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Dental Anesthesia

Wisdom teeth and anesthesia

08/18/2008

Question:

Hi, This morning I was supposed to have my wisdom teeth out. I took a valuim before I went like they told me to and then had some laughing gas before they put the needle in for the IV. I was very worried because I could see the monitors and my heart rate was 102 and bp was 138/89 which concerned me. The problem was I was so terrefied of getting put under the anestesthia that I started crying and saying I dont want to do it. So the doc left and gave me a min to think about it with the nurses. I finally said just do it, but the doc had already decided that "today is not the day". The doctor said he`d prefer if we did the procedure in a hospital instead. He said that patients who react how I was before they even began the anesthesia sometimes their subconscious fights once they get put under and the patient will kick and punch and then it`s hard to do the procedure. Is this true? Why couldn`t they just give me the anestesthia, that would make me relax wouldnt it? Putting me in a hospital to do it seems pointless, I will be just as terrefied then as well. Also, the next date they can get me in is 2 months from now and my wisdom teeth are killing me. I get ear aches and sore throats from them and I constantly feel pressure and pain. Is there anything they can do to get me in sooner? Last question...I am overweight, by about 50lbs, but in relatively good health. My blood pressure is usually normal and I have no other health problems besides the occasional panic attack. What kind of risk is there with me getting general anestesthia (conscious sedation). Any advice to stay calm for next time is also appreciated. Im not very worried about the actual wisdom tooth extraction, just the anesthesia. I have trust and control issues and even the laughing gas made me freak out because I began to feel out of control. But doing the procedure without some sort of drug to relax me is not an option, I even have hard time getting fillings. Please help. Thank you very much in advance.

Answer:

My guess is that your dentist was not going to do general anesthesia but rather moderate (conscious) sedation. In this case, you are awake during the procedure, but the drugs usually produce enough amnesia that you may not recall the procedure later in the day.

There is a small incidence of "paradoxical' reactions to some moderate sedation drugs. Instead of producing sedation, they produce excitation. This is usually thought to occur when the patient is very anxious and the medication releases inhibitions which the patient uses to keep control over their emotions. So, they may start getting excited, or cry and have the opposite reaction. It is more common in teenagers and young adults and women more than men. Your vital signs are typical of an anxious healthy young adult and are not a concern assuming you are otherwise healthy.

General anesthesia is a good idea, but this need not be done in a hospital. There are some oral surgeons who are trained in general anesthesia, but many only do deep sedation, an intermediate form between moderate sedation and general anesthesia. This may be all you require. You should inquire about this as it will not require a hospital visit which can be very costly.

Additionally, there are dentist anesthesiologists who can come to the office of your dentist and provide safe and effective general anesthesia which is excellent for these types of procedures. You can look for one at www.asdahq.org

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Response by:

Steven I Ganzberg, SB, DMD, MS Steven I Ganzberg, SB, DMD, MS
Formerly, Clinical Professor of Dentistry
College of Dentistry
The Ohio State University