Wisdom teeth extraction

jaimefay

I've got to have my two lower wisdom teeth out. Both are impacted, are repeatedly becoming infected and have caused cavities in the teeth in front of them that can't be gotten at/dealt with until my wisdom teeth are gone. My dentist has referred me to the Oral Surgery dept at the hospital and I've a first appointment with them in a couple of weeks. Dentist also told me that my wisdom teeth on the xray have long roots, and one of them is too close to my nerve and will probably mean taking out bits of my jawbone to get at it.

This is the complicated bit. I have a rare genetic condition called Ehlers-Danlos Syndrome, which basically means my collagen (connective tissue) is sub-standard. Among the huge range of problems this can cause, is weak teeth, fragile gums and oral mucosa, bad reactions to anaesthetic, jaw dislocations, and being resistant or impervious to local anaesthetics. It also means I heal slowly and poorly, scar easily, and that stitches need to stay in longer and tear out more easily.

I already know I'm more or less impervious to lignocaine. I've had deep fillings done without anaesthetic in the past and have developed a consequent unwillingness to go to the dentist, which is made worse by needing to find one with wheelchair access. I'm in severe chronic pain every minute of every day, and I cannot tolerate much more. I also find most dentists know nothing about the implications of EDS for dental work and will not listen to me or read the information I bring.

What I want, is to have both wisdom teeth removed at the same time, under general anaesthetic.

There are a few reasons for this.

-- Local anaesthetic is out of the question. I can't/won't put myself in the position where my wisdom teeth may be chiselled out while I have full sensation. I quite literally have nightmares about this.

-- Local anaesthetic with sedation is also out. I have a huge fear that all this will do is make it harder/impossible for me to protest that the local has had no effect.

-- Dentist has said they'll probably want to take them out one at a time, because they're on opposite sides. Given all the potential problems with the anaesthetic, stitches, etc - I'd rather have one anaesthetic, one surgeon to explain all this to, and one recovery period where I can't eat right/sleep, which will make my EDS hell on earth as a consequence.

-- They will probably try to open my jaw wider than it safely goes, and if I'm awake, if someone tries to keep my jaw open while I try to shut it, it will very likely dislocate. Don't need to deal with that on top of everything. Under a GA, I would think my muscles would relax more, so they'd be able to open my jaw wider without it falling off.

-- I've been warned that sedation could be dangerous for me, because my airway is as floppy and bendy as the rest of me, and I already have semi-regular issues with choking and aspirating, and need my muscle tension to help prevent that. If I have a GA, then they'll be looking out for my airway anyway while I'm under the anaesthesia.

I've been told that they try to avoid general anaesthetics for wisdom teeth removal wherever possible and am expecting a lot of pressure to have it done under a local.

Can I insist on a general, can I insist they do both sides at once, are these good enough reasons to say I won't have it done under a local, and do you think they'll actually listen to what I say about EDS and the implications for the surgery?

I'm sorry for the long post - like everything else with my body, it's complicated and I'm getting super-stressed about it.

Jaime

brook2jack

I presume it is Ehler Danlos type iii you have?

You cannot insist on any treatment, the surgical team have to decide in view of your complicated medical history what the safest treatment is for you. This may well involve some investigations , particularly by the anaesthetics team first.

IV sedation does not stop you indicating a problem with anaesthesia and is by far the safest option because whilst you are concious your airway is protected at the right amount the respiratory function isn't depressed ie you breathe normally and the jaw is far less likely to be traumatically dislocated. There are several local anaesthetic techniques and different types of local that can be tried. A general anaesthetic is the treatment of last resort.

An oral surgery specialist and a good anaesthetist should be well informed about the particular problems of working in the jaw with ED but they may well want to try a few investigations and options to avoid GA.

DanE2010

jaimefay wrote: »

I've got to have my two lower wisdom teeth out. Both are impacted, are repeatedly becoming infected and have caused cavities in the teeth in front of them that can't be gotten at/dealt with until my wisdom teeth are gone. My dentist has referred me to the Oral Surgery dept at the hospital and I've a first appointment with them in a couple of weeks. Dentist also told me that my wisdom teeth on the xray have long roots, and one of them is too close to my nerve and will probably mean taking out bits of my jawbone to get at it.

This is the complicated bit. I have a rare genetic condition called Ehlers-Danlos Syndrome, which basically means my collagen (connective tissue) is sub-standard. Among the huge range of problems this can cause, is weak teeth, fragile gums and oral mucosa, bad reactions to anaesthetic, jaw dislocations, and being resistant or impervious to local anaesthetics. It also means I heal slowly and poorly, scar easily, and that stitches need to stay in longer and tear out more easily.

I already know I'm more or less impervious to lignocaine. I've had deep fillings done without anaesthetic in the past and have developed a consequent unwillingness to go to the dentist, which is made worse by needing to find one with wheelchair access. I'm in severe chronic pain every minute of every day, and I cannot tolerate much more. I also find most dentists know nothing about the implications of EDS for dental work and will not listen to me or read the information I bring.

What I want, is to have both wisdom teeth removed at the same time, under general anaesthetic.

There are a few reasons for this.

-- Local anaesthetic is out of the question. I can't/won't put myself in the position where my wisdom teeth may be chiselled out while I have full sensation. I quite literally have nightmares about this.

-- Local anaesthetic with sedation is also out. I have a huge fear that all this will do is make it harder/impossible for me to protest that the local has had no effect.

-- Dentist has said they'll probably want to take them out one at a time, because they're on opposite sides. Given all the potential problems with the anaesthetic, stitches, etc - I'd rather have one anaesthetic, one surgeon to explain all this to, and one recovery period where I can't eat right/sleep, which will make my EDS hell on earth as a consequence.

-- They will probably try to open my jaw wider than it safely goes, and if I'm awake, if someone tries to keep my jaw open while I try to shut it, it will very likely dislocate. Don't need to deal with that on top of everything. Under a GA, I would think my muscles would relax more, so they'd be able to open my jaw wider without it falling off.

-- I've been warned that sedation could be dangerous for me, because my airway is as floppy and bendy as the rest of me, and I already have semi-regular issues with choking and aspirating, and need my muscle tension to help prevent that. If I have a GA, then they'll be looking out for my airway anyway while I'm under the anaesthesia.

I've been told that they try to avoid general anaesthetics for wisdom teeth removal wherever possible and am expecting a lot of pressure to have it done under a local.

Can I insist on a general, can I insist they do both sides at once, are these good enough reasons to say I won't have it done under a local, and do you think they'll actually listen to what I say about EDS and the implications for the surgery?

I'm sorry for the long post - like everything else with my body, it's complicated and I'm getting super-stressed about it.

Jaime

I would insist on general, I had my bottom 2 impacted wisdom teeth removed about a month ago and the dentist said it was best to do it under general as one looked like it was gonna be a tricky job to get out.

Turns out one side was very tricky and that side took longer to heal than the other and the swelling has only just gone down and I still cant open my mouth fully without pain.

Try not to get stressed about it (easier said than done!) explain your fears and concerns and get it all sorted before the extraction takes place, if u dont ask you dont get as the saying goes.

brook2jack

PS you should ask for referral for your routine treatment to your local community dentist (only a regular dentist or doctor can do this.)

They are there to provide treatment to those who cannot easily be treated in general practice and have specialists in special needs dentistry as well as specialised equipment .

The downside is waiting lists can be very long but the expertise is there.

jaimefay

Thanks for the replies.

Brook, I'm already seen by the Special Needs Dental Team - not one of the local dentists is wheelchair-accessible (regardless of what they advertise!).

Yes, it's hypermobility type EDS.

The point about sedation was that my body has a pretty poor track record of being able to keep breathing and swallowing correctly - especially when there's anything going on in my mouth or throat. I can only see sedation reducing the control of my airway, really. The other thing for me, is that I'm well know for odd reactions to drugs/bizarre side effects. You know, the ones listed in the 'this is technically possible so we have to tell you about it but it'll never happen' section of the leaflet?

Even if sedation was an option, I've seen too many dentists who insist it's not possible that local anaesthetic has no significant effect on me, and carry on anyway. I won't be hurt by someone else's pig headed ignorance again.

I know I can't *insist* on a GA... but I know I *can* refuse to have it done with LA/LA + sedation. So what happens if I do? I still need my wisdom teeth out - can they refuse to take them out because I don't agree to how they prefer to do it?

What do you mean by 'investigations' and 'trying' by the anaesthetic team? I'm really hoping it's not what I think - months on end of sporadic appointments where they guinea-pig me with every anaesthetic they can think of?

Firstly, can't wait that long - because of lack of access, I can only see the Special Needs Dentistry, which means appointments are three, four, five months apart at best. So I've already waited much much longer than anyone else would've.

Second, I'm overly sensitive to drug side effects, and my medication balance is an ongoing nightmare which is only changed gradually and carefully out of utter necessity. I'm not OK with being experimented on when there's another option, and the experiment has such a high risk of screwing other things up.

Do you think they might at least do both sides at once?

Dan, that's exactly what I expect to happen to me, to be honest - only it'll screw with all the other health stuff and I can see taking forever to put right. It's taken over three years to get a slight improvement in my health, I'm not willing to risk that on someone else's preference, especially when they aren't an EDS specialist and certainly aren't a 'Me' specialist!

I know I sound really overwhelmingly negative about this. It's difficult for me to explain online just how fragile a balance this is. I mean, by 'slight improvement', I mean it took three years and four - five? - specialists to get more than two hours sleep a night and to bring the pain *down* to 7/10 (as a guide, a full on head-exploding migraine rates about 3, 3.5).

I can't afford to be a guinea pig, or to let someone else's preference or assumptions about me or EDS be the deciding factor.

Brook, do you have any idea under what circumstances a GA *would* be considered appropriate for wisdom teeth extraction?

brook2jack

It is every persons right to refuse any treatment but you cannot insist on a treatment.

The surgeons and the anaethetists have to be sure that they have made the safest treatment plan for you. That might be GA that might be sedation. Only the team who can see you, your medical and dental history , and your x rays etc can safely tell. Ga is risky even in a perfectly healthy person , let alone someone who has weird drug interactions.

Your team will formulate a treatment plan based on safety overall. They should not rush into treatment because it may end up making you worse off than now. I understand your imperative to get it sorted quick , but right is better.

I think you risk making yourself overanxious about this. see the team first and see what they have to say and then , if necessary argue your corner.

Fletchasketch

I recently had an impacted canine removed under general aesthetic. I realised that it's not the same tooth, but the doctor was fine with it, and I think it sounds like you have more justification than I do! All the best.

geri1965_2

I'm not a dentist but I did have all four of mine out under GA at the same time, so I assume doing two sides at the same time is not an issue.

jaimefay

thanks again for replies!

Brook, I think you're right and I am winding myself up about this. Hard to stop though it doesn't help that it took over ten years of being told 'it's all in your head' 'stop making such a fuss' 'you'll grow out of it' etc before I was diagnosed with EDS and I regularly still get written off by doctors as lying/malingering/mad. I really don't trust medical practitioners of any kind any more. With the experiences I've had, I'd be mental *not* to be distrustful.

And on top of that, I'm on the autistic spectrum, don't do well with change, need my routine, hate new places and have serious issues with strangers in my personal space, let alone touching me, and I don't even want to *think* about someone putting their _fingers_ in my _mouth_ *shudder*. And don't even get me started on the germs. Yeah, I know, I am basically broken at every single bit of being a human.

Geri and Fletchasketch, thanks for letting me know how it went for you. Glad to hear it's possible to do both sides at once so hopefully I will only have to submit to this once.... *crosses fingers* so glad it's not a canine tooth, for some reason that sounds even worse! Comforting to know that people do survive this just fine, however hysterical I am.

Thanks again for the info and reassurances. I know I'm coming off as a massive pain in the posterior, but I really am that abnormal and while I know in the grand scheme of things this is a relatively minor occurrence, my non-rational self is still inside my head, running in circles, screaming and bouncing off the walls, and flailing.

Thanks again.

Fletchasketch

Not at all. I was terrified when I went in, but it was really so easy and hardly any pain. I even had to ask if it was done after the op, good old GA!

DanE2010

Hi Jamiefay I totally understand your concerns, I have ME and was worried about how I was going to recover afterwards, I tend to take longer to get over infections etc so I totally get why your anxious.

You can certainly do both sides at once that's what I had done, the bottom two wisdom teeth, both impacted. I went for the pre op appointment and had it x rayed again and the consultant talked me through what was going to happen and gave me a few leaflets about the procedure and being put under general, I came away feeling relaxed about the procedure after seeing him so I think this would help you also, you will be able to ask questions and talk through your fears.

I wasnt in any pain when I woke up it was 2 days later the pain kicked in as I got 'dry socket' in the socket where the tricky one was, apparently it was a hard job to get it out. Im only just back to normal now after 4 weeks, I wasnt prepared for that at all, but it can happen so if you the type of person who like to know what could happen and be prepared talk through what can happen after extraction with the surgeon and your dentist so you feel mentally prepared. I was treated very well in the whole process and on the day I cant praise them enough they were lovely to me because they knew id never been put to sleep or had an extraction before and I was abit nervous, the nurses were lovely and I was prescribed plenty of painkillers afterwards as well as a course of antibiotics. I was lucky that down here you get referred for surgery in a local private hospital so it was spotlessly clean and you are provided with brand new from the packet hospital own, stockings and slippers so no worries about germs. Once I woke up I was offered a cup of tea or coffe but I just opted for water, then after about 30 mins the nurse had me up out the bed and in a chair, 30 mins later my net of kin was called to pick me up (they dont mess about!) so was not in too long after I woke, then it was 3 weeks of mushy food as I couldnt open my jaw!

I hope it all goes well for you, do talk you fear through with the dentist/surgeon and im sure they will do their best to help with your concerns. And do ask for general and given your condition and concerns I dont think they would say no to be honest, unless there was some serious concern that it could be dangerous etc, I mean they put people to sleep daily for extractions so cant see it being a big issue.