Managing Wisdom Tooth Pain and Potential Complications

[zomgwtf]

Do you mean total numbness of the tongue so long as the novocaine lasts, or permanent numbness of the tongue? My tongue is certainly not numb now.

I also don't recall, these 29 years later, if I still felt any novocaine numbness after I woke up. I was very spaced out. But I did not accidentally bite my tongue or anything.

Novocaine is no longer used as an anesthesia... I'm pretty sure most dentist use lidocaine. I think the side effects that Monique are talking about however mostly have to do with anesthesia delivery to the inferior alveolar nerve. Sometimes the anesthesia can travel farther than expected causing numbness in the tongue and 'facial paralysis' however this goes away once the anesthesia wears off. (normally 1-2 hours depending on what was mixed with the anesthesia.) However an improperly placed needle can cause permanent numbness/paralysis but this is rare and is attributed to improper method and not the actually drugs themselves.

@russ, It seems to me that you're trying to make out what I'm saying to be a problem because a dentist can't administer anestheisic drugs? In that case all of the things dentists are supposed to be able to do must be done by an oral surgeon.
My dental office started out as a small office with one dentist and a few people to help him. Now it has I believe two dentist a small army of dental hygienist and secretaries. It's not very big at all though...
Anyways, I looked it up and dentist DO administer local anesthesia in America so I do not see where your problem is. Dentist here also can administer general anesthesia, after receiving proper training, under the request of the patient. Most dentist use inhalation methods for general anesthesia.

 

[zoobyshoe]

Novocaine is no longer used as an anesthesia... I'm pretty sure most dentist use lidocaine. I think the side effects that Monique are talking about however mostly have to do with anesthesia delivery to the inferior alveolar nerve. Sometimes the anesthesia can travel farther than expected causing numbness in the tongue and 'facial paralysis' however this goes away once the anesthesia wears off. (normally 1-2 hours depending on what was mixed with the anesthesia.) However an improperly placed needle can cause permanent numbness/paralysis but this is rare and is attributed to improper method and not the actually drugs themselves.

I've been to the dentist twice in the past 30 days and both times the numbness was accompanied by facial paralysis for the duration. In fact, the first time the paralysis lasted about 4 hours. I was getting alarmed, actually.

This site:

http://www.doctorspiller.com/local_anesthetics.htm#Procaine

not only confirms what you said about lidocaine, but indicates I have probably never had a shot of authentic novocaine in my life. Its use was discontinued in the 50's. It's funny that everyone seems still to refer to it as novocaine.

 

[russ_watters]

@russ, It seems to me that you're trying to make out what I'm saying to be a problem because a dentist can't administer anestheisic drugs? In that case all of the things dentists are supposed to be able to do must be done by an oral surgeon.

Though I didn't say the word, what I meant was that many wisdom tooth extractions require general anesthetic, which requires an anesthesiologist - which a dentist typically doesn't have. A dentist can administer local, but not general anesthetic.

Some of the others here described similar procedures to mine that were done under local instead of general, but their descriptions make me glad mine was done under general. I can't imagine someone hitting me in the face with a chisel and being awake for it!

I know anecdotes have limited utility, but it does sound like the descriptions from people from other countries imply that we in the US get general anesthetic for extractions done under local for them.

 

[zomgwtf]

Though I didn't say the word, what I meant was that many wisdom tooth extractions require general anesthetic, which requires an anesthesiologist - which a dentist typically doesn't have. A dentist can administer local, but not general anesthetic.

Some of the others here described similar procedures to mine that were done under local instead of general, but their descriptions make me glad mine was done under general. I can't imagine someone hitting me in the face with a chisel and being awake for it!

Dentist here also can administer general anesthesia, after receiving proper training, under the request of the patient. Most dentist use inhalation methods for general anesthesia.

https://www.physicsforums.com/newreply.php?do=newreply&p=2627971
Most dentist take the proper training in order to insure that they are able to administer anesthesic drugs themselves. Normally this is combined with their M.D. or further training of about 2 years. The dental office I go to the dentist can administer general anesthesia and put you unconscious but it's normally only done by the patient requesting it.
It's hardly necessary for extraction of any tooth and is more of a 'scared patient' factor. There are however extremely difficult cases where the patient is suggested to an oral surgeon but these are emergency situations. I'm pretty sure any dental work done in an emergency setting like this is covered by OHIP (insurance) so it's free and you undergo much heavier sedation than you would regularly undergo in a dental office situation. Its hardly necessary though and for the majority of dental extractions, never occurs.

It seems to me that you are basing what is regularly done in dental offices to what you experienced yourself.

 

[Count Iblis]

General anesthetic carries a small risk of severe complications that can lead a healthy person to die. For that reason, where I live this is only allowed in a hospital with intensive care unit facilities.

 

[Count Iblis]

Not always, they can also pull out both the upper ones and one of the lower ones in one go.

I'm glad they didn't do that to me.

 

[zomgwtf]

Hmm in America even pediatric dentist can administer general anesthesia. Haven't you guys ever heard of people being put unconscious by a dentist for a procedure by them using what is known as laughing gas? It's only used for patients who are uncooperative (some children) or patients who are scared/anxious or will have difficulties keeping their mouths open for extended periods of time. In those situations the patient has to request it it's not regularly used here for dentistry work exactly for the reason of "associated risks"(which are minimal as well) compared to local anesthesia and the local anesthesia does the exact same job.

There is absolutely no reason under normal circumstances that a normal anesthesic drug will not work for a dental procedure.

 

[Count Iblis]

The price you pay for that are the unfortunate deaths. You may have some extremely rare allergic reaction to the anesthesia and die if there is no ICU in the neighborhood. The anesthesia may trigger some heart rithm disturbance and you may go into cardiac arrest.

 

[zomgwtf]

The price you pay for that are the unfortunate deaths. You may have some extremely rare allergic reaction to the anesthesia and die if there is no ICU in the neighborhood. The anesthesia may trigger some heart rithm disturbance and you may go into cardiac arrest.

Maybe back in the 1950s... anesthesia has come a LONG way and it is much, MUCH safer now than ever before. In fact I can't think of any extreme side effects from nitrous oxide... I think you have a much better chance of paralysis from local anesthesia than you do of death from laughing gas. Anyways I'm assuming when russ talks about 'general anesthesia' he means more intense forms of anesthesia not including nitrous oxide (since it's a pretty weak form of general anesthesia especially for dental procedures). Generally speaking it is mixed with equal parts of O2 but that is adjusted to your comfort normally.

I do not see how the argument 'you need to go to an oral surgeon to have 3rd molar extractions done because you need a general anesthesia' applies. Getting a tooth extraction is FAR from requiring any form of heavy sedation... the nitrous oxide/local anesthesia supplid by a trained dentist is more than enough to be able to get you through the procedure with very, very minimal side effects. Only in extreme emergency cases that I spoke of earlier where surgery on the jaw is required etc. is necessary will you be sent to an oral surgeon. You can also choose to go to an oral surgeon on your own but it's not covered by OHIP and it's quite expensive.

 

[russ_watters]

Hmm in America even pediatric dentist can administer general anesthesia. Haven't you guys ever heard of people being put unconscious by a dentist for a procedure by them using what is known as laughing gas?

I'd never heard of it outside a movie - I was thinkingi that meant it was one of those things they used to do before they realized it was risky.

Er, maybe something different: the wiki implies that nitrous isn't typically used alone as a general anesthetic because it is too weak:

Nitrous oxide is a weak general anesthetic, and so is generally not used alone in general anesthesia.

http://en.wikipedia.org/wiki/Nitrous_oxide#In_medicine

My wisdom tooth extraction used IV general anesthetic.

 

[zomgwtf]

I'd never heard of it outside a movie - I was thinkingi that meant it was one of those things they used to do before they realized it was risky.

I had mentioned that nitrous oxide was a weak general anesthetic already, what does bringing that up have to offer? Mixing it with various other anethesic drugs or even just changing the ratio of N2O to O2 does occur which effects the sedation greatly. It all depends on the needs of the patient and what the dentist requires to be able to accomplish his work. It also alters what is necessary to be monitored.

Anyways about administering general anesthesia to children:
http://www.aapd.org/publications/brochures/anesthesia.asp

What normally will occur is that there will be a sedation injection as well as the N2O being administered possibly mixed. The flow rate must be properly adjusted for the size of the child and there are very strict restrictions set up for administering the N2O. This is for IV sedation or GA.

I have an article somewhere around dealing specifically with guidlines of administering general anesthesia to pediatric patients as well as ones dealing with conscious and deep sedation. If you want I could post look them up and post them... Since it seems to me you will not accept that dentists can and do administer their own anesthetic drugs. At first I thought it might have only been a Canadian dentist thing but as it turns out this isn't true, American dentist are pretty much the same. A big difference however has to do with the extent of insurance coverage in America whereas most Canadians don't really have to worry about that if they end up in the hospital.

My wisdom tooth extraction used IV general anesthetic.

Well IV sedation is known as deep sedation. It means you had remained conscious however you were in a 'sleepy' state. You still breath and are somewhat responsive to the dentist(they have to more than just talk to you though) your eyes do shut but you haven't lost conciousness yet. AFAIK deep sedation in America is not considered to be general anesthesia in America GA is considered as being unconscious and unresponsive as well your protective reflexes will more than likely not be operating (breathing). In some countries it is I'm pretty sure America is not one of those countries.

It's not really normal nor necessary to use this on patients for dental work, even tooth extractions. Generally speaking it's only done at the request of the patient or if the dentist thinks it would be best to go that route for a particular reason. I.e. the patient seems nervous or won't be able to sit still and follow what the dentist says etc.

 

[hamster143]

AFAIK deep sedation in America is not considered to be general anesthesia in America GA is considered as being unconscious and unresponsive as well your protective reflexes will more than likely not be operating (breathing)

That is correct. When we talk about extraction of wisdom teeth under general anesthesia, we imply that the patient is completely knocked out and only wakes up when the procedure is over. Nitrous sedation is useful when you deal with small kids (as any parent knows, it's very hard to convince a 3 year old to sit still while a stranger tries to drill holes in his teeth), and it's a lot safer than true GA, but it is not substantially superior to simple lidocaine when you need to perform complicated maneuvers in the least reachable corner of the patient's mouth for two hours.

 

[zomgwtf]

That is correct. When we talk about extraction of wisdom teeth under general anesthesia, we imply that the patient is completely knocked out and only wakes up when the procedure is over. Nitrous sedation is useful when you deal with small kids (as any parent knows, it's very hard to convince a 3 year old to sit still while a stranger tries to drill holes in his teeth), and it's a lot safer than true GA, but it is not substantially superior to simple lidocaine when you need to perform complicated maneuvers in the least reachable corner of the patient's mouth for two hours.

I completely agree with this statement and for the most part it has been how, at least I've known, the system here in Canada works. It may be safer than GA but there are still risks associated with even N2O (although they are extremely minimal). When you compare which method is better using conscious sedation methods are IMO the better option. The superiority of deeper sedation methods mostly comes out when children or an extremely nervous patient is involved. Possibly even for an exceedingly long procedure, but this wouldn't be too often for most tooth extraction cases.

This thread has been dragged way off course however . I've just been kinda bored and was in an argumentative mood the other day.

 

[Evo]

That is correct. When we talk about extraction of wisdom teeth under general anesthesia, we imply that the patient is completely knocked out and only wakes up when the procedure is over. Nitrous sedation is useful when you deal with small kids (as any parent knows, it's very hard to convince a 3 year old to sit still while a stranger tries to drill holes in his teeth), and it's a lot safer than true GA, but it is not substantially superior to simple lidocaine when you need to perform complicated maneuvers in the least reachable corner of the patient's mouth for two hours.

Actually oral surgeons do use general anesthesia with an anesthetist, it's done in an operating room, you are hooked up to all of the monitors, you are unconscious during the surgery and taken to a recovery room to wake up and they take you to the car in a wheelchair (someone else has to drive). Evo child had all 4 of hers take out at once, two were impacted, and the other two looked like they would become impacted.

 

[Moonbear]

General anesthetic carries a small risk of severe complications that can lead a healthy person to die. For that reason, where I live this is only allowed in a hospital with intensive care unit facilities.

This is not the case in the US. There are regulations, though, that protect the patients. The facility where general anesthesia is administered DOES need to have life support and resuscitation equipment available in the event of a major adverse reaction (stopping breathing), and staff fully trained, qualified, and present to resuscitate a patient in those circumstances.

Keep in mind, that one should not assume that a local anesthetic is inherently safer just because it is local. A patient can also have an adverse reaction to a local anesthetic just as much as they can a general anesthetic, so it's really a false sense of security to make a distinction between the two. For most dental procedures, however, they do not deeply anesthetize a patient. Usually, general anesthetic is given in a fairly low dose, only sufficient to lightly sedate the patient, not render them unconscious.

And, there ARE patients for whom local anesthetic is not an option. Their nerves just don't follow typical patterns/paths, or there are other anatomical anomalies that prevent access to those nerves, or they for some reason just don't respond to the local anesthetic, or have an allergy to the 'caine drugs (lidocaine, novacaine, etc.). The other advantage of a general anesthetic for things like wisdom teeth is that it will also help relax some of the other jaw muscles that would not relax with just a local anesthetic...this let's the dentist get your mouth stretched open a bit wider without causing pain so they can reach those teeth so far back in the mouth...especially important if they need to get in and surgically remove them rather than just pull on them.

 

[russ_watters]

Actually oral surgeons do use general anesthesia with an anesthetist, it's done in an operating room, you are hooked up to all of the monitors, you are unconscious during the surgery and taken to a recovery room to wake up and they take you to the car in a wheelchair (someone else has to drive). Evo child had all 4 of hers take out at once, two were impacted, and the other two looked like they would become impacted.

Well...my "recovery room" was a window sill with a seat cushion on it, and my mother helped me down the stairs and to her car, but other than that, yeah. I didn't wear a hospital gown, but I'm pretty sure I pulled-up my shirt to put some electrodes on my chest.

Everything about that surgery was worse than my hernia (which was about as easy as they get, so I was told). My teeth were pretty well impacted and it felt every bit as if I'd been hit in the face four times with a hammer and chisel (which I had). A week and a half later, I was still feeding pizza through the 1/2" slot my mouth formed.

 

[russ_watters]

I had mentioned that nitrous oxide was a weak general anesthetic already, what does bringing that up have to offer?

Apparently, I'm still not adequately getting the point across:

Well IV sedation is known as deep sedation. It means you had remained conscious however you were in a 'sleepy' state. You still breath and are somewhat responsive to the dentist(they have to more than just talk to you though) your eyes do shut but you haven't lost conciousness yet. AFAIK deep sedation in America is not considered to be general anesthesia in America GA is considered as being unconscious and unresponsive as well your protective reflexes will more than likely not be operating (breathing). In some countries it is I'm pretty sure America is not one of those countries.

Yes, I said "general anesthetic" and I meant it. As said by someone else, it means completely unconscious. That's the state I (and several of my friends) was in when I had my wisdom teeth out. Nitrous is not the same. I can believe that dentists deliver nitrous to make you groggy, but that isn't true/full general anesthetic and it isn't what my oral surgeon did.

Again, this is why an oral sugeon is needed: A dentist does not deliver real general anesthetic.

It's not really normal nor necessary to use this on patients for dental work, even tooth extractions. Generally speaking it's only done at the request of the patient or if the dentist thinks it would be best to go that route for a particular reason. I.e. the patient seems nervous or won't be able to sit still and follow what the dentist says etc.

Well apparently that's a difference betwen the US and Canada, then: In my experence and that of most of the people I know, getting wisdom teeth taken out by an oral surgeon with real general anesthetic was SOP.

I have also heard that if you're rich, you can request general anesthetic (not sure if that is true general anesthetic or just nitrous) for basic dental work like cavities and root canals.

 

[lisab]

My experience was very similar to Russ's. I had full anesthesia, and was very groggy for at least an hour after I woke up. No hospital or hospital gown, I wore normal clothes. It was done in an oral surgeon's office.

Then, a long week with a bruised face and not being able to move my jaw (no one told me to expect that, I was sure I had tetanus, haha).

 

[Count Iblis]

Moonbear, thanks for your detailed reply. I've read that before you can get general anesthesia, you cannot eat anything for many hours. That sounds extremely inconvenient to me.

 

[zomgwtf]

Apparently, I'm still not adequately getting the point across: Yes, I said "general anesthetic" and I meant it. As said by someone else, it means completely unconscious. That's the state I (and several of my friends) was in when I had my wisdom teeth out. Nitrous is not the same. I can believe that dentists deliver nitrous to make you groggy, but that isn't true/full general anesthetic and it isn't what my oral surgeon did.

That wasn't what I was talking about at all. Sure maybe you were under GA but it's not called IV sedation, that's not general anesthesia, that's deep sedation and you are still conscious for this.

As well it's not true that dentists can not administer anesthesiology, I don't know why you are under this impression all that is needed in both America and Canada to administer anesthetic drugs is the proper training and facilities. Most dentists DO have the proper training and plenty of offices, here at least, do have facilities for anesthisology right in the office. Nitrous oxide can make you unconscious and it definitely will bring about IV sedation, which in some countries (not America) would be considered GA.

 

[russ_watters]

That wasn't what I was talking about at all. Sure maybe you were under GA but it's not called IV sedation, that's not general anesthesia, that's deep sedation and you are still conscious for this.

I didn't use the term "IV sedation", you did. I said "IV general anesthetic" and it would seem you misread, thinking I meant "IV sedation". I did not. I meant exactly what I said: general anesthetic delivered via an IV. I said that because I wanted to make it clear I wasn't knocked out by a gas.

The rest of your post is following a similar track, arguing about something I made clear is not what I was talking about. Maybe it would help clarify if you answered a straightforward question: can a dentist administer a *real* general anesthetic (as per our discussion which defined it) or do you need an anesthesiologist for it?

Please do not answer that in some countries they consider nitrous to basically be a GA - you know by now that isn't what I'm talking about.

 

[zomgwtf]

OHHH you meant INTRAVENOUS. When talking about anesthesia it's usefull to use the full term for that because IV means LEVEL 4. That's MY mistake for misunderstanding though.

As well, to answer your question, yes dentists can administer GA sedation(this is what I've been saying the entire time and it will not change). The necesary tools etc., are bascially the same when the patient is in IV sedation. There are different guidlines for pediatric patients.

http://www.ada.org/prof/resources/positions/statements/anesthesia_guidelines.pdf

 

[fluidistic]

Update:
My gum is still red where I had the infection. The dentist told me it'd be better to remove the tooth, but it's not an obligation. However she checked out my other teeth and the upper left wisdom tooth has a huge tooth decay and the tooth caused my an ulcer (which didn't look good to her eyes!). She said it's urgent to remove this tooth. So I'm having it removed on 8th of april.
She didn't took a radiography of this upper tooth (though she did for my lower one, in case I wanted to remove it). I guess there's no danger to damage any nerve for the upper wisdom teeth, right?
She's going to do all by herself and she told me it could last between 5 to 20 minute and that it's a routine surgery.

I'll have to start to take antibiotics from the day of the little surgery.

 

[Evo]

If the x-ray is not too expensive, you may want one for piece of mind, just to make sure there isn't something odd (like when they found the roots of the tooth they were pulling were wrapped around the roots of the tooth next to it and required an oral surgeon).

 

[fluidistic]

This was it. I just got the tooth removed (30 minutes ago). A horrible experience, I almost fainted three times: the first time because of both anesthesias, the second time because of the sounds and sensation of the tooth during the dentist forced to extract it and another time while leaving because I thought about the huge place I now have in my mouth.
According to the dentist I should eat ice creams and "eat" only liquids for today.
I kept the tooth in case I need money: selling the ivory.

 

[Borek]

Get well fast. Weekend will be difficult, when anesthesia wears out.

 

[Evo]

This was it. I just got the tooth removed (30 minutes ago). A horrible experience, I almost fainted three times: the first time because of both anesthesias, the second time because of the sounds and sensation of the tooth during the dentist forced to extract it and another time while leaving because I thought about the huge place I now have in my mouth.
According to the dentist I should eat ice creams and "eat" only liquids for today.
I kept the tooth in case I need money: selling the ivory.

They didn't put you to sleep? They just numbed you? That's terrible. Make sure you don't get dry socket.

 

[fluidistic]

Get well fast. Weekend will be difficult, when anesthesia wears out.

Thanks :)
I was also scared about this, I asked the dentist and told me to take ibuprofen in case it hurts.
Now I need to buy some ice cream but I still lose blood. Too bad I'm not in Poland in winter, I'd have picked some snow to do the job.

They didn't put you to sleep? They just numbed you? That's terrible. Make sure you don't get dry socket.

She told me that the better for me now is to eat some ice cream. When I was leaving I told her secretary I wasn't feeling good and that I needed to sit on the chairs, which I did. After 5 minutes I left and I'm here now. I got rid of the bandage I had in the mouth, but it's still bleeding.
What is dry socket by the way?
She told me to put a lot of pillows in case I wanted to sleep.

 

[Borek]

told me to take ibuprofen in case it hurts.

It will hurt, no doubt about it :(

 

[fluidistic]

It will hurt, no doubt about it :(

Ok. I already have a bad headache! Last time ibuprofen killed almost totally the pain, I think it will work well.

I'll take it when the anesthesia leaves.
By the way, Borek, do you know what a dry socket means? In Evo's post I mean.

 

[Borek]

I guess http://en.wikipedia.org/wiki/Dry_socket

 

[fluidistic]

I guess http://en.wikipedia.org/wiki/Dry_socket

Thanks once again.

 

[Evo]

Thanks :)
I was also scared about this, I asked the dentist and told me to take ibuprofen in case it hurts.
Now I need to buy some ice cream but I still lose blood. Too bad I'm not in Poland in winter, I'd have picked some snow to do the job.

She told me that the better for me now is to eat some ice cream. When I was leaving I told her secretary I wasn't feeling good and that I needed to sit on the chairs, which I did. After 5 minutes I left and I'm here now. I got rid of the bandage I had in the mouth, but it's still bleeding.
What is dry socket by the way?
She told me to put a lot of pillows in case I wanted to sleep.

She didn't give you an instruction sheet on how to prevent dry socket?

http://www.mayoclinic.com/health/dry-socket/DS00778

http://www.webmd.com/oral-health/dry-socket-symptoms-and-treatment

 

[fluidistic]

She didn't give you an instruction sheet on how to prevent dry socket?

http://www.mayoclinic.com/health/dry-socket/DS00778

http://www.webmd.com/oral-health/dry-socket-symptoms-and-treatment

Thanks for the info. She told me not to shell out so that the blood clot forms. No, she didn't say a word on this. In wikipedia it's stated that it's much less common for upper wisdom teeth (mine was the upper left).
I still have the anesthesias effect and an increasing headache (now I remember, each time I have an anesthesia I have an headache after it).