Sunday, December 7, 2014

Anesthesia in the Dental Office

A reader sent this to me and I have reproduced it here with his/her permission.

Today, at age 47, I had all four of my wisdom teeth extracted. The top two were fully erupted, the bottom right one was a partial bony impact and the bottom left one was a full bony impact. By my request, I was given a local anesthetic only, the procedure took about an hour, and was entirely painless. I was able to drive myself to and from the appointment, and treated myself to a movie on my way home before the anesthetic wore off.

From everything I've read or have been told, it is very rare in the United States to have impacted wisdom teeth removed with only a local anesthetic. Apparently, the standard of care is to provide IV sedation (usually Versed) for a procedure that is absolutely painless if the local anesthetic is administered properly. Before finding the dental surgeon who performed the extractions today, I was told by a nurse at a different dental surgeon's office that IV sedation is "better for everyone involved" when impacted teeth are removed. Of course it's better for the provider when an extra $400-$500 can be tacked onto the bill and the patient won't remember a damned thing about what was done, and the patient can't object to his treatment because he "lacks capacity" under sedation. What arrogance to assume sedation is always "best" for the patient! Unless the patient states a desire to not remember the procedure or is so anxious that the procedure can't be done any other way, there is absolutely NO benefit to the patient.

It wouldn't be so upsetting if this was an isolated comment by a very callous nurse. About three weeks ago, I had my teeth cleaned at a clinic at a technical college. At that point, I knew I was going to have my wisdom teeth removed, and informed the hygienist who was supervising the student working on me. She made some comment about making sure I had someone to drive me home and being careful until the sedative wore off, and I told her that I had absolutely no intention of being sedated. The hygienist replied that the pain would be too great for a local anesthetic, and that I would need to have IV sedation. When I told her I knew what Versed was, that it does absolutely nothing to block pain, and that I already scheduled the surgery without sedation, she stared at me wide-eyed and open-mouthed. She mumbled something about the "dental surgeon knowing what was best," and I left. I was so bothered by her comment that I called her the next morning to ask why she lied to me. She completely denied lying about Versed, and said she had told me only that my surgeon would know whether or not the pain could be controlled by a local anesthetic.

When I first read this blog about 6 months ago, I thought many of the entries were over-the-top in painting a picture of a conspiracy among medical and dental providers about dissembling the true purpose and use of Versed. From my own experience with an endoscopy clinic earlier this year and having my wisdom teeth removed today, I convinced that there is at least a culture, if not a conspiracy, around this drug. There is a big difference between being told "this drug will help you relax" and "this drug will cause you to not remember anything that happens to you, although you will be awake." If more patients understood what they were being given, and why, more would refuse Versed. I suppose that some providers can justify the lie if they believe that a number of patients might forgo important procedures if they became anxious about the notion of being given a drug that would allow them to be awake, yet rob them of their memory. And it may be true that some patients would not be treated, it is not up to a provider, or up to ANYONE, to decide what is right for a patient, except the patient!

I've also learned that there ARE providers who will work with you and respect your wishes about not being administered Versed (or Propofol, or other amnestics.) If this is what you want, just be firm and state your intentions clearly. Someone who thinks they know what's best for you, regardless of your wishes, is probably not someone you want providing your care. Be patient, and find the right provider. He or she is out there!

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