Any Dental Surgeons In The House?

[SemperFi]

I have surgery scheduled for March 19 to remove an impacted wisdom tooth as well as the tooth right next to it which decayed because of its contact with the wisdom tooth over the years.
Obviously Novacaine will be used to numb the area around these two teeth. The surgeon also suggested the possibility of IV sedation if I was apprehensive about the procedure. That would cost me $400 out of pocket as insurance will not cover IV sedation. Really my main concern is not to feel any pain while he’s digging these teeth out. Is Novacain enough to do the trick or will being sedated lessen the pain?
Complicating the situation is having to stop taking blood thinners for 5 days prior to the surgery.
My only experience with having a wisdom tooth removed was 40 years ago and I do remember that the post op experience was not a pleasant one. Any thoughts or similar experiences would be helpful.

[RichM]

Hey Angelo. Sorry to hear about the surgery. All I can say is it’s a crap shoot. I just had a tooth removed last week. The hardest part was the shots to numb the area. The tooth came right out.

Several years ago, I had a back tooth taken out and the damn thing broke in half. I was in the chair for an hour and 15 minutes while they tried to get it out. I really thought they were going to pack my mouth with gauze, and send me to an Oral Surgeon. It eventually came out. All I can say is I wished I was asleep for that one.

Judging by the sound of the work you’re going to have done, I’d probably go the sedation route. When you wake up, it’s all over. If they have any issues, you won’t even know about them.

Wishing you the best.

Forgot to add, I’m no Dental Surgeon. Just giving you my personal experience.

[Fleetlord]

Sedation....not due to pain but having to sit still while they pound on your mouth.

Jaw gonna hurt afterwards

[dba]

I’ve been lucky as far as having wisdom teeth removed. I’ve been able to have my regular dentist take them out. He was very liberal with the Novocain application. Last time for a bottom right, I was numb to my eyeball.

I’m sure the dentists, doctors and surgeons will chime in with real medical knowledge, but I don’t know if the IV sedation will lessen the pain of the procedure. It’s usually afterward that it hurts, but it should sedate you to the point that you don’t hear any grinding if that’s needed or feel any of the pressure of your dentist trying to grasp purchase on the tooth to remove it.

Never pleasant, and I hope all goes well.

[datejustrms]

Angelo, I had an impacted upper wisdom tooth removed with just novacaine and it wasn't bad at all. I kept my eyes closed while they were doing the extraction and all I really felt was pressure. I thought it was going to be worse.

It will be a piece of cake, novacaine works wonders.

[joli160]

In hindsight I wish I had taken the IV. Would have been worth a watch for me

[cornerstore]

Had a simple tooth extraction 10 days ago. Gold crown hid the damage until it was too late,no alternative but to remove tooth. No sedation, no pain during procedure. Offered Ativan but declined. I’m taking Coumadin. New protocols are if under 3.5 reduce slightly to 2.5 and now it’s recommended you do not stop. I was 3.0 day of extraction no issues. Study link.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144934/

[TheVTCGuy]

Angelo, sorry about the trouble, but my serious and strongly urged advice is pay for the sedation. I had a root canal a couple months ago and had the sedation, I don’t remember a thing about the procedure; which is the way I like to have dental work done. You don’t want to be sitting in the dental chair, stressed, full of anxiety and thinking: “I wish I had paid the fricekn money.” For me, anything more then a cleaning is deserving of sedation.

[Dr.LJ]

Without a full portrait of the situation (medical history, if you take daily medication, etc.) it would be difficult for me to be specific in your case.

Local anesthetics, usually lidocaine and articaine that are now commonly used (more efficient and less risk of allergy than novocaine), are enough for dental surgery. Sedation, whether oral or IV, would be useful if the surgery is making you nervous and you know that on the day of the procedure it will be difficult to tolerate and handle all the noise and pressure sensation (you should not feel pain, but feeling the pressure is normal). Being anxious during the surgery will lessen the efficiency of the local anesthesia and therefore a sedation might be indicated in that case.

I would usually recommend IV sedation for more severe anxiety, otherwise oral sedation can be considered as an alternative.

[BBL]

Hey Semper.
Although my situation was not same as yours, last year had an entire oral reconstruction of sorts by a DMD and DDS from a dental office with excellent reputation.
Dentist approved: valium 30 min before appt., nitrous oxide, novocaine. IV was not an offered option because I had to be able to respond to directions during procedure.

Could nitrous oxide be an option before local novocaine? (Costs less than IV, unless IV is the only route your specialist if recommending.)

I hope 2th doc comes by....

Wishing you the best!
DM

[Dr.LJ]

Originally Posted by BBL

Could nitrous oxide be an option before local novocaine? (Costs less than IV, unless IV is the only route your specialist if recommending.)

Nitrous oxide is also a great option, quite simple to use for sedation. It does not, however, replace local anesthesia.

[BBL]

Originally Posted by Dr.LJ

Nitrous oxide is also a great option, quite simple to use for sedation. It does not, however, replace local anesthesia.

Yes, I know. I think my sentence was confusing.

I received nitrous oxide before the 'necessary' novocaine.

I have no recall of the several hours I was in that chair.

[SemperFi]

Originally Posted by Rich Mickol

Hey Angelo. Sorry to hear about the surgery. All I can say is it’s a crap shoot. I just had a tooth removed last week. The hardest part was the shots to numb the area. The tooth came right out.

Several years ago, I had a back tooth taken out and the damn thing broke in half. I was in the chair for an hour and 15 minutes while they tried to get it out. I really thought they were going to pack my mouth with gauze, and send me to an Oral Surgeon. It eventually came out. All I can say is I wished I was asleep for that one.

Judging by the sound of the work you’re going to have done, I’d probably go the sedation route. When you wake up, it’s all over. If they have any issues, you won’t even know about them.

Wishing you the best.

Forgot to add, I’m no Dental Surgeon. Just giving you my personal experience.

Originally Posted by Fleetlord

Sedation....not due to pain but having to sit still while they pound on your mouth.

Jaw gonna hurt afterwards

Originally Posted by dba

I’ve been lucky as far as having wisdom teeth removed. I’ve been able to have my regular dentist take them out. He was very liberal with the Novocain application. Last time for a bottom right, I was numb to my eyeball.

I’m sure the dentists, doctors and surgeons will chime in with real medical knowledge, but I don’t know if the IV sedation will lessen the pain of the procedure. It’s usually afterward that it hurts, but it should sedate you to the point that you don’t hear any grinding if that’s needed or feel any of the pressure of your dentist trying to grasp purchase on the tooth to remove it.

Never pleasant, and I hope all goes well.

Originally Posted by datejustrms

Angelo, I had an impacted upper wisdom tooth removed with just novacaine and it wasn't bad at all. I kept my eyes closed while they were doing the extraction and all I really felt was pressure. I thought it was going to be worse.

It will be a piece of cake, novacaine works wonders.

Originally Posted by joli160

In hindsight I wish I had taken the IV. Would have been worth a watch for me

Originally Posted by cornerstore

Had a simple tooth extraction 10 days ago. Gold crown hid the damage until it was too late,no alternative but to remove tooth. No sedation, no pain during procedure. Offered Ativan but declined. I’m taking Coumadin. New protocols are if under 3.5 reduce slightly to 2.5 and now it’s recommended you do not stop. I was 3.0 day of extraction no issues. Study link.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144934/

Originally Posted by TheVTCGuy

Angelo, sorry about the trouble, but my serious and strongly urged advice is pay for the sedation. I had a root canal a couple months ago and had the sedation, I don’t remember a thing about the procedure; which is the way I like to have dental work done. You don’t want to be sitting in the dental chair, stressed, full of anxiety and thinking: “I wish I had paid the fricekn money.” For me, anything more then a cleaning is deserving of sedation.

Originally Posted by Dr.LJ

Without a full portrait of the situation (medical history, if you take daily medication, etc.) it would be difficult for me to be specific in your case.

Local anesthetics, usually lidocaine and articaine that are now commonly used (more efficient and less risk of allergy than novocaine), are enough for dental surgery. Sedation, whether oral or IV, would be useful if the surgery is making you nervous and you know that on the day of the procedure it will be difficult to tolerate and handle all the noise and pressure sensation (you should not feel pain, but feeling the pressure is normal). Being anxious during the surgery will lessen the efficiency of the local anesthesia and therefore a sedation might be indicated in that case.

I would usually recommend IV sedation for more severe anxiety, otherwise oral sedation can be considered as an alternative.

Thank you for all of the replies.
I should have mentioned that aside from aspirin and blood thinners I also take thyroid (synthroid) prostate (tamsulosin) cholesterol (simvastin) and beta blocker (metoprolol tartrate) medications.
The surgeon also mentioned that one of the teeth is practically hollow so it will probably splinter during the procedure.
The consensus so far seems to be that IV sedation is the way to go.

[cornerstore]

You might get a laugh out this old clip on dentistry with Bob Hope. https://youtu.be/bY9IKLKj9vw

[Dr.LJ]

Usually, if it is a simple procedure, we generally don't ask the patient to stop aspirin. Now, if the surgery could be invasive (seems to be your case), it is another concern and the surgeon would have to evaluate the risks/benefits of stoping or not the aspirin.

As you are taking metoprolol, this would affect the quantity of epinephrine the surgeon could give you (it is combined to the local anesthetic to extend its effects). It should not be a problem as we have local anesthesia without epinephrine that we could use.

Originally Posted by BBL

Yes, I know. I think my sentence was confusing.

I received nitrous oxide before the 'necessary' novocaine.

I have no recall of the several hours I was in that chair.

Yep, one of its benefits is to cause anterograde amnesia .

[Pix]

If your going to be awake, a good set of headphones with your favorite tunes!

[Bigblu10]

Not to go off topic, but leave your watches at home and off the wrist!

[keithl]

What about a valium, or nitrous oxide? Both of those options I would think would be available.

Originally Posted by SemperFi

I have surgery scheduled for March 19 to remove an impacted wisdom tooth as well as the tooth right next to it which decayed because of its contact with the wisdom tooth over the years.
Obviously Novacaine will be used to numb the area around these two teeth. The surgeon also suggested the possibility of IV sedation if I was apprehensive about the procedure. That would cost me $400 out of pocket as insurance will not cover IV sedation. Really my main concern is not to feel any pain while he’s digging these teeth out. Is Novacain enough to do the trick or will being sedated lessen the pain?
Complicating the situation is having to stop taking blood thinners for 5 days prior to the surgery.
My only experience with having a wisdom tooth removed was 40 years ago and I do remember that the post op experience was not a pleasant one. Any thoughts or similar experiences would be helpful.

[SearChart]

Had two removed myself (both upper), both local anaesthesia, first one went flawlessly, second one was a b#tch since it didn't come out easily and the anaesthetic wasn't fully working yet.

I would never go full sedation, I rather have some pain or discomfort.

Edit: For those who don't know, one cannot even get sedated for small things like this here in the Netherlands. Asking for it and they will probably laugh, hard.

[swils8610]

Interesting topic. I have an impacted wisdom tooth as well. At age 46 it’s given me no issues. At a recent cleaning and general x-ray my dentist recommended seeing an oral surgeon to have it removed. He thinks it may become an issue. I have no idea how they could get to it! It has a slight “cloud” around it. I always thought you leave them alone if you have no issues. I’m for sedation.


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[GB-man]

I had all 4 removed at once and was sedated. Would be my preference to be sedated but of course you need to account for individual health concerns.

[Thatguy]

Originally Posted by TheVTCGuy

Angelo, sorry about the trouble, but my serious and strongly urged advice is pay for the sedation. I had a root canal a couple months ago and had the sedation, I don’t remember a thing about the procedure; which is the way I like to have dental work done. You don’t want to be sitting in the dental chair, stressed, full of anxiety and thinking: “I wish I had paid the fricekn money.” For me, anything more then a cleaning is deserving of sedation.

Agree 100%!

Question for dentists here- I have never gotten a straight answer on this. Every time I get the lidocaine shot it feels like the entire side of my face is getting shocked and I almost jump out of the chair. I am always told it’s a fluke and won’t happen with them but it always happens. What can cause this?

I am done with local and want to be out but that is proving hard to find.


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[TheVTCGuy]

Originally Posted by SearChart

Had two removed myself (both upper), both local anaesthesia, first one went flawlessly, second one was a b#tch since it didn't come out easily and the anaesthetic wasn't fully working yet.

I would never go full sedation, I rather have some pain or discomfort.

Edit: For those who don't know, one cannot even get sedated for small things like this here in the Netherlands. Asking for it and they will probably laugh, hard.

Remind me not to have any dental work done in the Netherlands

[SearChart]

Originally Posted by TheVTCGuy

Remind me not to have any dental work done in the Netherlands

Just breathe in and breathe out, a dentist will not harm or kill you.

[TheVTCGuy]

Originally Posted by SearChart

Just breathe in and breathe out, a dentist will not harm or kill you.

Rationally, I know that, and certainly their intention is to relieve pain, not inflict it. But I am a (somewhat) rare case in that I have a phobia of dentistry. To have a cavity fixed is an anxiety-producing experience beyond what I felt in combat, and I gladly pay the extra $140 for Nitrous and relaxing medicine they put under your tongue; pretty much have to for me to remain in the chair. Is it logical for me to be this way? Of course not, I know that, but it is what it is and for me, sedation is a necessary procedure when having dental work done. Go ahead, call me a Dorklehead.

[SearChart]

Originally Posted by TheVTCGuy

Rationally, I know that, and certainly their intention is to relieve pain, not inflict it. But I am a (somewhat) rare case in that I have a phobia of dentistry. To have a cavity fixed is an anxiety-producing experience beyond what I felt in combat, and I gladly pay the extra $140 for Nitrous and relaxing medicine they put under your tongue; pretty much have to for me to remain in the chair. Is it logical for me to be this way? Of course not, I know that, but it is what it is and for me, sedation is a necessary procedure when having dental work done. Go ahead, call me a Dorklehead.

I'm very sorry to hear that it really scares you that much. Please excuse my ignorance, I cannot imagine what it's like to have a phobia of some sort.

All that matters is that you have a good dentist who understands your phobia, and provides the appropriate care

[2th_doc]

Originally Posted by SemperFi

The surgeon also suggested the possibility of IV sedation if I was apprehensive about the procedure.

Without seeing the panoramic xray that quoted sentence is my biggest take away. The oral surgeon is suggesting IV sedation only if you are apprehensive. You know your apprehension level better than the oral surgeon.

On the other hand if the oral surgeon is not just “suggesting” but “recommending” IV sedation then it is in most cases a more involved procedure. Based on depth and angulation of impaction. And other variables at play that the oral surgeon would evaluate when looking at the panoramic xray. So in the case of a recommendation for IV sedation the oral surgeon knows better than you the difficulty of the 3rd molar extractions. So in that situation I would go with the oral surgeons recommendation.

The oral surgeon left the ball in your court. So I think you would be fine under local anesthesia. You could even add nitrous oxide for around $40 - $60.

[TheVTCGuy]

Originally Posted by SearChart

I'm very sorry to hear that it really scares you that much. Please excuse my ignorance, I cannot imagine what it's like to have a phobia of some sort.

All that matters is that you have a good dentist who understands your phobia, and provides the appropriate care

No offense taken Bas And thankfully, I do have an understanding Dentist.

[GradyPhilpott]

I've had more dental procedures that I care to admit and while I don't believe in enduring more pain than is absolutely necessary, given that I've had more than my share of that, too, I personally don't think I'd spend $400 for sedation.

I can deal with the procedure as long as the area is anesthetized and the dentist is willing to prescribe some decent pain meds for the recovery.

[1st amg]

I would need the sedation, in fact when they asked me for what type of sedation I would like for my four wisdom teeth, I said if you could get Mike Tyson to give me a jab combo to the chin, that would be great.....I wanted to be out cold.


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