Would a dentist allow some form of general anaesthesia in order to extract necrotic teeth from a whussy person?

August 1, 2007 7:06 AM

Major dental work required - nasty old dead teeth need to be removed (at least four of them) and I'm scared witless. Is asking for a general anaesthetic something that a dentist would allow?

A few years ago I had an abscess which resulted in a major infection causing me to look like the elephant woman and the tooth responsible had to be removed, during which the local anaesthetic did nothing and I cried like a baby for about an hour afterwards because I was so traumatised by the pain. Before this, pain was not something I feared (I've experienced childbirth twice). Now, I fear for my sanity if I have to endure it again. I have at least three molars that are beyond saving and one tooth near the front (I don't know the correct name for it) that I refer to as my mediaeval tooth because it is broken and black and really, really ugly which will all have to be extracted. I'm planning on getting a bridge for the teeth at the front (the tooth previously removed was on the opposite side of the mediaeval tooth). What I fear is that, because I have let my horrid teeth get to such a state that they are quite brittle, the extractions will not be easy and they may break into bits and the whole thing will be incredibly painful and traumatic and messy. Is asking for a general anaesthetic something that a dentist would allow? (I'm aware of the risks of general anaesthetics and I'm prepared for that). Even a twilight kind of anaesthetic would be better than me attempting to retain some kind of composure that I don't think I'm capable of. I'm in Australia, if that makes any kind of difference. And yes, my children brush their teeth twice a day and I will counsel them on the inadvisability of eating lollies and wondering what happens to all that sweet, sweet sugar that just kinda sits there for the rest of the day. I know I'm a whuss and responsible for the horror that is my mouth but I'm traumatised!

posted by h00py to health & fitness (21 comments total)

I had sedation last time I went to the dentist (UK). I didn't feel any pain before, during or after the extractions (other than the needle). However, while I'm normally a fairly calm person, I apparently because physically violent while under, basically fighting to get away from the dentist, nurse, etc. I have no memory of this.

I'm an extremely nervous dental patient, so my case might be an extreme one, but I'd advise speaking to the dentist beforehand and letting them know that you're very nervous.

Oh, and find someone you like and trust. Not just the nearest, or the cheapest. It'll make life much easier.
posted by Solomon at 7:12 AM on August 1, 2007

A dentist would probably allow this, but it really depends on the individual.

At least in the US, though, there are entire practices that will use General on all procedures, catering to the Fear Of Dentists crowd. I think they just call it "sedation dentistry".
posted by jozxyqk at 7:14 AM on August 1, 2007

Does Australia use nitrous oxide? It really calms you--I've felt several times that they could yank out all my teeth with a rusty pliers while I'm under nitrous and I'd still be all "La LA la..."

Some folks in the US request nitrous even for something as simple as a cleaning. I am no longer afraid to go to the dentist now that it's an option.

Also, I can't think why they couldn't knock you out, as they do for removal of impacted wisdom teeth here, but you will need to call around and find a dentist who does that.
posted by GaelFC at 7:29 AM on August 1, 2007

I don't know about Australia, but in the U.S. it's entirely common to have general anesthesia for wisdom tooth extractions. I had all four out at once and never knew a thing. Usually it's an oral surgeon who does this job, though.

A decent dentist will understand your fears and come up with something that works for you. You should explain to your dentist what you've explained here, and if he or she seems unsympathetic or uncomprehending, you need a different dentist.

I spent years traumatized about dentistry thanks to the ol' family dentist: "oh, you don't need novicaine for a little cavity like this...." but finally found a new dentist who is so relaxed and understanding -- and funny, that seems to help -- that I no longer fear the chair.

That said, when he needs to do work on my teeth, he prescribes me a couple of Valium to take beforehand. That also helps!
posted by tomboko at 7:30 AM on August 1, 2007

Sedation and general anesthesia are a world apart; if you are undergoing sedation, especially deep sedation, it can be more dangerous than a general anesthetic. It is less common in adults and I am in the US rather than Australia, but in our operating room a big portion of our business is pediatric dentists who do cases under general anesthesia. For an idea of what is meant by sedation vs. anesthesia, here are the descriptions the American Society of Anesthesiologists use. So it is certainly possible to have your work done under some degree of sedation, and while finding someone to do it under an actual general anesthetic is possible, I do not know how easy it would be in Australia. Sorry I can't be more informative, but I hope this at least gives you an idea of the options and some questions to ask your dentist.
posted by TedW at 7:33 AM on August 1, 2007

Here in the US, I have asked for I.V. anesthesia for extractions. It costs another $150 or so, but to me it's worth it. The way they explain it is that you are "barely under" but you'll have to have a ride home. And you can't eat anything for x number of hours before.

I am not a good dental patient. For one extraction, the dentist tried to talk me out of it, saying that with nitrous and novocaine, it would be quick and painless. I explained it wasn't the pain I had a problem with, it was the pressure and grinding and breaking and having tools in my mouth, no matter for how short a time. I told him, "I promise if I am awake, I will NOT cooperate with you!"
posted by The Deej at 7:40 AM on August 1, 2007

Does Australia use nitrous oxide? It really calms you

The effect varies from person to person. The only time I had it, I didn't notice any effect at all and I remained quite jumpy until the needle in my vein started pumping in valium and other good stuff.

And yes, there are many google hits for "sedation dentist australia."
posted by ROU_Xenophobe at 7:41 AM on August 1, 2007

The term they seem to use in my area is "comfort dentistry." They knock you out and you don't know a thing.

I'm an extremely jumpy dental patient after I had a horrible wisdom tooth experience, and I freaked out when I found out I needed some cavities drilled. The dentist offered me Valium and nitrous to help me through it. It turns out I didn't need either to tough it out, but at least the offer was on the table. Just talk to your dentist, and shop around until you find someone you're comfortable with. They've seen terrified patients before.
posted by christinetheslp at 8:00 AM on August 1, 2007

Again, 'don't know about Australia but in US...'
It's been my experience that most dentists are not equipped for general anesthesia (finding a place for the patient to sleep it off and someone to monitor them) but oral surgeons are.
I really enjoy Nitrous Oxide. I once heard a comedian say 'it still hurts like hell, but you just don't give a damn!'. But there seems to be a movement around here at least (northeast US) against using it. I haven't been able to get it this century. The last procedure I was supposed to get (but turned out not needed) the surgeon prescribed Valium instead.
posted by MtDewd at 8:03 AM on August 1, 2007

The only time I had any sort of sedation other than nitrous for dental work was at an oral surgeon's office, not a regular dentist. That said, I had what they called a "twilight sleep" sedation, or a valium IV. It was great for the first time - when I had one, mostly exposed wisdom tooth removed. It was not so great the second time when I had 3 seriously impacted wisdom teeth removed.

It's totally reasonable to ask your dentist about this, especially since you had such a bad experience in the past. I am sure that he or she can find a way for you to get through this procedure with as little pain and anguish as possible. And if he or she doesn't take your request/concerns seriously, then I would shop around for a new dentist.
posted by tastybrains at 8:12 AM on August 1, 2007

and the tooth responsible had to be removed, during which the local anaesthetic did nothing and I cried like a baby for about an hour afterwards because I was so traumatised by the pain.

Your problem isn't the local anesthetic, it's assertiveness. Different people have different needs and you need to not be shy about saying "I am not numb." Personally I numb up at the drop of a hat. My darling girlfriend last time had to get 4 shots before she was sufficiently numb for them to proceed.

Know when you walk in that you're not going to let them do anything to you that hurts. If you're not numb enough you say so and ask them to shoot you some more. If they refuse (which isn't going to happen) then you can stand up and leave.

The dentist is scary but you'll feel less afraid if you remind yourself of how much control you really have. You're not a prisoner there, you can demand they stop if they're hurting you.
posted by phearlez at 8:37 AM on August 1, 2007 [2 favorites has favorites]

ask around till you find a dentist that will do this because, yes, it is a reasonable request.

when I had my wisdom teeth out I was given valium before the procedure and a drip iv sedative. It worked perfectly.

ask if you can have a valium or other anti-anxiety med and think about taking some in the days after because IMO it is as important to treat the anxiety as well as the pain.

valerarian might help with the anxiety but tell your dentist if you use it.

I am not a dentist or a doctor.
posted by cda at 8:37 AM on August 1, 2007

One other suggestion - take your iPod or Walkman or whatever if you like. Many dentists offer stereo headphones to their patients, but I like to take my own music. It helps to relax you, and you won't hear all the traditional sounds of the dental tools.
posted by Oriole Adams at 9:34 AM on August 1, 2007

IANAD--but I play one on TV. Your problem with the first extraction with local anesthesia was that you had an infection. The infected tissue has a more acidic pH than normal tissue. The injectable anesthetic doesn't work worth a darn at infected-tissue pH. I know this, because I had the same experience with an impacted wisdom tooth that had abscessed. If it hadn't been for the nitrous, I would have been in agony.

If your other teeth aren't infected, you'd almost certainly be okay with the local. That said, why traumatize yourself? Let them knock you out.
posted by WyoWhy at 10:16 AM on August 1, 2007

Your problem isn't the local anesthetic, it's assertiveness. Different people have different needs and you need to not be shy about saying "I am not numb."

I'd say the problem is the dentist, who should be far more careful about whether his patients are numbed and should be far, far more attuned to whether his patients are in visible pain.
posted by ROU_Xenophobe at 10:27 AM on August 1, 2007

Talk to a regular doctor about your anxiety problem and get yourself a prescription for Xanax. Take it before you go. Some doctors will hand out anti-anxiety medications for people who have to undergo difficult procedures (ie, for cancer patients who freak out at going to the oncologist, etc).
posted by crazycanuck at 11:16 AM on August 1, 2007

I am a horrible dental patient, scared of any procedure and pain. Inconveniently I am also scared of general anaesthetics. The most important step is to find a dentist you trust and who is caring. That said, the last time I needed lots of dental work done (wisdom extractions AND root canals!), the dentist prescribed me valium and halcyon, plus gave me a shot of benadryl once I got into the chair. The valium calms you and makes you not care. The halcyon blanks your memory so you don't remember anything while under the influence. That freaks some people out, but I prefer not to remember anything about dentistry so I was fine with it. The shot of benadryl just made me dozy.
posted by Joh at 12:26 PM on August 1, 2007

what phearlez says deserves to be underlined: ongoing, intense pain in the dentist chair is not acceptable: you should STOP your dentist any time you feel intense pain. It is likely you are dealing with not enough local or it needing to be injected into a different or larger area (I have through misfortune more than neglect had a TON of dental work).

There are dentist who advertise and cater to patients with anxiety or for "pain free" dentistry. Contact one and discuss your options. A good relationship with your dentist is of great value, having a good relationship is a lot more important to me in dentistry than with, say, my personal G.P.

And please, please see a dentist twice a year from now on and do everything they say? Teeth problems are pretty uniform in that they get significantly worse, more difficult and uncomfortable to treat, and more expensive with neglect.
posted by nanojath at 12:29 PM on August 1, 2007

As a slightly different data point, I'm in NZ and when I had impacted wisdom teeth removed I was given the options of local only, sedation or general anaesthetic. I had a local only but I know many many people who went for the general. We also have the 'sedation denistry' or 'pain-free dentistry' stuff advertised here. I don't see why Australia's dental system should be radically different than ours, particularly given one of our main chains (Lumino) originated in Australia.

More importantly, the dentist should be talking through your options before the procedure, preferably at the initial consultation. You shouldn't even have to specifically bring up the general, the dentist should be making suggestions and asking your opinion, giving you an opening. Use that opportunity to tell them what you want. Your fears are totally reasonable and normal and how you outlined the situation here is fine, and asking for a general is a valid request. You also have the right to feel happy with what the dentist is going to do before you proceed, both the pain management plan and the actual dental procedures, so find someone else if you don't. There are plenty of dentists out there willing to do a good job.
posted by shelleycat at 3:01 PM on August 1, 2007

I don't want to scare you, but talk with your dentist or oral surgeon carefully, and ask if there are any situations in which he'd change his mind and not sedate you.

When I went to the oral surgeon to have my wisdom teeth out, he had promised I would be completely under, but when he had trouble starting an IV, he decided not to put me all the way under. He didn't tell me this, and I ended up just being in a twilight sleep, wondering why I was awake. I was pretty angry.
posted by IndigoRain at 3:32 PM on August 2, 2007

(FWIW, I really didn't have a lot of pain during the procedure... it just scared me a little that I was awake and he was yanking on my teeth.)
posted by IndigoRain at 3:33 PM on August 2, 2007