Wisdom teeth options

[leviathan]

All 4 of mine are impacted, so I'm thinking of getting them out in December due to horror stories about intracranial abscesses and the like. The dentist I spoke with says I should be fine getting local plus taking some PO benzos an hour before the procedure.

Has anyone here had all 4 impacted out with local anesthesia who would have in retrospect rather had maybe IV conscious sedation or general anesthesia instead?

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[Bertelman]

I can say I had all 4 out with what was probably general. Anesthesia provider was present. Nighty-night, woke up buzzed, was great.

I say go to sleep.

 

[SouthSideSteve]

I was out, but benzos and local is about what I'd expect from socialized medicine. Maybe they'll give you a stick to bite on too.

 

[Gimlet]

I remember getting nitrous through the little gray nose mask, but don't remember any IVs. The OMFS guy and another person/assistant were there...no idea if the assistant was specifically for anesthesia or not.

Last thing I remember is talking about walruses with the oral surgeon, then I was awake in what felt like a second later with the operation complete. They told me to hold tight and they'd grab a wheelchair to take me out in, but I was so out of it I just followed them right out of the room and walked to my dad's truck. Watched a rental of one of the Chris Farley/David Spade movies when I got home (I think it was Black Sheep) and had to watch it again two weeks later because I didn't remember a single second of the movie even though I was awake through the whole thing.

 

[cchoukal]

I had nitrous and benzos administered by the oral surgeon. he may have done local, as well. it was fine, but if I knew then what I know now, I might have asked about monitoring, safety, etc.

 

[DREDAY]

By impacted do you mean? full bony impaction? partial bony impaction? soft tissue impaction? also what is the position of the tooth? If its full or partial bony, I would personally get IV sedation. I wouldn't want to go through it awake. It is possible for you to do it under local, but sometimes it would just be inhumane.

All 4 of mine are impacted, so I'm thinking of getting them out in December due to horror stories about intracranial abscesses and the like. The dentist I spoke with says I should be fine getting local plus taking some PO benzos an hour before the procedure.

Has anyone here had all 4 impacted out with local anesthesia who would have in retrospect rather had maybe IV conscious sedation or general anesthesia instead?

 

[leviathan]

By impacted do you mean? full bony impaction? partial bony impaction? soft tissue impaction? also what is the position of the tooth? If its full or partial bony, I would personally get IV sedation. I wouldn't want to go through it awake. It is possible for you to do it under local, but sometimes it would just be inhumane.

I'm not sure. I've seen the x-rays, they are completely sideways and underneath the gums, but I don't know to what extent. I'm thinking I'm going to just ask for a minimum of IV sedation.

As long as this isn't asking for medical advice, at what point should an anesthesiologist be present?

 

[lord_jeebus]

I had a fun time with IV sedation. The oral surgeon knew I was going into anesthesia so he made it an educational experience...

He did some sort of block, Versed has erased my memory of that and his teaching efforts there, if he made any, were for nothing.

Then he tells me "this is what Versed feels like" and pushed Versed. Impressive.

Then "this is what fentanyl feels like."

I remember being fairly aware of what was going on at times, like "there is a big drill in my mouth" but not caring at all.

 

[narcusprince]

I have actually provided anesthesia for dental extractions during my ambulatory month. We used prop/alfenta, gave toradol/zofran. We used a Mac safe nasal cannula with some periodic jaw thrust from the surgeons. Pt's woke up feeling good.
Narc

 

[dhb]

Has anyone here had all 4 impacted out with local anesthesia who would have in retrospect rather had maybe IV conscious sedation or general anesthesia instead?

I did them under local w no sedation and the experience wasn't great to say the least. Some form of sedation should be considered if the extraction isn't strait forward.

 

[DREDAY]

By definition OMFS are certified in General Anesthesia and do their own IV sedation. They are very competent in providing IV sedation with minimal risks.

I'm not sure. I've seen the x-rays, they are completely sideways and underneath the gums, but I don't know to what extent. I'm thinking I'm going to just ask for a minimum of IV sedation.

As long as this isn't asking for medical advice, at what point should an anesthesiologist be present?

 

[psychbender]

Ohhh, the pleasant memories of getting my wisdom teeth removed. I was given 5mg of PO diazepam to take on the way to the dentist's office in the morning, got some local and breathed deep from the nitrous...then woke up in the middle of the procedure, arms flailing about wildly, in a fair bit of pain, with the dentist saying, "Now Psych, just calm down..." Things got a bit dark, then I recall waking again after he said he was finished, getting up, and storming off down the hallway to sit in his "recovery room," with his assistant chasing after me, saying that I shouldn't be walking right now. Ahhh, memories...

 

[Bertelman]

By definition OMFS are certified in General Anesthesia and do their own IV sedation. They are very competent in providing IV sedation with minimal risks.

I'm not really sure what "certified in General Anesthesia" means. Did they get a certificate to frame and place behind their desk? Where I worked before, they rotated with anesthesia for one month.

Furthermore, you shouldn't equate general anesthesia with IV sedation, though they do often overlap in the wrong hands.

 

[MErc44]

I remember getting nitrous through the little gray nose mask, but don't remember any IVs. The OMFS guy and another person/assistant were there...no idea if the assistant was specifically for anesthesia or not.

Last thing I remember is talking about walruses with the oral surgeon, then I was awake in what felt like a second later with the operation complete. They told me to hold tight and they'd grab a wheelchair to take me out in, but I was so out of it I just followed them right out of the room and walked to my dad's truck. Watched a rental of one of the Chris Farley/David Spade movies when I got home (I think it was Black Sheep) and had to watch it again two weeks later because I didn't remember a single second of the movie even though I was awake through the whole thing.

I had a similar experience except I rented Heat and thought it must have been a terrible movie because it put me to sleep. Haha, I don't know what they gave me for sedation and I don't remember having a pulse oximeter or any source of oxygen applied before I drifted off.

 

[lord_jeebus]

I'm not really sure what "certified in General Anesthesia" means. Did they get a certificate to frame and place behind their desk? Where I worked before, they rotated with anesthesia for one month.

Furthermore, you shouldn't equate general anesthesia with IV sedation, though they do often overlap in the wrong hands.

I asked my oral surgeon how much anesthesia he had done and he said 6 months of doing his own cases. He trained in the military so it might have been different there.

 

[mmag]

I had all four of my fully impacted wisdom teeth out under local with no benzo premedication. That was when I was 20 and probably better able to handle it. The only unpleasant part was the sawing and breaking up of the teeth while the oral surgeon was humming along. I'd lean towards IV sedation if I had to have it done now. It's boring to keep your mouth open and be awake during the extraction.

 

[DREDAY]

This is taken out of the American Association of Oral and Maxillofacial Surgeons website:


The oral and maxillofacial surgery residency enables oral and maxillofacial surgeons to perform a wide variety of procedures in both an office setting and a hospital environment. These four to six year residencies incorporate extensive training in anesthesia administration, including local anesthesia, nitrous oxide, intravenous sedation and general anesthesia, all of which the surgeon may appropriately, competently and safely administer in the oral and maxillofacial surgery office to meet the unique requirements of the patient and the procedure.

Below is the link:

http://www.aaoms.org/treatments.php

I'm not really sure what "certified in General Anesthesia" means. Did they get a certificate to frame and place behind their desk? Where I worked before, they rotated with anesthesia for one month.

Furthermore, you shouldn't equate general anesthesia with IV sedation, though they do often overlap in the wrong hands.

 

[Bertelman]

This is taken out of the American Association of Oral and Maxillofacial Surgeons website:


The oral and maxillofacial surgery residency enables oral and maxillofacial surgeons to perform a wide variety of procedures in both an office setting and a hospital environment. These four to six year residencies incorporate extensive training in anesthesia administration, including local anesthesia, nitrous oxide, intravenous sedation and general anesthesia, all of which the surgeon may appropriately, competently and safely administer in the oral and maxillofacial surgery office to meet the unique requirements of the patient and the procedure.

Below is the link:

http://www.aaoms.org/treatments.php

I don't really care what the OMF propaganda says. What is extensive training? Under what circumstances do they perform general anesthesia? Who trains them?

FWIW, this board is focused on the education of anesthesiologists, so don't be surprised if there is a bias towards having a well-trained, competent person dedicated to the administration of the anesthetic. I'd be hesitant to have the same practitioner administering general anesthesia while he extracted my teeth. We undergo 4 years of training to perform general anesthesia safely to practically any patient. Pardon us if we express doubt that someone can receive adequate training in a matter of months.

Your bias lies in the fact that you hear of this being done frequently w/o complication. Our bias is that we frequently hear of the complications. I'm not knocking the OMF guys. The two in my med class were bright as hell. Allow me to question the relevance of a "certificate in General Anesthesiology" while I toil towards a 4-year DIPLOMA followed by board cert, though.

 

[DREDAY]

No need to get defensive, I was answering your question on whether OMFS are trained to do General Anesthesia. They do 4-6 months running their own GA in an OR in the medical center, and 2-3 years doing in-office IV sedations. My "bias" lies on published evidence of OMFS having minimal complications in administering IV sedation.

I don't really care what the OMF propaganda says. What is extensive training? Under what circumstances do they perform general anesthesia? Who trains them?

FWIW, this board is focused on the education of anesthesiologists, so don't be surprised if there is a bias towards having a well-trained, competent person dedicated to the administration of the anesthetic. I'd be hesitant to have the same practitioner administering general anesthesia while he extracted my teeth. We undergo 4 years of training to perform general anesthesia safely to practically any patient. Pardon us if we express doubt that someone can receive adequate training in a matter of months.

Your bias lies in the fact that you hear of this being done frequently w/o complication. Our bias is that we frequently hear of the complications. I'm not knocking the OMF guys. The two in my med class were bright as hell. Allow me to question the relevance of a "certificate in General Anesthesiology" while I toil towards a 4-year DIPLOMA followed by board cert, though.

 

[Bertelman]

No need to get defensive, I was answering your question on whether OMFS are trained to do General Anesthesia. They do 4-6 months running their own GA in an OR in the medical center, and 2-3 years doing in-office IV sedations. My "bias" lies on published evidence of OMFS having minimal complications in administering IV sedation.

That sounds reasonable. I was unaware they spent 6 dedicated months in the OR under the medical direction of an anesthesiologist. That sounds much better than "certified in general anesthesia".

 

[urge]

I had local and po benzo. My mom got charged $500 cash for the "conscious sedation". What a scam. I was 17 and didn't know better. I'm still pissed!

 

[coldweatherblue]

I had mine out with p/o benzos + nitrous oxide + local block. The dentist provided anesthesia. The bottom two were impacted.

It wasn't a horrible experience but I definitely remember a lot of the procedure. I remember getting the block, the incisions, my friend (whose mom worked there) pointing at me laughing as blood gushed out of my mouth, I remember the dentist standing on part of the chair with his elbow on my chest for leverage trying to yank out one of the impacted ones, lol.. so yeah if I had the same procedure done today I probably would've asked for a few more valium beforehand.

 

[chocomorsel]

Ohhh, the pleasant memories of getting my wisdom teeth removed. I was given 5mg of PO diazepam to take on the way to the dentist's office in the morning, got some local and breathed deep from the nitrous...then woke up in the middle of the procedure, arms flailing about wildly, in a fair bit of pain, with the dentist saying, "Now Psych, just calm down..." Things got a bit dark, then I recall waking again after he said he was finished, getting up, and storming off down the hallway to sit in his "recovery room," with his assistant chasing after me, saying that I shouldn't be walking right now. Ahhh, memories...

OMFG!!! This was hilarious. Thanks so much for making me LMAO

 

[armorshell]

I had mine out with p/o benzos + nitrous oxide + local block. The dentist provided anesthesia. The bottom two were impacted.

It wasn't a horrible experience but I definitely remember a lot of the procedure. I remember getting the block, the incisions, my friend (whose mom worked there) pointing at me laughing as blood gushed out of my mouth, I remember the dentist standing on part of the chair with his elbow on my chest for leverage trying to yank out one of the impacted ones, lol.. so yeah if I had the same procedure done today I probably would've asked for a few more valium beforehand.

I don't know who these guys are that are leveraging off the chairs, walls, body parts, but I keep hearing from my patients so it must be true. I can't tell you how many times my patients have told me "The last guy had a kick plate on the wall he could put his foot on!" or "Yeah, he had his knee on my chest and was pulling with both hands!"

Not how I was taught to do it.

 

[Hockeyguy]

I just had mine taken out today. Three-day weekend so I had my dentist yank them this AM. I only had uppers. My Dentist is a stud. He did straight local and yanked them both in less then 10 minutes. Seriously I am foing fine. I would say find a guy with a good rep and you'll be fine. N2O or benzos would have been overkill in my opinion.

 

[Doctor Bagel]

I had local and po benzo. My mom got charged $500 cash for the "conscious sedation". What a scam. I was 17 and didn't know better. I'm still pissed!

Lame, I think that's about what I paid for general anesthesia for mine. Personally, I liked being knocked out, but if your oral surgeon says it's OK, then he/she might be right. Mine looked at my xrays and said I pretty much had to be put under.

 

[traumasurg]

All 4 of mine are impacted, so I'm thinking of getting them out in December due to horror stories about intracranial abscesses and the like. The dentist I spoke with says I should be fine getting local plus taking some PO benzos an hour before the procedure.

Has anyone here had all 4 impacted out with local anesthesia who would have in retrospect rather had maybe IV conscious sedation or general anesthesia instead?

I had mine taken out under GA and I highly recommend it. I had it done in the OR with an anesthesiologist because my mom is a paranoid nurse. It went off without a hitch.

It still didn't help the dry socket afterwards.