I wrote a post about how IV sedation benefited me during a dental procedure back in 2010, which subsequently led to several emails from fellow dental anxiety sufferers wanting to know more. Thank you guys for writing in, and I hope you managed to get your dental woes sorted out sans the anxiety! I guess this will be a sequel. Kind of.
Warning – super long post ahead!
I hate sequels, especially of the dental drama variety. Holiday sequels, family comedy sequels, “funny moments in the office” sequels, yeap bring them on. But medical sequels (too much of them) and dental sequels can well stay out of my way. But that’s life – full of ups and downs.
Unfortunately, a filling on my right upper molar failed miserably. I currently have pain on chewing, and considering the depth of the cavity, I opted to do an elective root canal treatment with the blessings of my current dentist. (And another crown thereafter. Yes, another.)
And of course, with me being all jittery about dental procedures, I opted to be sedated once again.
With my medical history being too complex now, my dentist didn’t feel too comfortable doing the root canal himself. So he referred me to an endodontic specialist whom I saw for the first time last week.
The endodontist was a really nice guy, and I really enjoyed chatting with him. And me being me, I flooded him with loads of questions. But not once did he show any sign of irritation. It was only when he wanted to do an “ice test” (putting a cold object on my tooth to test the level of nerve sensitivity) on my tooth did I freak out. It was then followed by my howls of “ohmygosh, so embarassing!” thereafter, with the endodontist and his assistant smiling reassuringly at me.
He then asked me why was I so anxious about dental work and where my dental anxiety originated from. Not the first dentist to ever ask me this question. To be honest, I never really thought about it, and my responses to previous dentists had always been a shrug. I only knew that yeah, I get anxious about dental work.
I thought about it a little on the spot, but was only able to vaguely trace it to my experience with my primary school dentist.
My response to him? “Because my primary school dentist was a prick.”
He could barely hold back his chuckle.
After having gone through one round of root canal treatment a coupla’ weeks ago – with another coming along three days from now – with IV sedation, I feel it’s beneficial to share how it went, and to let you guys know that there is such an option available.
Not many folks are aware that they can opt for IV sedation on top of local anaesthasia for minor surgical procedures, or for dental procedures. At least, not in Singapore. Based on some of the overseas forums I’ve read, IV sedation is more commonly practiced in the U.S. or U.K. Whereas, it is comparatively rarer here.
IV sedation involves the administration of a mixture anti-anxiety drugs and a sedative directly into the bloodstream via an IV line usually inserted at the back of the hand. The drugs put the patient into a state of light sleep, thus rendering him/her unaware of the procedure being carried out, but will not bring about a complete loss of unconsciousness. (Note: Not to be confused with General Anaesthasia.)
IV sedation helps a lot when dealing with procedural anxiety. I get generally apprehensive when it comes to medical procedures. That’s common, so does everyone else. However, nothing scares the shit out of me more than getting a dental procedure done.
I didn’t opt for IV sedation to cope with the fear though. I felt it was a better option for me because of my background heart condition. Heart condition plus procedural anxiety do not get along. The last thing I wanted was to end up in atrial tachycardia or explode into one of my epic heart flutter attacks in the midst of getting such a procedure done – which is why I chose to be sedated.
I spent about a week researching intensively on IV sedation and its pros and cons, and eventually decided that it was the best choice for me. My decision was met with a fair amount of resistance though, which held me back a little – but I stood firm with my decision and went ahead with it eventually.
I wasn’t at all surprised by the resistance expressed though. IV sedation is not as commonly practiced here, hence the reduced exposure to such cases (leading to the “huh?! Is it even necessary?!” mentality), and the general lack of awareness about it. One of my doctors even mixed up IV sedation with General Anaesthasia (the latter of which is much, much riskier).
General Anaesthasia induces deep unconsciousness and requires intensive monitoring of the patient’s vital signs. GA also takes much longer to recover from, with a higher risk of complications as it greatly suppresses the cardiovascular and respiratory systems. Patients under GA are always intensively monitored with the whole horde of menacing beeping machines you see in the Critical Care Units.
That is not to say that IV sedation is completely risk-free, though. There are very, very rare incidences of patients requiring artificial resuscitation as they were too deeply sedated. But every medical procedure has its fair share of risks. Even the root-canal procedure I went through had a risk level of complications far higher than the actual sedation itself (because mine unfortunately, also involved a deep infection of the bone).
IV sedation on the other hand, acts on the central nervous system which in turn, suppresses the cardiovascular and respiratory systems, but only slightly. The patient is unaware of what is going on due to the amnesia-inducing properties of the drug, but will not be completely unconscious which makes it much easier for the anaesthetist to manage.
I recovered really quickly post-sedation – “coming to” within 15 minutes after drug administration was stopped, and could even walk (albeit a little wobbly) almost immediately. I was monitored throughout the time I was “out” – but only with an pulse oxymeter and a blood pressure cuff … because that is only about what was needed.
It really helped me in the sense that it slowed down my usually rapid heart rate. And because I was “out”, there wasn’t any anxiety experienced that could potentially bring on a full fledged attack. The only minus about it was the involvement of an IV butterfly needle (which didn’t bode well with my general fear of needles). But better that, than to remain in a state of extreme stress for two hours with a potential atrial tachycardia attack lying in the background.
There are some inconveniences that accompany IV sedation though, such as the need to remain rested for the remaining day, and slight nausea. However, if you have background medical conditions that can potentially complicate a procedure, or severe procedural anxiety, IV sedation benefits more than anything else.
Of course, there are the sceptics that claim that “IV sedation is for pussies”, “You aren’t man enough if you need IV sedation”, or “IV sedation is only an easy way from anxiety.”
Forget all that, because all those are simply noise interfering with the patient’s personal decision based on his/her own background.
Ultimately, I believe it is about what’s best for you, and your comfort level.
If you’re curious and want to read up more, here are some links to help you.
And yeah, the whole purpose of this post is to let you guys know that when it comes to stuff like these, you have options to choose from. Don’t let fear stop you from undergoing any procedure you have to go for because recovery (or the prevention of further complications and infection) matters more than anything else.
And also to the folks with underlying medical conditions (like me) that could cause complications in conjunction with anxiety – look, choices!
Meanwhile, wish me the best of luck for this coming Thursday – it’s Round 2 of my Root Canal procedure (yes folks, with IV sedation) and I am going to have to contend with a swollen left cheek, various aches and pains, and potential light fever for two days after that. Whoopie.