Dentistry/erupted wisdom teeth removal - dentist or oral surgeon?
QUESTION: I just found out from orthodontist and my dentist that I will need all four wisdom teeth removed and then other molars slightly ground down to fix my bite. I have an open bite which causes lots of jaw pain and clenching at night. My dentist said he removes 90% of his patients' wisdom teeth (other 10% get referred to board certified oral surgeon), and feels confident that he could remove mine with just local anathesia and "blue pill"?. (He is an excellent dentist and on top dentists in Portland Oregon list for several years). I am 42 years old and my wisdom teeth are straight and erupted (not impacted). I made a consult appointment with oral surgeon next week because of my age and maybe wanting IV sedation, but am now reconsidering if that is necessary. It will cost more because of IV sedation and more per tooth (my ins covers 100% w/dentist only). Is it worth it to do sedation with oral surgeon and what are risks? Could I get same results with general dentist? **My husband doesn't want me to do sedation because I had an atrial fibrilation attack last month and had to be sedated and then shocked back into heart rhythm (was only IV sedated 5 minutes). I don't have any real health problems/risks. The A-Fib has only happened twice in my life due to dehydration.**
ANSWER: Marla - Let me first tell you that you are a patient that needs a dentist who is skilled, not only in dentistry, but medicine also. I am not saying that you will develop a medical problem, but with your history of atrial fibrillation, the most common type of a local anesthetic, to make the area numb, cannot be used with you. That anesthetic cannot be used because it has epinephrine included. If you are given the proper anesthetic for you, without epinephrine, the length of time that the numbing last is much less. The possibility of it wearing off during the extractions will mean additional injections. To avoid this, which is definitely a more stressful situation, you should have a sedative. A pill sedative is not sufficient to calm the episode. For that reason alone, IV sedation is important to eliminate any stress you are exposed to.
The oral and maxillofacial surgeon is medically trained in hospitals, and with your medical history, it is important to be in the hands of a doctor who can recognize and control any situation that might develop. It most likely will not occur, but it is best to be prepared, especially with your history. I would also suggest that you speak with your physician. Inform the doctor of the procedure you will undergo and let that doctor help make the decision and also come up with any suggestions.
I wish you well. If you have any additional questions, feel free to contact me again.
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QUESTION: Thanks so much. I will have the oral surgeon (DMD, ABOMS, MD) contact my cardiologist regarding anesthesia. They both work at the same hospital (St Vincent's). I didn't realize I couldn't have the local anesthesia. I would prefer IV sedation just so I don't have to experience the extractions. Is recovery time longer considering my age (42) even though all 4 teeth are fully erupted and mostly straight?
Maria - Please let me straighten this out. You can have local anesthetic without epinephrine, but the anesthetic for a fairly long procedure, such as what you might need done, may not be sufficient for your comfort. Recovery should be fairly quick from the sedation. The recovery from the extractions should not be long if they are all erupted.
It should all go quickly for you.