sedated in this manner. It doesn't feel like anything - you will probably have a specific final memory before the sedation, then as you come back to reality a jumble of images. It is literally a chunk taken from your life, although you may have flashbacks of the procedure afterwards. Not disturbing, but a few days afterwards I could see snapshot images of what had happened (I think? Still not sure TBH.)

The best course of action is to say everything you posted here to the dentist and explain you are anxious. Let him talk you through it and it should be fine. It will be over and done with before you know it - in a very literal sense.
posted by fire&wings at 3:10 PM on April 27, 2006

can you bring a friend or a family member with you to sit with you during the procedure (with a book or magazine - it's a long visit)

this will allay take care of a few issues at once - the friend can help you into the taxi (or their car), you will have a friendly presence there as you are going through your extractions, and if you are curious to remember what happened during the extraction, the friend will be there to tell you about that as well.
posted by seawallrunner at 3:47 PM on April 27, 2006

I had several extractions not long ago. I had some anxiety issues and I hate sedation, too. I also used to use drugs as a kid, but that was a while ago. Here's how I went through it.

1. I stayed "busy" right up to getting in the chair. I read. I cleaned. I cleaned some more, and then I played some engrossing video games. I recommend just "not thinking about it" and that's not easy, so I recommend keeping yourself occupied.

2. They laid me flat in the chair and started up some nitrous. They put an IV in my arm - I didn't care, I was loopy. I woke up, I remember "an experience" - there are sounds like a zipper, that I remember - it was a dream state. Trust me on one thing: Whatever you do, whatever happens while you're in the chair? It's completely mental. You won't be speaking and you won't be moving around. No one's going to hear you air the dirty laundry. After the procedure, I remember standing in the lobby - lots of cotton in my mouth. Then I remember being helped onto my couch.

3. Tell your dentist your fears. They will understand, they will give you all the help you need to get through it.

4. my experience with memory before and after is like everyone else's - a final memory - the nitrous mask - followed by standing in the lobby of the dentist office, and then some minor montages on the way to my house.
posted by disclaimer at 4:01 PM on April 27, 2006

My wisdom teeth: The mask went on, and then I was in another room, asking my father why they hadn't started yet.

(It was already done, of course.)
posted by mendel at 4:06 PM on April 27, 2006

I don't know how much my comments will help allay your anxiety, and IANAD, but I have had major surgery, including oral surgery, on several occasions, and have learned more than many laymen about anesthesia. Modern anesthesia usually involves using a number of drugs and chemicals to suppress pain, and to relax you and put you in a hypnotic state where your memories of an unpleasant procedure are minimized. Using several agents with different target actions allows doctors to use lower overall doses of the drugs, and to tailor the effects to those you need for the procedure you are having, and your individual medical needs.

The dentist or oral surgeon administering doing your procedure has a number of choices of anesthetic/analgesic agents to use. Typically for oral procedures, combinations of sodium thiopental and Valium may be injected intravenously to act as hypnotic agents to relax you and limit your memory of the procedure, and these agents are responsible for the "twilight" description of this type of anesthesia. Local injections of novocaine into the mouth will probably be the analgesic element of the combination. Sometimes, a low concentration of nitrous oxide gas is offered in combination with oxygen in a nasal canula, as an adjunct element of the anesthesia (this helps keep you oxygenated and relaxed, and may make it easier to breathe, and to "wake up" easily at the end of the procedure).

This combination of drugs will typically lack the muscle relaxants or general paralytic agents such as the synthetic versions of curare needed for general surgery, which can cause panic in patients during induction, as they feel themselves becoming unable to move or breathe, and fear apnea. You should not have any of this sensation, because such agents are typically not used during dental sedation. You don't need to be completely immobilized for oral procedures, and the hypnotic agents used will make you want to be compliant with the doctor's directions for opening your mouth and turning your head as needed, yet leave you able to respond to questions. This allows the care team to assess your condition readily throughout the procedure, as well. You may make some vocalizations during the procedure, but these are rarely of any coherency, and medical staff tend to ignore them. You've probably said more during some stressful dreams at some point in your life, than you will, intelligbly, during an oral extraction procedure, with your mouth full of guaze, implements, and fingers.

Overall, you should never feel "out of control" during this procedure, as you may have previously with street drugs. During the induction phase of the administration of the anesthetic, you may feel a warmth at the IV site in your hand or arm, and you may have a slight metallic taste as the sodium thiopental or ketamine solution is introduced. You will generally then just quickly feel sleepy, and this will happen in a matter of about 15 to 30 seconds, perhaps even as you are asked to count backwards from 100.

You'll "wake up" an hour or two later, perhaps as a result of the administration of a waking agent, and the wearing off of the sodium thiopental solution. You may have a slight headache if either thiopental or another sedating agent such as ketamine is used, but many people don't remember any such headaches.

It's clear that you are anxious about receiving anesthesia, but you should discuss this with your dentist/surgeon before beginning the procedure, as you have laid it out here. You'll do better throughout the procedure if you can relax, and work with the staff and the drugs, and you can't do this if you are needlessly anxious. So, talk, and take the advice of the staff.

And finally, because your profile suggests you are female, it is fair of you to want to be especially sure of whom is going to be in the treatment suite with you during the procedure. Some practices can offer a videotape of the room, for verification of what went on "while you were out" that can greatly allay your fears, whereas in others, the presence of a nurse or assistant at all times when a procedure involves anesthetics is mandated by law. Discuss this with the staff. It's not the first time they've heard such things, and again, to get the best outcome, you have to be comfortable and cooperative, and in a good frame of mind. So ask what you have to ask, to come to a relaxed and confident state of mind, before beginning.

Good luck. Don't be afraid needlessly.
posted by paulsc at 4:26 PM on April 27, 2006 [2 favorites]

The last thing I remember before my wisdom teeth were pulled was that the song "Train to Marrakesh" was playing over the intercom and I was giggling because I thought "this song is about drugs!" And then I woke up with my mouth all packed with cotton gauze. In between a couple of hours had passed.
posted by Sara Anne at 4:30 PM on April 27, 2006

I think going with a friend is a good idea.

When I had my teeth out (long ago), I was so out to lunch afterwards that it was all a friend could do to get me in the car and home. I was pretty zonked out. I hope you'll be OK in a cab on your own.
posted by bim at 4:59 PM on April 27, 2006

You really don't need sedation. I had mine out without. You are so shot full of novocain that it doesn't hurt.

Its not bad if you can handle the sensation of teeth being forcibly wrenched from your jaw.
posted by MonkeySaltedNuts at 5:14 PM on April 27, 2006

Sedation is the only way to go with dental procedures where they are yanking or cutting teeth out of your mouth. It is truly miraculous--you will wake up thinking why didn't they start yet, and yet your teeth are gone! It's amazing. I'm not going to say you have nothing to worry about, because with any procedure involving anesthesia there is always risk. But it makes this procedure a lot more pleasant.
Good luck. Relax. Follow all of the instructions they give you and you'll do fine.
posted by FergieBelle at 5:24 PM on April 27, 2006

When I had my wisdom teeth out this past summer, I also was put under with nitrous. They put an IV in my arm, put the mask over my face, and *maybe* a minute later, I was out. It doesn't really feel like anything, except I distinctly remember my ears feeling fuzzy and then I got very tired. When I woke up an hour or two later, they put me in a wheelchair, wheeled me to my mother's car and she drove me home. In the car I basically fell asleep and stayed asleep for the rest of the day.

I agree with the others to tell your dentist; they've handled stuff like this (and probably much worse) before.

If you're really worried about the 'memory loss' I'd have a trusted friend or relative with you, so that they can fill you in. Also, it will probably be good to have them help you into the cab and into your bed when you get home. In all likelihood, you will not be able to do this yourself.

Wisdom teeth removal tip: your cheeks will probably hurt badly. put frozen vegetables in small ziplocks. take an old pair of pantyhose, cut a leg and toe off (making a sleeve). tie a knot in the middle, place a ziplock of vegetables in each side, tie at the top of your head (like the the cartoons of people with toothaches). vegetables are better than ice because you can always refreeze and/or eat them. good luck.
posted by Flamingo at 6:19 PM on April 27, 2006

I had IV valium when I had my wisdom teeth out and I was afraid that I'd feel out of control, as well. I didn't at all. Just as everyone has said, I sat in the chair and they gave me the IV. The next thing was the dentist saying to me "got the first one!" and then I was sitting in the chair and the IV was out and my mother was talking to the dentist. It was perfectly pleasant and I had no feelings of being out of it -- it was like being (mostly) asleep.
Seriously, I've secretly wished they could give me IV valium for every dentist and/or doctor appointment.
posted by jdl at 6:48 PM on April 27, 2006

I am having a wisdom tooth extracted Monday. I have had 2 previous extractions under sedation. After the first sedation experience, I decided: IT'S THE ONLY WAY TO GO!

My first experience: I was thinking, why are the lines in the wallpaper moving like waves? Then... "OK we're done."

Second Experience: Assistant is asking me questions like where do I work, how many kids do I have etc. I am answering, then I say "I know you are just talking to me to see when the sedation kicks in." Then... "OK we're done!"

They won't let you drive yourself home tho. I have a friend lined up for transportation. You will need to do the same.
posted by The Deej at 6:54 PM on April 27, 2006

I did a 7 hour dental procedure about a month ago (long story of neglected teeth and a decision to take care of it). 7 extractions, two fillings, a bone spur removed from my jaw, and periodontal laser surgery..

I did it under sedation. A pill an hour before the appointment... by the time I was in the chair I was pretty looped, but I was awake through the whole thing... good dentist, NO pain at all.

At this point I can barely remember the 7 hours, just a few disjointed images, but there was never a sense of not being in control, even though I probably wasn't.

And, yes, take a friend, there was no way I could have driven there and back again in that condition.

Sedation dentistry is the ONLY way to go if you have anxiety about this type of treatment. I would do this again in a heartbeat and wouldn't have waited 25 years if I had any clue how easy it would be. And...now I can smile! :)
posted by HuronBob at 7:25 PM on April 27, 2006

I remember being partly conscious under sedation when I had mine out, though it didn't hurt. This was 23 years ago, when I was 15. They put an automatic blood pressure cuff on me and I remember that it started to itch when it inflated.
posted by brujita at 10:06 PM on April 27, 2006

MonkeySaltedNuts, allow me to disagree. If the dentist feels that sedation is necessary, it probably is. When I had my lower two removed, the dentist knew it would be a difficult extraction, recommended general but felt that local anesthesia was doable. Being a poor student without insurance, I took the local.

Well. It turned out that the teeth were wedged pretty tight and rather than being able to pull them, they had to be crushed and removed in pieces. It took three and a half hours. The novocaine wore off twice. If I had to do it again, I'd pick the general and damn the cost.
posted by bonehead at 6:27 AM on April 28, 2006

Like all of life's tough questions, one should look to Penny Arcade for answers:

I was given a prescription for Ativan before a recent dentist appointment and I still have one of the two tablets given to me. I gotta say this I was blown away by how much the Ativan helped with my anxiety. It didn’t just help, it got rid of it entirely. In its place was a carefree feeling of contentment with just a hint of drowsiness. I sat there in the car while Kara drove me to the dentist marveling at my new found easy-going demeanor. I remember thinking to myself, “Wow, is this what normal humans feel like??"

From http://www.penny-arcade.com/2004/02/25
posted by NortonDC at 7:18 AM on April 28, 2006

Look at the loss of memory as a blessing. There is no reason to want to remember a tooth extraction.

If you're afraid of being taken advantage of whilst under sedation, request a friend or female nurse be present for the procedure.

If you're afraid of losing control in the chair, remember that sedatives aren't like psychedelic drugs - they simply relax you. You just feel all lovely and calm and everything is good. You might laugh - that's OK. You might burble incoherently - that's OK too. And for the most of the procedure, you won't be very talkative because a) you'll be sedated and b) you'll have a bunch of stuff in your mouth.

All the sedatives and premeds and anaesthetics I've had have been thoroughly pleasant. I too was worried about the potential psychedelic/panic-inducing effects, and there aren't any.
posted by pollystark at 8:22 AM on April 28, 2006

Thanks everybody for your reassurances and advice. I ended up taking my father up on his repeated offers to drive all the way into Montreal to pick me up after my appointment. So I don't have to worry about taking a cab home alone or falling down the stairs when I get to my apartment, and he doesn't have to worry about any of that either.
posted by ITheCosmos at 9:38 AM on April 28, 2006

#bonehead: If the dentist feels that sedation is necessary, it probably is.

The thing is that sedation is the assumed treatment. When my dentist was explaining the proceedure and started talking about sedation I asked if it was really necessary. He said in my case it was not but most people don't ask about it.

For me it took about 4 minutes for 4 teeth to be pulled.

But by all means if the dentist thinks it could be a long involved proceedure then go for sedation. ITheCosmos it seems has never gotten any indication from her dentist the sedation is necessary and maybe she should ask.
posted by MonkeySaltedNuts at 9:54 AM on April 28, 2006

I'm glad you asked this - I'm having my wisdom teeth removed in mid-May, so I'm a bit nervous about it, too. They're doing the same to me - Valium, but not knocking me out. paulsc, you helped a lot, thanks.
And MonkeySaltedNuts, way to put that graphic image in my head. "Forcibly wrenched" is not a pretty picture. I think I'll go read the other one again...
posted by denimflavored at 11:28 AM on April 28, 2006

Twilight anesthesia is usually done with a benzodiazepine and a narcotic. The IV benzodiazepine is the strongest anti-anxiety medication known. If you stay awake/aware long enough to have any experience at all, you can expect to be transported into a blissful, calm place where no anxiety is possible.
posted by ikkyu2 at 6:44 PM on April 28, 2006

It seems that I have genetically bad teeth and so I've had a lot of experience with dentists.

It got to the point that I hate Novocaine - it gives me headaches and a numb drooling mouth for 3+ hours. So for minor drilling I would rather experience a few seconds of sharp pain than the sensation of many hypodermics and a lasting Novocaine hangover. If what started off as minor turns out to be excruciating then I can always call a halt and ask for the needle.

For major drilling or extractions of course Novocaine is good. When facing wisdom tooth extraction, I asked my dentist if putting me under would mean no Novocaine. "No" he said, because Novocaine constricts blood vessels and reduces bleeding so it is always used.

Since my dentist said my wisdom teeth were an easy extraction I elected for no sedation and it was quick and I didn't become unaware of part of my life. Plus I was aware enough to be able to clamp down on the gauze pads so that my unconscious mouth didn't fill with the blood gushing out of the empty sockets.

Of course, after the Novocaine wears off you will experience a bunch of pain because something that was painless to wrench/tear away has made your body complain about it. The aftereffect pain is worse than what you would feel even if there was no sedation or no Novocaine.

This is where something like vicodan comes in. When I took it I felt that it just turned down the pain and I could function normally - that is until I had an urge to watch TV and selected a "funny" show that I never thought was all that funny and got a bad case of the giggles.
posted by MonkeySaltedNuts at 8:47 PM on April 28, 2006

The very last thing you should do is stop off at the ladies' room. Trust me on this. I've had dental work that went on long enough they had to lighten the nitrous and let me get up. Yours won't be that long, but it's still a good idea.

If they forget to tell you, if the sockets bleed at home, you put a damp tea bag over it for a while. (Most dentists will actually tell you to do this, it's not like an old wives tale or something.)
posted by deep_cover at 7:57 AM on April 29, 2006