Is nitrous oxide at the dentist worth the cost?

June 2, 2008 7:37 AM

I suffer from dental anxiety, especially when having shots. Is it worth the extra money to get nitrous oxide when having a crown put on?

I have a very sensitive gag reflex and dental anxiety. My anxiety seems to be triggered in one of two ways- when I get a shot, I immediately freak out, start crying, breathing rapidly, etc., and they have to give me 5-10 minutes to recover before they can do anything. If I don't get a shot I can hold out for maybe 10 minutes of having work done (like a cleaning) before I get the same response. The problem is not just the pain of the needle but the sensation of feeling the stuff go in and feeling them move the needle around.

So far, I've always toughed it out through the occasional filling, cleaning, etc., but I'm facing more significant work and I'm not sure how to proceed.

My back molar is cracked (one filling on the top and one on the side, and a crack has formed between them) and is causing me some pain. My dentist says that I need a crown on it to keep it from breaking off and causing more trouble.

I have never had nitrous but have heard that it can really help ease anxiety for people like me. My dentist charges $90 for the nitrous.

So, people who know - would the nitrous help enough to be worth the extra money? I don't like spending extra money unless I need to, but I also hate the way getting shots in my mouth makes me feel.

posted by oblique red to health & fitness (27 comments total)

Yes, yes a thousand times yes!!
posted by pearlybob at 7:47 AM on June 2, 2008

Does your dentist give you a topical on the gum prior to the injection? Mine does and it helps. I haven't had nitrous since I was a kid. I do recall just being completely stoned on it. I think my dentist used to jack that stuff up though.
I too have anxiety in the chair. But not from the shots. Mine is from the drill. The sound, the feel... all evil.
I would say in your case, you should go for the nitrous. It should relax you, or get you high, what have you. And if you are getting a crown, they will be doing some significant drilling to prep the tooth, which can mean some time in the chair.
Good luck.
posted by a3matrix at 7:50 AM on June 2, 2008

Yes. Absolutely.
posted by epersonae at 7:52 AM on June 2, 2008

There is probably a small additional risk, but personally I would do it. I've only had nitrous in conjunction with other more serious drugs administered intravenously, but it seems like it would be useful by itself.
posted by aramaic at 8:11 AM on June 2, 2008

I had nitrous about 20 years ago for a wisdom tooth extraction, and had delightfully vivid hallucinations which I recall to this day. As a matter of fact, I remember hearing the oral surgeon and his assistant laughing in the background at some of what I was trying to say in my stupor.

So, last fall when I had a rear molar extracted, I jumped at the opportunity to have the $90 nitrous in addition to the local Novocaine needed. While I felt absolutely no pain during the process, I think the dosage of nitrous was dramatically lower than the one 20 years ago. No hallucinations at all. I think it just relaxed me a bit.

I'm a real wimp when it comes to anything medical, so there was never any question in my mind that I wanted everything they offered in terms of pain and stress relief.
posted by imjustsaying at 8:14 AM on June 2, 2008

Just had a root canal and crown. The needles my dentists used (one dentist for each procedure) were almost unfeelable; add in a topical, and they are unfeelable.

Make your anxiety expressly clear to the doc, and make sure you use a well-recommended dentist. Consider getting a specialist for separate work (such as root canals). Don't drink caffeine beforehand (unless you are an addict). You should be fine.
posted by IAmBroom at 8:25 AM on June 2, 2008

Nitrous oxide is a fun experience with or without someone drilling at your mouth, so I would go for it if you like soft hallucinatory fuzzy feelings.
posted by bluenausea at 8:34 AM on June 2, 2008

Don't do what the straightener suggests. That is a really bad and dangerous idea. It also won't really give you an accurate impression of what having nitrous at the dentist is like.

Go with the nitrous. It will greatly reduce your anxiety. I have only had it once, and it made the dental work much less stressful. I also freak out at the dentist - once, everyone in the waiting room left, I was hollering so much. The time with the nitrous was extremely easy and smooth. I was still nervous, until it kicked in.

Some insurance cos. will cover the cost partially, so if you have dental insurance you could check on that. You could also ask your dentist about prescribing an anti-anxiety medication for the day of the treatment. Many will give you one dose of Valium or something similar, which also makes it much, much easier to go through the necessary evil that is a dental procedure. Just make sure you have someone to drive or bring you home, or that you can take public transport, if you go with a pill in addition to or instead of the nitrous. That might also be a less expensive option. Dentists are used to anxiety and should be understanding and helpful. If not, find a dentist that will work with you to reduce your anxiety as much as possible.
posted by k8lin at 8:35 AM on June 2, 2008

Do you have anxiety at any other time than at the dentists? Because, if so, you probably do not want nitrous. I hate the dentist too and when I finally got the nerve up to go after several years, I asked for nitrous, thinking, hey, I love nitrous! I had it in balloons back in the day and it was fun! And also, I had it during dental surgery many years ago along with a lot of other fun drugs and if those people would have gotten their fingers out of my mouth I would have been having a perfectly splendid time! Unfortunately, this time the nitrous sent me into a full blown really bad panic attack - so bad that the dentist came dashing into the room to find out why my heartbeat had gone off the scale. Then I had to leave with no dental work done.

He said, "Why didn't you tell me that you have anxiety? Nitrous is completely contraindicated for people with anxiety." Well, he didn't ask me and I didn't know. Therefore, if you're being treated for generalized anxiety or even think you may have it - panic attacks, etc, there's tons of symptoms to look up online - you shouldn't go for the nitrous. Try to get the dentist or another doctor to give you some Klonopin or something like that instead.
posted by mygothlaundry at 8:45 AM on June 2, 2008

As a lifelong anxious dental patient, I only recently discovered nitrous and it makes going to the dentist bearable now. Even though it costs every time you use it, it's really worth it.
posted by mathowie at 8:48 AM on June 2, 2008

I'm generally phobic about needles. I've learned to look the other way when it comes to vaccines and whatnot. Oral shots, though, absolutely scare the living hell out of me, in that "I would rather you pull all my fingernails out and put my nuts in a vice" way.

And then my dentist introduced me to nitrous. Oh, yes. Needle in my mouth? Sure...go right ahead...just keep the gas coming...

Highly recommended.
posted by Thorzdad at 8:51 AM on June 2, 2008

I have a friend who has severe dental anxiety, and when she needed to have a root canal, she told her dentist and he prescribed a couple of xanax for her - it worked like a charm.

I also agree - nitrous will make your anxiety worse!

And as for whipped cream whippets being dangerous? Pish tosh! I should be dead 10000 times over if that were the case.
posted by The Light Fantastic at 9:11 AM on June 2, 2008

Don't do what the straightener suggests. That is a really bad and dangerous idea.

Let me put it this way, if you would rather first try a small amount of legally available nitrous oxide in the privacy of your own home where you would be able to gauge your reaction to it without the anxiety inducing stimuli of latex covered fingers and needles complicating the experience, please don't hesitate to follow up with a request for tips on how to safely enjoy nitrous oxide.
posted by The Straightener at 9:18 AM on June 2, 2008

A dentist in the local area advertises for 'sedation dentistry'. It's like it sounds, but I don't know any more than that. You may want to question your dentist about this.
posted by mcarthey at 9:34 AM on June 2, 2008

The effect of nitrous on me was "Hey, I can feel lots of this stuff, but I don't care. Whoopee!" As noted above, this could vary from person to person.

I'd second mcarthey and ask your dentist about 'sedation dentistry' options.
posted by gimonca at 9:43 AM on June 2, 2008

nthing gas/anti-anxiety drugs. Three things:
1. Your dentist is ripping you off. $90 for nitrous?!?! My dentist charges $25 for use during periodontal procedures and cleanings (mine run 1 hour 15 minutes). It's a bigger pain to work around for something like a crown, but an extra $65 of hassle? I don't think so.
2. Check your insurance. My insurance covers nitrous for sufficiently awful procedures, but I pay out of pocket to use it for routine procedures like cleaning.
3. Also anti-anxiety drugs are cheaper. You probably want something like Xanax (generic alprazolam) - shorter half-life than Klonopin and Valium. $13.95 at drugstore.com for 90 .5 mg tablets.
posted by crazycanuck at 9:54 AM on June 2, 2008

FWIW I second the application of a local on the gum before the needle. I recently changed dentists, and the new one does something odd. She grabs the cheek and wiggles and waggles it while inserting the needle. I never feel the actual needle. Probably because of all the cheek wagging. (mine not hers ;)
posted by Gungho at 9:58 AM on June 2, 2008

Getting the crown on is easy, and it's usually a second appointment. If you easily gag, it's the first appointment where they do the upper mold that will cause problems. Last time I had this, I ended-up taking it out on my own before it had set. Something about the sensation of it setting against the upper mouth. Apparently there's sprays the dentist can apply to numb the gag reflex, and things I've read has said humming helps. Personally still trying to avoid getting the crown I need because of the molds. Apparently there's 3D imaging technology available to bypass them, but I don't think it's widespread yet.
posted by hungrysquirrels at 10:00 AM on June 2, 2008

When I had nitrous (for an extraction), I found that it was a pretty mild sensation—I acutally asked the doc to crank it up some after he had first turned it on, because I wasn't feeling like much other I'm Sitting In The Dentists Chair In Dread—but I think it helped a lot. Nothing profound in how I felt, and that's actually kind of specifically what's so great about it: everything's just kind of laid back and, hey, okay. I recall feeling fairly objectively navelgazy about how and to what degree it was working, which is impressive considering a guy had a wrench in my mouth at the time.

Highly recommended, in other words. Mild overall effect but it does what it says on the tin (actual laughing excluded, in my case). I hate going to the dentist, but I hated going to the dentist less that day than I would have expected.
posted by cortex at 10:02 AM on June 2, 2008

nthing go with the nitrous (although your dentist does seem to charge a lot for it). I am a non-apologetic dental procedure wimp (bad, bad history). I have nitrous for everything, cleanings included. In fact, nobody is allowed to touch my mouth until I'm under the influence...on the front of my chart, in large, bold black sharpie it says 'use nitrous.'

The years of bad experiences with dentists left me so anxious about dental work I actually put the tips of my fingers through the vinyl arms of an exam chair once. My current dentist, bless him & all his little elves, worked with me to make sure I feel *nothing* remotely related to pain when he works on my mouth. Nitrous helps enormously...it's not that you're so out of it you don't know what is going on, but the world becomes wrapped in cotton wool and floaty, so you can take a disinterested view of what's happening. I'm so acclimated to the nitrous now that I go on a mental vacation as soon as the mask goes on, and nobody bothers to talk to me at all until I'm back on oxygen. An equally phobic uncle goes one step further and plugs into his ipod as soon as the mask goes on, so he doesn't have to hear the drill, or the crack of enamel, or any other anxiety-inducing sounds. Neither of our dentists object to our coping mechanisms, and your dentist shouldn't either.

A good dentist is one that listens to your concerns and works with you to alleviate them, and that includes doing whatever it is that works to help calm your dental work anxiety. If that means you need nitrous to get through an appointment without biting anyone, your dentist should be the first one to suggest it.
posted by faineant at 10:52 AM on June 2, 2008

Most people react well to nitrous oxide to some degree, but the one time I tried it last year I found it did little or nothing to relax me. I asked the dentist if I was getting enough, as I didn't feel any change at all during prep, but he said I was getting the standard dosage. I found that the topical anaesthetic gel still made the needle almost painless, but I can't say that the added expense of nitrous oxide would have been worth it if I had been paying the bill myself.

So, if you have insurance, or if you're willing to weigh $90 against the prospect of smoothing out a very uncomfortable experience, AND if you don't have generalized anxiety, as mygothlibrary described, I'd say try it. You are very likely one of the people who will benefit, and if you aren't, you're just out a few bucks.
posted by maudlin at 11:17 AM on June 2, 2008

I've never had nitrous, but I am a major dental chicken, and I have had Valium/Xanax beforehand, which was fantastic and I highly recommend it. Of course someone needs to drive you home afterwards, but its worth it.
posted by Joh at 11:51 AM on June 2, 2008

I love the nitrous, and it's made it possible for me to go to the dentist after many years' avoidance. I also get prescription anti-anxiety meds, and together they make even the most grueling periodontal procedure a real pleasure. Yes, DO get someone to drive you, at least the first time.
posted by TochterAusElysium at 12:57 PM on June 2, 2008

Oh, and bring an iPod and some trippy music and you'll wish you had a dental appointment every week!
posted by TochterAusElysium at 12:58 PM on June 2, 2008

Second nitrous and music -- I've always had trouble getting work done, and that makes it much easier. Also the effects fade quickly, so I don't feel drugged all day.
posted by nalyd at 5:21 PM on June 2, 2008

Thirding nitrous and music. Be prepared to not drive for a bit afterwards.
posted by GPF at 8:07 PM on June 2, 2008

Just wanted to thank everyone for the advice! I'm going to go ahead and try it for the first appointment, and then see how it works and take it from there in the future.
posted by oblique red at 8:40 AM on June 3, 2008