Re: Need Help Local prob ... is Halcion the answer??

From: Shyster (shyster_at_lawyers.nu)
Date: 09/05/04 

Date: Sun, 05 Sep 2004 03:19:11 GMT

"Steven Bornfeld" <dentaltwinnospam@earthlink.net> wrote in message
news:413A75F5.80203@earthlink.net...
>
>
> Emily wrote:
> > Hi,
> >
> > I have a pretty good case of dental anxiety myself. This year I had to
have
> > two root canals (both with crowns) and a replacement crown, and I
elected to
> > use oral sedation twice. My dentist uses nitrous oxide and novacaine as
> > well during the oral sedation.
> >
> > The first appointment, I don't remember a thing until I sorta came to
while
> > they were working on the last tooth. I felt a little wince of pain
(this
> > tooth had always been sensitive and hard to numb up; it was an upper
tooth)
> > so made a noise and pointed, and they quickly gave me another shot
(which I
> > didn't feel at all), and I dozed back off. No more pain.
> >
> > The second appointment, I was not as asleep when I arrived at the
office; I
> > was very drugged up but still conscious, and when she started working on
the
> > tooth (a different one), I felt a little something, again made a noise
and
> > pointed, got another shot, and promptly dozed off for the rest of the
appt.
> > I have only very vague memories of either appointment, and only a few
bits
> > here and there, so the amnesiac aspect is there, but not complete (at
least
> > for me).
> >
> > My dentist uses a combination of Halcion with one other medication I
can't
> > recall now. It's incredibly expensive since she doesn't write a
fillable
> > Rx, just gives you the meds. You take Valium the night before, then the
> > Halcion + other med the morning of the appointment, then someone else
drives
> > you there and back. Both times I got home and napped for a couple more
> > hours after the appointments, and was pretty well wiped out the rest of
the
> > day. It cost around $375 each time for the oral sedation (not covered
by
> > insurance, of course), which is outrageous for three little pills, but
in
> > light of my anxiety, I was willing to pay that not once but twice!
>
>
> Well, I am not prepared to say whether this fee is unusual or not. But
> you are certainly not paying $375 for "three little pills"

He did say oral sedation which means the dentist just prescribed some pills
for anxiety and pain. You need a lot of training for that?

--you are
> paying for the training, and certification of the dentist, as well as
> the knowledge in how to manage your sedation.
> Administering sedation used to be fairly uncomplicated
> administratively, but in some states (New York, for example) being
> certified in enteral and parenteral sedative use is a pretty involved
> thing. (I am not certified myself.)
>
> >
> > However, given the fact that I did feel some pain at both appointments
*even
> > after a shot of novacaine and with nitrous* and had to request another
shot,
> > I cannot imagine getting through the appointments on the oral sedation
> > alone. My pain tolerance is very low, though. Yours might be higher,
> > especially since you've managed to have dental drilling done with only
> > nitrous in the past (I could not do that - never ever). I don't mind
the
> > shots nor the after-effects (just numbness for a few hours, nothing
> > long-term like what you've experienced). I just don't want ANY pain
from
> > the drill.
>
>
> There are two issues, as you've said--anxiety and pain. If there is
> pain, the level of sedation necessary to allow treatment will need to be
> much deeper.
> Back in the dark ages of my residency, even folks undergoing dental
> surgery under general anesthesia in the operating room got a local.

Why do you think that's unusual? Patients were usually given a short acting
barbituate IV which would wear off as soon as the needle was taken out. They
would then be in pain without the local.

>
> Steve
>
> >
> > So....I don't know what to tell you. If you didn't get the
after-effects
> > from the needle, I'd say to go for the local since while you're sedated
it
> > will not bother you one bit to have the shots, I don't think. I guess
it
> > depends on how bad the after-effects are that you get. I wish I could
say
> > you'll feel no pain with Halcion, but I can't. I know that *I* would
feel
> > pain!
> >
> > Good luck!
> > Emily
> >
> > "Synergie" <wlmcdonald@accesswave.ca> wrote in message
> > news:XQo_c.58708$vO1.318709@nnrp1.uunet.ca...
> >
> >>I have very deep anxiety with dentistry... I still force myself to go,
> >>and when I have needed work, I have insisted on the use of nitrous
> >>oxide. My fear deals mainly with the needle. I won't let them give me
> >>local.... at all! Because of this, I suffered through an appointment of
> >>a very deep filling with no freezing, and only nitrous oxide. It used
> >>to work better when I was younger, almost knocking me out and making it
> >>so I didnt need any freezing. But that last appointment, I felt
> >>everything, and was too scared to let them know because I knew they
> >>would drag out the needle.
> >>
> >>Now to the present.... I need another filling fixed. I didn't want to
> >>try the nitrous again as I believe that the last dentist did not use
> >>enough percentage or something. My current dentist (and I am only
> >>switching dentists because I am in the military and we get who we get)
> >>anyway she doesn't use nitrous anyway and suggested oral sedation, more
> >>specifically Halcion. I have a prescription for .25 mg the night before,
> >>.25 mg an hour before the appt and and extra pill to bring with me in
> >>case I need it. The plan is to do the work with no local at my request.
> >>Do you think that I can handle it under the Halcion without the local?

No. Take the local it's safer. Use xanax and morphine for anxiety and pain.
If you're sore from the injection take some codeine for a few days.

> >>
> >>And just for background... the issue with freezing was brought on by not
> >>just fear, but also the fact that every time I ever got it when Iwas
> >>younger, my jaw would always be very sore afterward, sometimes lasting
> >>several days. The dentist would never listen to me, and always tried to
> >>say it was just because I was holding my mouth open for a long period of
> >>time. But when i switched to just Nitrous, I had no soreness after. It
> >>seems like the soreness is always located right where the injection site
> >>was. The bottom ones were the worst. I would not be able to fully open
> >>my mouth for 3-4 days and had to take mortin etc just to be able to
> >>function. Am I a complete oddball that local affects me this way?
> >>Should I just be 'biting the bullet' so to speak and live with the
> >>soreness after? Because I really am more comfortable with dealing with
> >>the pain of the drilling during the apt than 3-4 days of nagging
> >>soreness after. They think at my dentist office that I am wimp and an
> >>anommoly. I hope that the Halcion puts me out enough to deal with the
> >>pain of the drilling, and I hope it has the amnesic effect that they
> >>told me about.... I don't want to remember the appt.
> >>
> >>Please someone answer my questions... The appt is still several weeks
> >>away and I am already losing sleep over it.
> >>
> >
> >
> >
>

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