"Conscious" IV sedation failed at the dentist - what now?
December 21, 2017 2:41 PM   Subscribe

Yesterday I had two root canals and two extractions at the dentist while under IV sedation. But I never fell "asleep" and I remember pretty much everything that happened and now I'm even more terrified of going back...which is bad, because I have two more root canals and an incredible amount of fillings left to do. What now? (CW: there's a lot of traumatic dental work details within - most folks will probably be fine with it, but if you're like me then you probably don't want to read it.)

Basically I have shitty teeth, mostly due to genetics. That, coupled with a bunch of traumatic dental experiences over the past 35 years, as well as a current lack of dental insurance, have left me with a completely appalling set of choppers that have recently started to hurt. A lot.

The only good dental experience I've had was when I had my wisdom teeth out in 2011 (shoutout to Dr. Tomaich in Davis, CA!). I went in, I drank a little cup of midazolam, and a few hours later I woke up and it was all over. They inserted the IV after I was out (which was nice, due to my needle phobia). That's what I was looking for this time. I wanted to be completely knocked out and not remember anything about what was likely to be a really awful experience.

Of course, none of the dentists in my town of 10,000 people practice any sort of sedation beyond oral benzodiazepenes, which I've tried many times before but do not help much. So I went further afield and I found the nearest dentist who practices IV sedation, who is 80 miles south of here in another state. I told every single member of his staff and the dentist himself about my experience with Dr. Tomaich and that was exactly what I was looking for and they promised me that I would fall asleep and not remember a thing. They even said that when I arrived at my appointment yesterday morning. "Oh don't be scared, soon you'll be asleep and you won't remember anything!" At least four different people said those words to me.

Well, they were wrong. First off, the IV was placed when I got there without any sort of sedation, which caused a HUGE amount of anxiety before things even got started (and I told them over and over that I have a major needle phobia). Then I was completely awake during the entire four hour procedure. I remember every single thing that happened. At one point when the dentist was filing during my root canal I cried out in pain and he yelled at me for "screaming" and threatened to stop the procedure and send me home. That traumatized the fuck out of me and then just laid there in pain, too scared to speak up when it hurt because I was worried he was going to berate me again or kick me out with fucking holes in my teeth.

After the root canals were done, he did the extraction of the last molar the upper left; the tooth broke off with a sickening crack and he had to dig around to get the rest of it. In retrospect that wasn't nearly as bad as the extraction of the last molar on the the lower right, which not only broke off but then required extensive drilling to break the rest of the tooth down into parts that would be easier to remove. Unfortunately I cried out in pain AGAIN because of the drilling and then he smugly told me that he hadn't even touched my tooth with the drill and that I was just imagining things (don't fucking tell me I'm not in pain when I am, you jerk). That extraction was the worst of the entire four hours, and he had to cut open my gum to get the tooth out and then suture it back closed again.

It's still really swollen and sore right now. And I can't get the prescription for painkillers that they gave me (five Norco) filled because they were written in another state. (When I called the office to let them know about it they said, "Huh, that's never happened before. Sorry!" I've also told the office no less than five times that I can't take large amounts of NSAIDs because I've had gastric bypass and they mess with my stomach. But they didn't seem to acknowledge that or, if they did, they didn't care. Also when I called this morning the person I spoke to said that she was off yesterday but she heard "all about my procedures", which was fucking humiliating.)

Before I left yesterday I noted to the staff that I was awake for the whole thing and THEN they told me that it was CONSCIOUS sedation and that most people "just go to sleep" and that they gave me as much sedation as was possible. As far as I know, I had fentanyl and diazepam. I remember the diazepam burned when it went into the IV. And I don't know the total dosage, but I DO know that I remember pretty much everything that happened.

And like I said above, I'm terrified about my next appointment next month. I don't want to go back there. I feel like they don't care about me as a patient or as a person, and that I've been labeled as a difficult patient. But I don't know what else to do and I can't calm down or stop crying about what happened. Also because it was two root canals that involve two crowns (which I've already paid for), I have to go back to get those cemented and set.

Complication: I'm supposed to have two more root canals and a cleaning when I have those crowns set next month. Also there are only two or three other dentists that practice IV sedation the same town and it's all "conscious" sedation. What do I do?

I don't want to give his man tens of thousands more of my money, but at the same time -- is this the best dental care I'm going to get in the area? I'm already paying so much money out of pocket, but as far as I can tell conscious IV sedation is supposedly the best I'm going to get. I don't understand why I was completely unaware for my wisdom teeth removal, but I remember everything about yesterday.

And I'm sorry if this doesn't make much sense. I'm in a lot of pain and my anxiety is through the roof and has been a while now. I'm just hoping that there's another MeFite out there who has been through something similar and can offer advice or a path or something. Anyway, thank you in advance.
posted by elsietheeel to Health & Fitness (24 answers total) 1 user marked this as a favorite
This sounds really upsetting; I’m so sorry you had to deal with that.

I think you should have the permanent crowns cemented in next month, but tell the dentist that you aren’t ready for the two additional root canals and the cleaning. (You can cite the expense, if that’s easier - it’s what I would do, probably.)

Then, shop around for a dentist that offers general anesthesia - you’ll probably have to travel and pay for this, but it will be worth it for you. (For reference, I had a pretty minor oral surgery last month and was offered four options: Local, Nitrous Oxide, Conscious Sedation (what I chose), and General.) If you can’t find a dentist near-ish you that does General, or if the price is out of your budget, then you should shop around until you can find a dentist who specializes in “gentle dentistry” and offers Conscious Sedation. This is a Thing in most larger cities now, and they will make SURE you don’t have a repeat of this traumatizing incident.

I hope you feel better soon.
posted by schroedingersgirl at 3:08 PM on December 21, 2017 [4 favorites]

Sending you lots of good thoughts -- this sounds truly terrifying. I agree with schroedingersgirl that what you're looking for is general anesthesia. This is what I had for my wisdom teeth removal, and it is the only time I've ever actually been truly "knocked out" for a dental procedure. That said, I'm not sure whether dentists are likely to offer general anesthesia for things like root canals...my memory from my wisdom teeth surgery is that the only practices that offer it are oral surgeons (not regular dentists), because it requires an anesthesiologist working in an operating room to administer it. With any drug where you will be totally knocked out, they need to be monitoring your breathing, etc. much more closely and so it really is more in the "surgery" column than the "dentistry" column. So, you may want to look for oral surgeons and see if they will do any of the procedures that you need.

I would definitely look into getting a different dentist for your next round of procedures regardless -- even if they are offering the same basic pain medications, you can definitely find someone who is better at dealing with dental anxiety and will be more honest with you about what you can expect. (For example, my current dentist is AMAZING on this front ... they take my anxiety about dental stuff seriously, for big stuff they will literally have one of the assistants come in to hold my hand and help my stay calm, etc.). I cannot even imagine anyone at this office scolding me for letting them know I am in pain! You could also ask about being prescribed some anti-anxiety medicine to take before your appointments. You would need to get someone to drive you, but I've found it to be very helpful in keeping me calm. Obviously this doesn't impact the pain side of things, but it does help me feel calmer and more positive about the experience overall.
posted by rainbowbrite at 3:17 PM on December 21, 2017 [3 favorites]

Also, re: getting the permanent crowns cemented in next month—

I’m only recommending you do this with your current dentist since you’ve already paid (and the dentist has likely already sent your impressions to the lab so the crowns can be made), and because the procedure in my experience is quick, basically painless, and straightforward.

First, and most importantly, since those teeth have been root canal’d, you will have very little feeling in them.

Second, the procedure is really simple: the dentist will just need to remove the temporary crowns (which, in my experience, come off very easily), chip off any stuck-on cement if necessary, and place the permanent crown. They may make minor adjustments to the teeth, but again, you won’t really have much feeling in those teeth anymore.

I’ve had a few crowns placed in my day (pro-tip, always use the handrail when walking down steps...) and have never needed local anesthesia when I get the permanent crowns placed. Hopefully you’ll have a similarly easy experience there!
posted by schroedingersgirl at 3:20 PM on December 21, 2017 [1 favorite]

I'm so sorry this happened. I have two questions for you that may help you find a better experience.

1. Are you red headed? Stick with me here. There is a belief that redheads are more difficult to sedate/anesthetize because of genetic mutations to certain receptors that manage pain. I am not a scientist so I won't try to say more than this but you can google around about this and also there are doctors who are very aware of this phenomenon and know that redheads take a larger dose of everything.

2. Did you see a dentist or an oral surgeon? From my experience with having 4 impacted/infected wisdom teeth extracted, dentists will not do more than conscious sedation while you have to go to an oral surgeon office with an anesthesiologist on hand if you want something like general sedation or twilight sedation (which is not full general anesthesia but basically scrambles your memories so you have no recollection of the event). An oral surgeon can also offer you gas before starting the IV which will make you not care about the needle and will relax you enough for the full sedation to kick in more easily. I did valium + gas + twilight sedation and it was a lovely experience. The only downside is the gas gave me terrible nausea a few hours after I woke up, but laying down made it fine.

I hope this info helps open up your options and/or advocate more clearly for your needs.
posted by joan_holloway at 3:30 PM on December 21, 2017 [1 favorite]

Ugh. This is the worst. I am the same- none of those "usual" methods work on me. I demanded real IV sedation for my last round of dental surgery (horrible wisdom teeth extraction). It was the best. No issues and my recovery was super-fast. I really recommend you try to find another location that is more amenable to accepting that some people are just not receptive to lesser sedation methods.
posted by I_Love_Bananas at 3:38 PM on December 21, 2017

1. Are you red headed? Stick with me here. There is a belief that redheads are more difficult to sedate/anesthetize because of genetic mutations to certain receptors that manage pain. I am not a scientist so I won't try to say more than this but you can google around about this and also there are doctors who are very aware of this phenomenon and know that redheads take a larger dose of everything.

I don't have anything but a personal cite but some people's nerves take a different route around their face. An MRI can find this and then the injections go where they should.
posted by Mr. Yuck at 3:40 PM on December 21, 2017

This is terrible, and I'm so sorry. I think you should contact Dr. Tomaich's office for referrals to oral surgeons in the CA cities nearest you. After speaking with those referrals, arrange to have the new crowns shipped to whichever one you've chosen to continue your care.

Mind you, I have no idea if the new doc can request such a transfer, or if you'll need to do it yourself, or if it's even possible. I just feel very strongly you shouldn't let cruddy dentist treat you ever again. He's out of state; if this was a matter of being physically unable to travel to his office for further treatment, what would your options be?
posted by Iris Gambol at 3:57 PM on December 21, 2017 [1 favorite]

At one point when the dentist was filing during my root canal I cried out in pain and he yelled at me for "screaming" and threatened to stop the procedure and send me home.

This is not how it is supposed to be. I'd say that's unacceptable, even. One of the only fragmentary memories I have of IV sedated oral surgery is the doctor asking me if I could feel a thing at all, and giving me more local when I could. They did horrible things to me for hours, and I had almost no physical discomfort. My understanding is that you are not in fact unconscious, since you can respond to directions and they can get your attention, but you are in some kind of dissociative state where you aren't concerned in the slightest that people are doing surgery on you.
posted by thelonius at 5:23 PM on December 21, 2017 [1 favorite]

I’m so sorry this happened to you.

If you have taken anything with naxolone as an ingredient, for instance the medication Contrave, the Fentanyl would not have have worked.

A while back I was on Contrave and in need of dental sedation type anesthesia for dental implants and bone grafts. I asked my oral surgeon if I needed to discontinue Contrave, and he was not familiar with the drug. I also spoke with a pharmacist who could not really give me a definitive answer... I ended up stopping a couple of weeks before my surgery. During surgery, I noticed I was never really completely out of it as I had been previously at the same office or with other twilight sedation like during an endscopy. I was fully awake during a portion of the procedure.

I hope you find a compassionate provider and can get your work completed. Best wishes.
posted by FergieBelle at 5:39 PM on December 21, 2017

Yes, this sounds horrible. Getting the crowns put on though is not bad. There are no nerve endings, no drillings etc...just maybe scraping cement and banging around your gums a bit (to adjust fit). I am also terrified of the dentist these days, and I have to get nitrous/twilight sedation for any procedure- ie my recent root canal- otherwise I almost jump out of the chair the whole entire time.

General anesthesia is serious though, you need someone to pick you up and you have to be careful about eating prior to the procedure....i think you just need better conscious sedation....more gas, more dissociation. And you will need to switch offices for the next root canals, that's clear. Even if the next place is really far away. If you don't/can't trust your dentist, that just magnifies all issues.
posted by bquarters at 5:52 PM on December 21, 2017

I’m one of those peoples whose nerves run around their face in a weird way. I HATED going to the dentist, and consequently didn’t go and got bad teeth. My current dentist gets it. Heavy sedation for even minor tooth cleanings, gas, overhead movies, compassionate dental assistants, you name it. Find a dentist that isn’t a jerk.
posted by Marinara at 8:46 PM on December 21, 2017 [1 favorite]

I'm sorry this happened to you. It sounds horrible.

Having the crowns put in place should be very nearly painless, especially with the nerve gone. Since you've already paid for them and they are bleeping expensive, you should let the current dentist put those in. For the rest? Fuck that guy. Go elsewhere. And make sure he knows why you're going elsewhere for the rest of your expensive procedures.

"Conscious sedation" really is just another phrase for "twilight sedation," though. You most likely got the same form of sedation each time. It's not that people actually "go to sleep," per se--they will usually be able to follow commands. It's that the drugs tamper with their ability to remember what happened. For instance, in your first experience, you would still have been appeared awake when they put the IV in, could have moved your arm for them, and so on. It's just that you didn't/don't remember it. It sounds like this time, for whatever reason, you didn't get an adequate dose of benzodiazepines to induce amnesia (or painkillers!). The major alternative is general anesthesia. But I personally would be quite reluctant to go for general anesthesia with a dentist for whom that wasn't the major part of his practice. There have been a number of horrible stories recently of children dying under anesthesia in the dentist's chair. As an adult, you may have to go to an oral surgeon. Also $$$.
posted by praemunire at 10:42 PM on December 21, 2017

Find a dentist that isn’t a jerk.

That's really what this boils down to. Because the dentist you described absolutely was one.
posted by flabdablet at 2:10 AM on December 22, 2017 [4 favorites]

Yes, get an oral surgeon. They will knock you and can finish this work, except for the crowns--I would agree with the others here to let this office put those in, but that is it. You still will need a dentist, so find a new one. Ask your friends and coworkers who they go to, and if they like them. There are some great dentist out there, and when you find one it is a good experience.
posted by chocolatetiara at 7:26 AM on December 22, 2017

I didn't read under the fold because I'm not sure I want to know the details, so this might be totally off base.

Take a look at dental tourism. Generally this is done to save money if people need a lot of work done, but another advantage is that in some countries you actually go to a hospital and have an actual anesthesiologist. IIR Thailand was one of them, but I turned out to need a lot less dental work than I thought so I didn't keep looking after that. There's some types of sedation that dental offices in the US are allowed to do in office without an anesthesiologist, but it sounds like it might be better for you to have someone there whose only duty is to focus on anesthesia.

So glad I can turn off this from showing up in my recent activity list
posted by yohko at 3:00 PM on December 22, 2017

Thank you everyone for your responses. I was worried that I was overreacting and now I understand that I wasn't, at all.

The first thing I'm going to do is call Dr. Tomaich's office and ask if I was under a general or if they just use different drugs for their IV sedation. It's entirely possible that I was under a general for my wisdom teeth, as Dr. Tomaich is an MD as well as a DDS -- although I don't remember being intubated.

(Speaking of intubation, today I remembered that when I had an endoscopy under IV sedation a few years ago I wasn't completely under for that either, so maybe I'm one of those weirdos that doesn't sedate well?)

Unfortunately, traveling back into California isn't an option for this. It's a four hour drive to the nearest city in good weather and in bad weather it would take something like eight. Hell, it took us four hours to drive the 80 miles to the dentist on Wednesday. And there aren't that many dentists that offer IV sedation in Reno. Also I'm paying for all of this out of pocket with the last of my savings. I'm going to have to file for bankruptcy after this is all over. And I thought I had found the best dentist possible, who advertised gentle dentistry, IV sedation, compassionate care, and a complete understanding of dental anxiety.

Speaking of, I was very clear about my dental anxiety at my first appointment. I also told them that I was resistant to novocaine and that I had a very strong gag reflex and a phobia of needles. They did not take any of that into consideration at my second appointment, despite me reminding them. The assistants WERE very sweet and held my hand at first, but none of that matters now that I'm scared of the dentist himself. The thing that upsets me the most is that he seemed so kind and understanding at my intake appointment and then for him to be so callous during the procedures? It took me so long to get up the nerve to go to the dentist and I feel like this experience has set me back years. I'm back to feeling paralyzed over finding a new dentist and then making a call and then going to the appointment.

I am not redheaded and I usually have a normal to high pain threshold, except for dental stuff, so it's possible that my face nerves are extra weird. I also do not take anything with naloxone as an ingredient.

Even with IV sedation they require you to have a ride home and you can't eat or drink anything prior to the procedure. I did not have gas of any sort and never have had any. Pharmacogenetic testing indicates that I am highly resistant to nitrous oxide and that, coupled with my extreme dental phobia, means I don't even want to *try* that route.

Anyway, after I figure out what sort of meds I had during my wisdom teeth removal I'll call around Reno to see if anyone else follows the same protocol. And I'll call the bad dentist's office and tell them that I've decided to just get the crowns set that day and not proceed with rest of the procedures at this time. And after that appointment is over I'm going to ask for my chart and x-rays and then give them a strongly worded letter.

Thank you again for your suggestions and advice. I really appreciate it.
posted by elsietheeel at 6:28 PM on December 22, 2017 [2 favorites]

I feel so angry on your behalf - this sedation doesn't work well on me either, the drug they use is usually midazolam/versed and saying it doesn't work on you (even if you can repeat back things said during procedures) opens you up to a world of medical scorn and tags you as difficult. This drug doesn't make pain any less worse, it just makes you forget, and then when you don't forget it really really sucks. I am a very boring normal person and it made me feel unsettled and irrationally angry for about a month after, there are many online pages where people have similar experiences (all labelled as kooks of course). Hang in there and be super kind to yourself and careful during the next while, the weird betrayed and used feeling is quite unlike anything else.
posted by meepmeow at 10:10 AM on December 24, 2017 [1 favorite]

Midazolam is known for making you forget what happened while you were under the influence of it, and diazepam isn't - that, combined with you obviously not getting enough local anaesthetic/analgesia during the procedure could be enough to explain the difference. Also, fentanyl wears off incredibly quickly - I have been given IV fentanyl once and I would swear that it had worn off in about five minutes (though my perception of time is obviously suspect under the influence) - if they just gave you it at the beginning it might not last the whole procedure.

My facial nerves apparently take odd routes around my jaw, which means that I have had pain when having fillings/extractions at the back of my mouth. But having had good dentists, when I've gone "ow", they have stopped, re-assessed what was numb and what wasn't, and said something along the lines of "oh, you are one of the people who have the nerves in different places" and given me more local anaesthetic. I view this as basic competency in a dentist.
posted by Vortisaur at 2:21 AM on December 31, 2017 [1 favorite]

He used midazolam this time, the experience was much more positive, and yes, the pharmacogenetic testing was correct; nitrous oxidide does not work on me.

Which is REALLY disappointing.
posted by elsietheeel at 4:12 PM on January 22, 2018 [1 favorite]

Now that I'm not all hopped up on the sedation meds left in my body and have slept for the past 18 hours I'll elaborate a bit.

I think he was in a really bad mood last time. That does NOT excuse the way he acted in ANY way shape or form, and if I wasn't under a time crunch here I would probably look for a new dentist (and once the rest of my current treatment plan is complete - which is probably going to be two appointments; I have one more root canal+crown and one crown without root canal, and then an incredible amount of fillings, and that's it) but I need to get this done as quickly as possible and starting over with a new dentist isn't a good option right now. So it was a huge relief that he was in a goofy, cheerful mood and made lots of jokes during the appointment and that it went pretty smoothly, with very little pain (that he responded to quickly as soon as I indicated).

We did have a very rough start where I nearly walked out (and yelled at him for making me feel like I was a bad patient and told him exactly how I felt about how he acted during my last appointment) because he couldn't find a vein. Like nearly a half hour to find a vein. Like to the point where he was talking about looking for a vein in my ankle. That was when I nearly walked out. I have a needle phobia. That was when he put the nitrous on. He finally found one in my left hand. I took a photo of it for next time. (This was super weird too, because at the last appointment the IV placement was the best and easiest part of the appointment.)

Anyway. Extenuating circumstances means I'm sticking with this guy for the next two appointments, and then I'm going to shop around again. Interestingly enough, I think my new therapist (WHOM I ADORE) has a brother-in-law in Reno who does sedation dentistry.

Oh! And also before this appointment I did end up calling Dr. Tomaich's office and asking about my wisdom teeth appointment. They confirmed that they DO use conscious sedation with midazolam, fentanyl, and propofol, but that since Dr. T is an MD as well as a DDS (or DMD?) that he's more comfortable putting patients under deeper sedation and that patient experiences at other dentists will likely be more conscious/aware. And also that because they don't need you to follow instructions during extractions (unlike root canals) they can put you further out.

Long story short; sucks to be me! But maybe not so much? I don't know. The worst two parts of yesterday were the IV placement and the scaling (oh I had a cleaning, too). And honestly, I think the scaling was the worst.

I hate teeth. I honestly think I should have used the $20k I'm spending on root canals and crowns and just had all my teeth pulled and gotten dentures like grandma did when she was 40.
posted by elsietheeel at 10:19 AM on January 23, 2018 [1 favorite]

Also I am still REALLY disappointed that nitrous oxide doesn't work.

And it explains SO much about parties in my 20s.
posted by elsietheeel at 10:21 AM on January 23, 2018

I had my third appointment yesterday. It was the best appointment so far. They put the nitrous on me as soon as I got there (and it worked a little this time!) because it also helps expose the veins apparently, he stuck me once in the hand and got the vein the first time, he was generous with the midazolam, and once again he was in a goofy, jokey mood (which I think is his default). I even had a surprise root canal and it was NBD (honestly, root canals are NBD to me if there's enough novocaine).

I am nervous about my last appointment in this series, which will be gluing three crowns, 10+ fillings, and the second half of my cleaning (the fine scaling). My biggest problem with the dentist is the high-pitched noise of the drill (root canals and crowns have more of the grindy drill sound and that doesn't bother me) and my incredibly sensitive gums (so scaling is torturous), so this one may be the worst one of all of them, but I'm hoping since they won't have to keep me awake for x-rays like with root canals, maybe they can sedate me a little more? It's hard to say.

Anyway, I've come around to the idea that the first appointment was just him having a bad day and not realizing how resistant I am to things like benzos and novocaine. Now, that will never excuse his behavior and the things he said that day, but I AM glad that I gave him a second chance. He's a nice man with a ridiculous sense of humor and while I still hate going to the dentist, this last appointment was probably my second best dental experience ever, and that was WITH two root canals, a build-up for a crown, and I think some random fillings because that area was already numb (best experience still my wisdom teeth TKO). His staff are also really wonderful and if they weren't so great I'd probably be looking around for other dentists, but for now I'll stick with this guy.

Also, in another thread jessamyn said that caffeine counteracts novocain. I was skeptical, but as soon as I got out of the chair I went to Starbucks and got an grande iced red eye. Within an hour I was completely un-numb. I'm a believer!
posted by elsietheeel at 8:15 AM on February 14, 2018

I'm so glad your dental experiences are improving, and that you feel better about things! Your perseverance is impressive and inspirational. If they can't sedate you more for the next appointment, perhaps you could wear earplugs like these to help drown out the drilling, or listen to music through earbuds.
posted by Iris Gambol at 10:21 AM on February 16, 2018 [1 favorite]

My last appointment was yesterday (I also had one in April and it wasn't the last because there was too much to do at once). It was the best experience yet, thanks to my friends midazolam and fentanyl. The staff there are wonderful and the dentist himself was yet again in a jovial, jokey mood. I just must have caught him on a bad day that first time. They're impressed with my resistance to sedation; apparently nobody recovers faster than I do.

Anyway, I just wanted to say that first impressions DO count and they matter a lot, but giving people a second chance, even in what seems like an impossible situation, can be important as well. I'm glad I gave this dentist another go, and I'm so SO thankful that Ask.MeFi assured me that my first appointment wasn't right so that I was able to speak up for myself and turn a bad experience into a good one. Thank you, everyone!
posted by elsietheeel at 6:55 AM on May 24, 2018 [1 favorite]

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