# Conscious Sedation for Wisdom Tooth Extraction



## rwik123 (Dec 23, 2011)

So here's the deal. I'm having my wisdom teeth taken out next week at an oral surgery office. At first I was just going to opt for novocaine. The oral surgeon talked against it and advised me to go with the concious sedation method. Maybe it's just me but it just seems sketchy to get anesthesia in an out of hospital setting. Their procedure consists of a propofol drip, I assume titrated to effect. All you medics out there; is this safe and not risky? I know it goes on all the time without any problems. I assume a CRNA will be delivering the meds and monitoring... According to their website. Maybe I'm just anxious and wary, so any info would be great. First time getting any kind of anesthesia so I thought the resources of emtlife would provide a wealth of information.  

Thanks!


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## lightsandsirens5 (Dec 23, 2011)

Dude, I would not recommend going with novacane for a wisdom tooth removal. Just sayin.....

I had conscious sedation for my mouth butchering, errrrr.....wisdom tooth removal, with no problems at all.


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## adamjh3 (Dec 23, 2011)

I also had conscious sedation when I got mine pulled (all four). I think that's pretty much the norm. I do distinctly remember getting out of my chair post operation and yelling "Woo! Party at my house!" The rest is like it didn't happen.


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## DesertMedic66 (Dec 23, 2011)

I don't know what I was given but I was out cold. They had to pull 2 and then crack and remove the other 2. It took about 20 mins. I was still pretty out of it when I woke up. But I never had any pain.


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## fast65 (Dec 23, 2011)

firefite said:


> I don't know what I was given but I was out cold. They had to pull 2 and then crack and remove the other 2. It took about 20 mins. I was still pretty out of it when I woke up. But I never had any pain.



That's the same thing they had to do with mine too. I don't remember a single thing about getting mine out...I'll assume I had some sort of conscious sedation.


Sent from my iPhone using Tapatalk


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## usalsfyre (Dec 23, 2011)

If anesthesia is delivering it, pretty safe. Conscious sedation is done in outpatient settings all the time.

If it's just the dentist doing "sedation dentistry" on the other hand...


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## SSwain (Dec 23, 2011)

I had all 4 of mine pulled with just novocaine. Granted the roots were perfect for doing this, and I had tons of novocaine injected.


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## MMiz (Dec 23, 2011)

I had one pulled with just Novocaine and was teaching the next morning.


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## Handsome Robb (Dec 23, 2011)

I had 4, all impacted...conscious sedation and I still have all my brain cells...actually that's debatable


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## Handsome Robb (Dec 23, 2011)

SSwain said:


> I had all 4 of mine pulled with just novocaine. Granted the roots were perfect for doing this, and I had tons of novocaine injected.



Eff that. You sir, are much more manly than I am.


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## mycrofft (Dec 23, 2011)

*Do you trust the doctor?*

 They flat-out anesthetized me due to roots firmly into my max sinuses.
I was given proposal and knocked out"lightly" for diagnostics and for cardioversions. It was like "Count backwards from two". Quick recovery overall, but I felt like i was just a little off for about a week. Probably psychological.


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## Medic Tim (Dec 23, 2011)

I had novocaine and nitrous oxide  gas for mine


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## FourLoko (Dec 23, 2011)

Had four out at the same time. I was out, not sure what they gave me but I did the countdown and don't remember anything after that. Pretty scary and awesome.


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## rwik123 (Dec 23, 2011)

usalsfyre said:


> If anesthesia is delivering it, pretty safe. Conscious sedation is done in outpatient settings all the time.
> 
> If it's just the dentist doing "sedation dentistry" on the other hand...



Yeah..its being done in an oral surgery office..doctor is a MD/DDS. From what everyone else has been saying it seems to be very safe. The only thing that bothered me was the out of hospital part..being that when administering any type of anestesia you want to be able to provide life support and step beyond the level you are performing. IE, intubation/respiratory measures even when you are performing conscious.


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## Handsome Robb (Dec 23, 2011)

I think you are reading a little to far into it. I'd be willing to bet that he does these surgeries and sedations on a pretty regular basis, but that's just me. Also, he's got a bvm and a telephone with 911 and a paramedic with tubes and toys in the area, unless you are out in the freakin boonies.

Totally your choice though. Do whatever you feel comfortable with.


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## Shishkabob (Dec 23, 2011)

Are there risks?  Definitely.  Infact, Yahoo just ran an article about the risks associated with it, showcasing a couple of deaths from 'normal' dental procedures.  However, that's obviously the exception, and a rarity.


Dentists are required to have CPR, I believe they also have ACLS, and most dental hygenists I've met also have CPR.   But then again... so do nursing home nurses...


Paramedics do conscious sedation out of the hospital all the time too.  Heck, I've done conscious sedation, freaked a nurse out who thought it was illegal, but she obviously had no clue what she was talking about.




You'll be fine.  Enjoy the free drugs, and use some sick days just because! ^_^


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## River (Dec 27, 2011)

I had that done when I needed to have a molar worked on.  No problems at all, but I was a little stoned between that and the pain meds.  I remember insisting that I was ok to walk, and then promptly walking into a row of chairs in the waiting room.

On the plus side, I felt nothing during the procedure.  And once I slept for a bit at home, there were no bad effects from the sedation.


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## DrankTheKoolaid (Dec 27, 2011)

*re*

Go with the juice!  And should be relatively safe as in most states an ACLS qualified RN must be present during the procedure.


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## tssemt2010 (Dec 27, 2011)

worked for my bosses brother one day doin conscious sedations, we did fentanyl, propfol and versed, they monitor you very closely and keep a crash cart handy, i wouldnt hesitate to do it


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## Nimrod_BasketCase (Dec 28, 2011)

I had 2 of my wisdom teeth removed both with novocaine and at different times.


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## BaldEagle (Dec 28, 2011)

I just had three taken out yesterday. I had nitrous, then the sedation and the Novocain as extra precaution. I dont remember anything from the surgery but afterward i insisted i can walk then walked into the door. I was basically out of it for the rest of the day. Today i am not really in pain its just uncomfortable and saddening not being able to eat what looks good :sad:


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## silver (Dec 28, 2011)

Ive had 9 teeth pulled at one time (baby and adult) with only novocaine. Never again...


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## Cup of Joe (Dec 28, 2011)

I had a few orbicularis otis muscles removed with only novocaine.  Need to get all my wisdom teeth removed soon.


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## medicdan (Dec 28, 2011)

rwik, rather than share personal experiences (I've had several, including tonsil removal under general this past summer), let me try to refocus you on questions to ask...

-- Who, how many, and what qualifications are the personnel in attendence? Who will be in the room with you, who is in the office/building? Is your DDS performing the procedure with a hygenist present? Is there an RN? You mentioned the dentist is also an MD-- what specialty, what post-med school training (other than dental residency)? Does your dentist have BCLS? ACLS? Hygenist? 

-- What meds, specifically is the provider planning on using? IV to be established? Who's starting the line/qualifications? What sedatives? Propofol? Ketamine? Versed? What analgesia during the procedure? Fentanyl? Nitrous? 

-- What equipment/procedures does he use to monitor you during the procedure? BP? Pulse? How often? Cardiac Monitor? O2 Sat? What are his capabilities policies if anything deviates from normal? 

-- What emergency equipment and procedures exist, and how readily? Does the office have an AED? Manual defib? Advanced airway equipment? Policies for when to call EMS? Average response time (you may know this best)? 

-- What is you're provider's rate of complications? How often does he perform this particular procedure/how long have they been doing it? Changed procedure recently? Active in local professional community? Journals? Dental equivalent of M&M Rounds? How transparent are they about their success/complications? Infection risks? KevinMD.com had an interesting blog post a few days ago about how we all feel our surgeon is "the best" but perhaps we need to look deeper into their track records.
http://www.kevinmd.com/blog/2011/12/informed-judgment-abilities-surgeon.html
-- What is the local precedent for propofol use in outpatient clinics? Does your DPH require particular standards to be met, and does the office have this credential? Is propofol commonly used for surgeries like your's, or is another drug used more commonly? Why one or the other? Do non-dental providers commonly use propofol in outpatient clinics? What monitoring is required in hospital when it's used? 

-- What does the consent form look like? 

After asking these questions, you need to think for yourself how you feel about these risks and contingencies. There's a fine line between being an empowered patient and being a pain in the ***, but you're a medical professional yourself and understand the risks better than many other patients. 

I'll leave my questions for you here... Good luck, let us know how it works out!


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## rwik123 (Dec 28, 2011)

emt.dan said:


> rwik, rather than share personal experiences (I've had several, including tonsil removal under general this past summer), let me try to refocus you on questions to ask...
> 
> -- Who, how many, and what qualifications are the personnel in attendence? Who will be in the room with you, who is in the office/building? Is your DDS performing the procedure with a hygenist present? Is there an RN? You mentioned the dentist is also an MD-- what specialty, what post-med school training (other than dental residency)? Does your dentist have BCLS? ACLS? Hygenist?
> 
> ...



This morning was the day of my procedure! It went much better than i though it would. 

-All the anesthesia was done my a CRNA

-Maybe someone can help me out with this part. I was under the impression that this procedure was going to be conscious sedation. When i go back for the follow up next week i'll have to ask about the details. When I asked what drugs they were using she said propofol with other gases to keep me asleep. I was actually ASLEEP. Not the twighlight sleep or conscious sedation with versed, fet, and propofol. The last thing I remember was her pushing the propofol and her placing a mask over my face (which was hooked up to the normal OR suite anesthesia machine). Later when I woke up, my left nostril was numb. *Was a nasally intubated?* How could they manage me sleep with gases when they were working on my mouth? Do they often utilize nasal intubation for dentistry? The doctor was a DMD, MD..MD in Oral and Maxillofacial surgery, and DMD in dental medicine. I assume both her and the CRNA had ACLS. 

-Meds were propofol with the gases she mentioned (don't remember which ones specifically..administered i assume through the machine). She mentioned 2 other drugs which I can't recall along with a dose of zofran. Was hooked up to an EKG, NIBP, pulse ox and i imagine gases were monitored through the drager machine.

Thanks again for the all the wisdom and advice everyone. I wouldn't question going through this experience again and recommend it to anyone going through any oral surgery procedure.

oh and oxycodone does wonderful work :yay:


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## BaldEagle (Dec 29, 2011)

just a quick tip that i would do if i could do it again...keep up wit the meds! yesterday was day 2 for me and i was barely swollen and in little pain so i didnt take my meds so i could respond to calls. well last night the swelling and pain flared and i was taking over the counter stuff so i had to wait several hours for them to wear off to take my vicodin. i wanted to sleep but the pain prevented me. so when they say the third day is the worst, they arent kidding.


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## VinBin (Jan 5, 2012)

Anytime you go "under" or are put in a "less conscious" state, there are inherent risks, why take them if you don't have to?

I've had all four wisdom teeth taken with just local (all were impacted, if that makes any difference). I'll be honest, it was relatively painless after the initial injections. I think the key is to have a skilled dentist who ensures that the entire region is fully numb more than anything else. 

Now, the week that followed extraction was hell, but the procedure is very doable with just local anesthetic...


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## johnrsemt (Jan 9, 2012)

Man I don't even do fillings or root canals without Nitrous and major amounts of Xylocaine (Novacaine on steroids; and it usually doesn't make me sick afterward, except last week).   Xylocaine also lasts longer, which makes drinking from a straw fun.

   When I had my Wisdom teeth out the Dentist knocked me all the way out.  He did it on his own dime, too;  he said he wasn't going to touch me if I was awake; and my parents insurance wouldn't pay for knocking me out.  So the dentist paid for it.

   I will admit freely:  I am a dental WIMP


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## johnrsemt (Mar 14, 2019)

I don't let the dentist touch me for things like that if I am awake.  I had an oral surgeon in Indiana call my Dentist in Utah about my history, before he did a cyst removal, and my dentist told him that he (dentist) would pay half the general, because the oral surgeon wouldn't be able to touch my mouth if I was awake, but the insurance wasn't going to pay for it.  The Oral Surgeon and my dentist (from 3 years earlier) split the cost of general.  I don't remember the day at all.

I do heavy Xylocaine and heavy Nitrous, and I don't sleep for 24-36 hours before for a root canal, and I still hate it


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## Carlos Danger (Mar 14, 2019)

johnrsemt said:


> I do heavy Xylocaine and heavy Nitrous, and I don't sleep for 24-36 hours before for a root canal, and I still hate it


What is heavy xylocaine?


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## CANMAN (Mar 15, 2019)

rwik123 said:


> Yeah..its being done in an oral surgery office..doctor is a MD/DDS. From what everyone else has been saying it seems to be very safe. The only thing that bothered me was the out of hospital part..being that when administering any type of anestesia you want to be able to provide life support and step beyond the level you are performing. IE, intubation/respiratory measures even when you are performing conscious.



Common practice, oral surgeon's offices do this stuff day in and day out. My old program used to rotate in and out of an oral surgeon's office to do intubations on the regular. You will be fine....


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## johnrsemt (Mar 28, 2019)

Lots and lots of Xyolocaine;   My wife has to do Valium the night before and morning of Dental work but I drive her in for it, but I can't do that because I usually do it on days that I go in by myself.  It is a 50 minute drive 1 way.


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## Carlos Danger (Mar 28, 2019)

johnrsemt said:


> Lots and lots of Xyolocaine;   My wife has to do Valium the night before and morning of Dental work but I drive her in for it, but I can't do that because I usually do it on days that I go in by myself.  It is a 50 minute drive 1 way.


The reason I asked is because when referring to local anesthetics, "heavy" means that solutes (usually dextrose) have been added to the anesthetic in order to make the solution hyperbaric as compared to CSF. It usually refers to 0.5% or 0.75% bupivacaine being used for a spinal anesthetic. I had never heard of hyperbaric ("heavy") lidocaine and couldn't imagine why it would be used for dental infiltration or nerve block.

For whatever it's worth, "Xylocaine" is just a brand of normal lidocaine. It and bupivacaine are the most commonly used local anesthetics, and lidocaine is only a little more potent than procaine (Novocaine), which I don't think is really used anywhere anymore.


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