arg! Wisdom teeth extractions

[RSXer]

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Just wanted to get a quick poll from those who got their widom teeth pulled. Just came back from the oral surgeon and he made me a bit more concerned than when I came in. 1 upper tooth is going to be a simple extraction while the other 3 are all impacted and have not erupted at all.

He gave me the option of either going under during surgery, local anesthsia, or local anesthesia + nitrous. Which one did you think I should do?

I think I have a fairly high pain threshold, but the more I talked to this guy, the more freaked out I got. Oh well, I told him I'd judt do the local, but I figured I'd see what other's experienced here 🙂

 

[juan7677]

I took both my bottoms out last year. They too were impacted and so was somewhat complicated to take out. The oral surgeon just gave me local anesthetics and I didn't feel any pain during the procedure. Just alot of pressure. I have to get my top 2 out after finals. I'm starting to feel pain in that area.

 

[erinb03]

You should be fine with just the lidocaine. I had all four of mine taken out when I was fifteen, and I only had the local. They were all fully impacted and were causing me some severe pain. I don't really think I have that high of a pain tolerance; I usually whine over every little thing, but honestly, it was not that bad during or after if you take your pain meds correctly....
EB

 

[RSXer]

cool, thanx for the info 🙂 I'm feeling more confident about just doing the local anesthesia now. I don't think oral surgery will be something I'm interested in, but I still wanna be conscoius to see what the heck they're doing to me 😉

 

[Yah-E]

I had all four of my 3rd molars extracted back in summer 2000 at the University of Minnesota School of Dentistry (Minnesota is where I did my undergraduate work). I had the Chef Resident at the time performed the surgery while a supervising faculty "supervised". It was a really cool experience for me, since my Chef Resident surgeon and the supervising faculty knew that I will eventually start dental school in the near future, the supervising faculty held a mirror and explained to me every step of the way while the surgery was ongoing.

I only had local for the surgery so I stayed conscious. My maxillary left 3rd molar (#16) was completely erupted while #s 1, 17, and 32 were either partly erupted or impacted.

My worse tooth was #17 (mandibular left 3rd molar) because it was distal angulared (pointing backwards into the ramus of the mandible)! To extract this tooth, my surgeon had to remove a lot of my mandible tissue near the angle of the mandible. We were afraid that there may be a chance that my mandible would crack at the angle. Luckily for me, everything went smoothly and now I'm glad that I had my 3rds removed!

So not only had I removed my 3rds, done by great surgeons, but I also got to watch it step by step for cheap. Some cool stuff.

 

[smile_doctor]

If you have partial bony impactions, I would recommend the local + nitrous. If you are at all anxious about the procedure, the nitrous will take the edge off. You'll appreciate this distraction from any possible pressure or cracking noises.

Forget about the oral surgeon. Bring on the scalpel, mallet, and crane pick and we'll take care of those molars this Fall at UMB! (kidding)

 

[DrJeff]

A few words of advice........Take the drugs, a remember better living through chemistry is a good thing. If you think that you'll be a better dentist for having it done via local only, you really won't end up that way. To be honest with you, after dental school, most of the wisdom teeth (especially sets of wizzy's) that your patients need out will be done at the oral surgeons office. Are wisdom teeth tough to get out, no, not if you've done a few sets and are comfortable with laying a flap and/or sectioning a tooth if needed. But most of the time as a GP, you'll send them to the surgeon simply because in most cases due to malpractice insurance reasons, you as a GP, won't have the ability to offer IV sedation to your patients, and the O.S. will. Plus then, you don't have to "deal" with the post operative occasional complications (i.e. dry socket, varying pain levels, suture removal on a gagger, etc, etc, etc).

Take the drugs, enjoy the drugs, be able to tell your patients what its like(or the fact that you don't remember anything about it), since that's how you'll be dealing with most of your patients wisdom teeth. Plus, trust me, most surgeons actually prefer their patients to be sedated since you don't remeber them making fun of you while your doped up! 😀

 

[DeltronZ]

Totally knock yourself out, it will be easier for the surgeon and a better experience for yourself.

 

[dentisttobe]

You are forgetting that RSXer was only given the option of local anesthetic. Besides more and more gp's and oral surgeons only offer local anesthesia for simpler procedures because of the risks of cardiac arrest associated with general anesthesia. General anesthesia may not be offered by request in many offices. In fact, the oral surgeon that took my wisdom teeth out only offered local. All you feel is pressure and they give you more lidocaine during the procedure if necessary.

dentisttobe

 

[Stanford Fencer]

Hey Yah-E,

I didn't know that you went to Minnesota for undegrad. I was introduced to Dr. James Swift from the OMFS dept. of Minnesota at the latest ADEA conference (San Antonio). He was a very gracious and charming surgeon... great presence. I came away from the conversation very impressed.

 

[XCanadianRagwee]

I went competely under. I didn't want to hear anything, see anything or remotely feel any pressure anywhere. Super glad I did.

Took no time at all, went home slept all day except when I was woken up and given some nice drugs to keep me pain free.

 

[sjdent]

Very uneventful when I had all 4 taken out. None had erupted, and when I asked if I could just have local anes., my Dr. said, "if you don't go under, it will be an experience you will NEVER forget." Yikes! Needless to say, I was happily put under and it was no problem. Do recall it being rather painful once the drugs wore off, however.

 

[Yah-E]

Yes, U of MN is where I did undergraduate work and Dr. Swift is a pretty cool surgeon dude! Additionally, he's actually a pretty important person in the prestige OMS circuit. He's a board director of American Board of Oral & maxillofacial Surgery, a "big dog" that you'll have to interact with when you take your OMS boards.

http://www.aboms.org/General_Information/BoardofDirectors.htm

How are things going for you this year? Hanging in there? Top 20? What's up with you this summer? I can't believe in another 2 months (15 more exams, 14 after today), I'll be finished with my first year! 😱

Alright bud, let me know what's going on your side of the hood.

😎

 

[RSXer]

Actually, I WAS offered to be knocked out. I would just prefer to have local anesthetic instead. Oh well, it seems like you all are 50/50 about this, so I'll just go with the local and most likely super-size it with nitrous 😉

Haha, smil-doc! Yeah, I was defintiely thinknig about having it done at Maryland.....hmmm....maybe its something I should look into more. I just figured since I have dental insurance willing to pay 80%, I can handle the rest. If I had no dental insurance though....I'd definitely wait it out this fall. Heck, if Maryland will do it for free, I'd even let Mrs. Brown get a crack at them 😀....on second thought.....

 

[smile_doctor]

LOL

 

[ehop24]

I'm really surprised.

I had all four extracted under IV sedation anesthesia. I expected more people to have had the same.

The oral surgeon that performed the extractions ended up offering me a job. I worked for him for about 4 months, and in that time, I assisted in around 200 3rd molar extractions. Of these, more than 90% were under IV sedation.

I am very surprised that so many people just had local anes.

By the way, IV sedation...only way to go. Prick in the arm, count to ten, next thing I remember was the car ride home. Nice.

Anybody want to comment on the fact that my IV sedation seems rare?

 

[RSXer]

Hey ehop. Thanx for your insight. Yeah, all my friends that got their wisdom teeth out have gotten the general anesthesia so you got me thinking again.

Maybe you can answer some of my q's:

1) Is it common for an oral surgeon to do the anesthesia himself? or is it more common for the surgeon to have an anesthesiologist when a patient wants general?

2) When administering general anesthesia, should the surgeon have a pulse oximeter as a monitor?

3) Any other questions you can think of that I should ask the oral surgeon when determining if he/she has all the training/equipment needed for a safe surgery?

Thanks. I know I may be sounding a bit paranoid now, but the more I learn about this stuff, the more skeptical I am about this doctor.

 

[ehop24]

1 and 3) It is very common for the oral surgeon to do the anesthesia. I don't know many (any?) OMFS docs that would pay an anesthesiologist to be present.

However....at our office, an EMT was present AT ALL TIMES when we used general anesthesia. The EMT's duty was to monitor the vitals of the patient (including, per question 2, a pulse oximeter).

specifically, the Pulse ox is a must. Most graduating dental students are being taught that it should be used every time nitrous is administered as well, especially in kids. I wouldnt go under without the pulse ox.

By the way, the iv sedation doesnt really put you "under". All it does is drug you up so you don't remember anything that happens. I know it sounds kind of weird, but the patients are responsive at times throughout the procedure. Ask them afterwards though, and they are clueless as to what occured.

For every general anesthesia op, there was the surgeon, an assistant, and an EMT. The EMT was a big help, and quite an extensive safety blanket in case anything were to go wrong.

In 4 months, nothing ever did go wrong. Keep that in mind.

A typical extraction lasted maybe 30 minutes, beginning to end, if even that long.

These guys often do 6 or 7 a day.

 

[RSXer]

Great info. Thankx again.

One last question. You said that an extraction typically lasted 30 min. Is that for each tooth? I just wanted to clarify how long you think it would take for all 4 wisdoms: The 2 lower ones are impacted and haven't erupted at all. One upper is partially erupted and the other is a simple extraction.

The reason I ask is because the doc quoted me general anesthesia by the 1/2 hour.

Thanks in advance 🙂

 

[huguesseattle]

rule #1: never generalize for wisdom teeth and never listen others experiences: every case is particular and has its requirement (I know what I'm talking about, I pulled out hundreds of them)

if you can attach a scan of your panorex, we could have a better idea of your case and the type of sedation you would require.

Hugues

 

[RSXer]

Hey Hugues, thanks for the reminder. Yeah, I do realize that every situation will be different, but seeing that I originally didn't have much info about the procedure, I thought that getting some general info about how the procedure goes would be helpful....and it has been. In fact, becuase of the help here, I'll be more able to articulate my concers with my oral surgeon. Of course, I'll take this info with a grain of salf....seeing that its coming from an online forum (but a pre-dental forum nonetheless).

Lol! I don't think that I'll be able to scan my panorex. THat would be kinda cool though 😉