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Medical Forum / General / Dentistry / November 2005Wisdom tooth extraction while fully awake
On the advice of our dentist, my daughter is going to an oral surgeon this week to see if she needs her wisdom teeth extracted. She had oral surgery a few years ago to connect a chain to an impacted tooth and insisted on staying awake. She handled the surgery without a complaint. So, now she wants to stay awake if she needs the 4 teeth removed. She has incredible staying power but the surgeon's office told me that one of the doctors in the practice refuses to do them awake, and another only does them once in a blue moon on fully awake patients and that it is very rare.My daughter is like me, she is more afraid of the anesthesia. I can withstand quite intensive procedures without incident while awake and I think she will be able to do the same. I would like to know the opinions of other surgeons with respect to wisdom teeth removal. Thanks. >On the advice of our dentist, my daughter is going to an oral surgeon this >week to see if she needs her wisdom teeth extracted. She had oral surgery a [quoted text clipped - 4 lines] >the practice refuses to do them awake, and another only does them once in a >blue moon Wait for the next blue moon .... I am with your daughter on this. Joel >on fully awake patients and that it is very rare.My daughter is >like me, she is more afraid of the anesthesia. I can withstand quite >intensive procedures without incident while awake and I think she will be >able to do the same. I would like to know the opinions of other surgeons >with respect to wisdom teeth removal. Thanks. >On the advice of our dentist, my daughter is going to an oral surgeon this >week to see if she needs her wisdom teeth extracted. She had oral surgery a [quoted text clipped - 8 lines] >able to do the same. I would like to know the opinions of other surgeons >with respect to wisdom teeth removal. Thanks. My theory is that if the patient needs to be asleep, the tooth problably does not need removing! (Has to do with how deeply submerged in the jaw it is.) > On the advice of our dentist, my daughter is going to an oral surgeon this > week to see if she needs her wisdom teeth extracted. She had oral surgery a [quoted text clipped - 8 lines] > able to do the same. I would like to know the opinions of other surgeons > with respect to wisdom teeth removal. Thanks. If she is an otherwise manageable patient, I don't understand refusing to do this on a conscious patient if she so desires. OTOH, and esp. if awake, I probably would encourage her to have only the 2 right side or 2 left side per visit. If you explain this and they are adamant, I'd find another surgeon. Steve  Signature{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 Arial;}} {\*\generator Msftedit 5.41.15.1507;}\viewkind4\uc1\pard\f0\fs20 Remove "nospam" to reply\par } >> On the advice of our dentist, my daughter is going to an oral surgeon this >> week to see if she needs her wisdom teeth extracted. She had oral surgery a [quoted text clipped - 16 lines] > >Steve I just had mine extracted, while awake, and while it was painful it was bearable. It was one of those things where just about the time it got to be really painful, it was over. I admittedly am a chicken, when it comes to dental pain. I would think having 2 done at once would be fine for someone who can easily withstand dental pain. 4 at once - from the standpoint of this patient - seems excessive. The after-surgery pain is no picnic, either, and a friend of mine had complications after having his one tooth extracted, and had to go back to the dentist like every day for a week or something to have it tended to. Me, I am having bone slivers come through my gum after the extraction (a month ago) and while that is not super painful it is certainly no fun. So I would think having 4 done at once would just increase the chance of these kinds of complications, and having these complications on more than one tooth at a time would be pretty unpleasant. Just my uneducated opinion based on my own experience and anecdotal hearsay. [..] > I just had mine extracted, while awake, and while it was painful it > was bearable. Did you get anything to numb the area? I got that and the only thing I felt was a split second feeling that felt like it was pulled out. It wasn't pain at all. I guess, I was the only lucky person that I knew of. I was 26 going 27 when taken out. > On Mon, 14 Nov 2005 03:24:11 GMT, Steven Bornfeld > > Just my uneducated opinion based on my own experience and anecdotal > hearsay. To which I will add my own uneducated anecdotal heresy. (sp error intentional) Once you are finally numb; well...you are numb. I have had two wisdom teeth pulled over the years, always while fully awake. One of them was a worst-case scenario involving a hammer & chisel, and the other was amazingly easy, but they were both bearable. The biggest issue was always the recovery process, not the procedure itself. There seems to be a movement towards putting patients "out" for more and more types of procedures, not just dental. I have had a few colonoscopies over my life, always done awake. I always found the procedure to be uncomfortable, slightly degrading, yet interesting. Always done awake, that is, until the last one; where they insisted that I should be asleep. The process took an extra hour (because of the recovery process) and my wife had to take a half day off work because they required that I be escorted. Frankly, I wish that they would just do it the old way. Vaughn >>On Mon, 14 Nov 2005 03:24:11 GMT, Steven Bornfeld >> [quoted text clipped - 20 lines] > > Vaughn I was asleep for a colonoscopy this past summer, and the whole procedure took 1/2 hr. from the time they put the needle in my arm until the time they kicked me off the table. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > I was asleep for a colonoscopy this past summer, and the whole >procedure took 1/2 hr. from the time they put the needle in my arm until >the time they kicked me off the table. > >Steve I had a sigmoidoscopy, (not sure what the difference is) but I walked out of there feeling I'd been raped. The doctor was very rough, seemed to be in a hurry, and it hurt like hell! Now I'm afraid to go in for a colonoscopy. >> I was asleep for a colonoscopy this past summer, and the whole >>procedure took 1/2 hr. from the time they put the needle in my arm until [quoted text clipped - 6 lines] > to be in a hurry, and it hurt like hell! Now I'm afraid to go in for a > colonoscopy. Sigmoidoscopy is considered an archaeic and ineffective procedure, and only covers the distal end of the bowel. I believe the colonoscopy extends at least back to the ileo-coecal valve. My brother had one conscious and said it was only mildly uncomfortable. The preparation is by far the most arduous part of the procedure, and even that has become far easier as it is practiced by most gastroenterologists. There was no postop pain, and my only mistake was trying to do too much afterward on a hot day, being already rather dehydrated. Steve >Now I'm afraid to go in for a >colonoscopy. You should fear colon CA more. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > > I was asleep for a colonoscopy this past summer, and the whole > >procedure took 1/2 hr. from the time they put the needle in my arm until [quoted text clipped - 5 lines] > to be in a hurry, and it hurt like hell! Now I'm afraid to go in for a > colonoscopy. Umm ..... I got a hangnail pulled out once...... SP SignatureTake out the TRAASH to reply >> On Mon, 14 Nov 2005 03:24:11 GMT, Steven Bornfeld >> [quoted text clipped - 18 lines] >work because they required that I be escorted. Frankly, I wish that they would >just do it the old way. You just sent shivers up my spine. Yikes. Thats alotta hose... >Vaughn Ten-Foot Pole. >> On Mon, 14 Nov 2005 03:24:11 GMT, Steven Bornfeld >> [quoted text clipped - 20 lines] > >Vaughn -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Ten-Foot Pole. Huh? Vaughn >> Ten-Foot Pole. > > Huh? > >Vaughn colonoscopies with a ten-foot pole. Ouch ! -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>>Ten-Foot Pole. >> [quoted text clipped - 8 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com It's a pretty long hose. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > If she is an otherwise manageable patient, I don't understand refusing to > do this on a conscious patient if she so desires. > OTOH, and esp. if awake, I probably would encourage her to have only the 2 > right side or 2 left side per visit. > If you explain this and they are adamant, I'd find another surgeon. Any chance we are dealing with a insurance preferred provider surgeon who needs to do the sedation in order to make enough money to break even. Signature/ Amatus / > >> On the advice of our dentist, my daughter is going to an oral surgeon [quoted text clipped - 17 lines] > > Steve >> On the advice of our dentist, my daughter is going to an oral surgeon this >> week to see if she needs her wisdom teeth extracted. She had oral surgery a [quoted text clipped - 16 lines] > >Steve Agreed, but I would like to look at the pan before deciding. If it's four 'hop and pops' doing with a local should be fine Perhaps a little nitrous or diazepam for tougher ones. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>>On the advice of our dentist, my daughter is going to an oral surgeon this >>>week to see if she needs her wisdom teeth extracted. She had oral surgery a [quoted text clipped - 25 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com Cute. Is there an ADA code for "hop and pop"? Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >>> OTOH, and esp. if awake, I probably would encourage her to have only >>>the 2 right side or 2 left side per visit. [quoted text clipped - 8 lines] >> >> W_B > Cute. Is there an ADA code for "hop and pop"? > >Steve 1, 2, 3, Go ! -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >On the advice of our dentist, my daughter is going to an oral surgeon this >week to see if she needs her wisdom teeth extracted. She had oral surgery a [quoted text clipped - 8 lines] >able to do the same. I would like to know the opinions of other surgeons >with respect to wisdom teeth removal. Thanks. A couple of comments.... Obviously fear, anxiety and an inability to get fully numb are eliminated with general anesthesia. Anesthesia administered by an OMFS has a safety record second to none. Regardless of local or general anesthesia, the post-op course will be the same. Although, something to be said about getting in & out alot quicker while the patient is asleep. The only time I am adamant about the patient being unconscious for wisdom tooth removal is when I know I am in for a difficult procedure. ~~~~~~~~~~~~~~~~~~~~~ David A. King, D.M.D. Diplomate, American Board of OMS Fellow, American Association of OMS HTTP://WWW.DEOMFS.COM I have taken out some very difficult wisdom teeth and the patients are always awake. The problem here with the oral surgeon is an economic one. If the patient is awake, greater care and time are required. If the patient is asleep, they can whip through more patients in one workday. Most oral surgeons use general anaesthesia with wisdom teeth for this reason. It has nothing to do with the health of the patients. It has to do with making the jaguar car payment. >It has to do with making the jaguar car payment. My Jaguar is paid off. White 4-door with red leather interior. Leaping cat on the bonnet. Trunk big enough to carry a viola da gamba in. Track is wider in front than in the rear (makes 4 tire tracks in snow or mud). 3.4 Salon. Great fun ! BTW, after talking about this to my OMFS group (well at least the ones I like to use), I think they feel they can genuinely provide more pain free care this way. I think it helps them schedule consistently as well. I know they always assume everyone wants to be sedated, because most of the cases we send them are tougher and need to be sedated. However, the group I use will happily work without sedation if the patient prefers. Signature/ Amatus / >I have taken out some very difficult wisdom teeth and the patients are >always awake. [quoted text clipped - 5 lines] > to do with the health of the patients. It has to do with making the > jaguar car payment. >>It has to do with making the jaguar car payment. > [quoted text clipped - 9 lines] >we send them are tougher and need to be sedated. However, the group I use >will happily work without sedation if the patient prefers. But see JWN likes putting his two cents in and you ruined it for him. > But see JWN likes putting his two cents in and you ruined it for him. Maybe he could put the 2 cents in a different vending machine ? Signature/ Amatus / > >>>It has to do with making the jaguar car payment. [quoted text clipped - 14 lines] > > But see JWN likes putting his two cents in and you ruined it for him. >> But see JWN likes putting his two cents in and you ruined it for him. > >Maybe he could put the 2 cents in a different vending machine ? The one that dispenses fortune cookies ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com I seem to have struck a nerve haha. I'm glad the OMFS community in the States is so much more caring than it is in Canada. In my candid "off-duty" conversations with my OMFS friends here, the use of GA was often a conversation of economics. I'm not talking about LeForts, Sagittal splits, etc. Wisdom teeth they agreed could 'almost' always be removed on a conscious patient. It can be done in under an hour on an anesthetized patient. I do agree with you that makes scheduling easier. >I seem to have struck a nerve haha. > [quoted text clipped - 6 lines] > >I do agree with you that makes scheduling easier. Funny, especially if I am going to get the short stick with reimbursement, its with the anesthesia. > Funny, especially if I am going to get the short stick with > reimbursement, its with the anesthesia. I could see a bait-and -switch HMO practice _possibly_ wanting GA to increase their ability to bill for things which are not a covered benefit. Fortunately, none of the OMFS's I know would do that. Signature/ Amatus / > >>I seem to have struck a nerve haha. [quoted text clipped - 13 lines] > Funny, especially if I am going to get the short stick with > reimbursement, its with the anesthesia. >> Funny, especially if I am going to get the short stick with >> reimbursement, its with the anesthesia. > >I could see a bait-and -switch HMO practice _possibly_ wanting GA to >increase their ability to bill for things which are not a covered benefit. >Fortunately, none of the OMFS's I know would do that. reimbursement for general anesthesia, especially with an HMO, isnt worth the liability. Its unbelievable sometimes. > reimbursement for general anesthesia, especially with an HMO, isn't > worth the liability. Its unbelievable sometimes. I was figuring they would push it in cases where it was _NOT_ a covered benefit, so that it could be billed at full fair. Signature/ Amatus / > >>> Funny, especially if I am going to get the short stick with [quoted text clipped - 6 lines] > reimbursement for general anesthesia, especially with an HMO, isnt > worth the liability. Its unbelievable sometimes. >> reimbursement for general anesthesia, especially with an HMO, isn't >> worth the liability. Its unbelievable sometimes. > >I was figuring they would push it in cases where it was _NOT_ a covered >benefit, so that it could be billed at full fair. But you know what happens with those stinkin' HMO contracts, cant bill any remaining and chances are they wont fork it out if it isnt covered. > But you know what happens with those stinkin' HMO contracts, cant bill > any remaining and chances are they wont fork it out if it isn't > covered. I have never dealt with an HMO contract. The times I have spoken with dentist who work with those plans all tell me they hunt for all the procedures which are NOT covered benefits, and limit their practice to those procedures only. Signature/ Amatus / > >>> reimbursement for general anesthesia, especially with an HMO, isn't [quoted text clipped - 6 lines] > any remaining and chances are they wont fork it out if it isnt > covered. >>>It has to do with making the jaguar car payment. >> [quoted text clipped - 11 lines] > >But see JWN likes putting his two cents in and you ruined it for him. Yeah, ain't it sad. BTW Jaguar is now made by Ford. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > BTW Jaguar is now made by Ford. Mine was made before the Ford dissolution of the company. Who would want to drive a new Jaguar with a Ford V-8 or V-6 in it ? Signature/ Amatus / > >>>>It has to do with making the jaguar car payment. [quoted text clipped - 26 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com > > BTW Jaguar is now made by Ford. > > Mine was made before the Ford dissolution of the company. Who would want to > drive a new Jaguar with a Ford V-8 or V-6 in it ? And my Volvo was still made in Sweden!!! Can you imagine that? TW [snip] > And my Volvo was still made in Sweden!!! Can you imagine that? I can't help but wonder how long that will still happen. Jaguars have moved to this side of the pond. Saab plants are closing as GM wants to build those here, too. Signature/ Amatus / > >> > BTW Jaguar is now made by Ford. [quoted text clipped - 8 lines] >> > [snip] > > And my Volvo was still made in Sweden!!! Can you imagine that? > > I can't help but wonder how long that will still happen. Jaguars have moved > to this side of the pond. Saab plants are closing as GM wants to build > those here, too. Yes, Ford Motor Company got into the action. TW > / > "The Webby" <nospamattmjiatroepidemicnospam@san.rr.com> wrote in message [quoted text clipped - 12 lines] > >> > > [snip] > > > BTW Jaguar is now made by Ford. > > [quoted text clipped - 4 lines] > > TW ... and MY Mercury Topaz is still rusting to bits.... SP SignatureTake out the TRAASH to reply > ... and MY Mercury Topaz is still rusting to bits.... Is it the crap they put on the roads to melt the ice? My gosh, that brings back memories of my long-lost childhood. (Vaughn stares into the distance, clouds of mist magically appear, a ghostly trio plays harps softly...) In Detroit, they have/had a huge salt mine http://info.detnews.com/history/story/index.cfm?id=17&category=business that provided the hundreds of tons of salt that they spread on the roads every year. Of course, that rock salt melted the cars too, but in the "Motor City" destruction of thousands of automobiles was just considered job security. Vaughn > > ... and MY Mercury Topaz is still rusting to bits.... > > Is it the crap they put on the roads to melt the ice? Naw.... just a crappy car. I guess the salt doesn't help, though. > My gosh, that brings back memories of my long-lost childhood. > (Vaughn stares into the distance, clouds of mist magically appear, a > ghostly trio plays harps softly...) Geezzzz you must-a had _some_ childhood.... > In Detroit, they have/had a huge salt mine > http://info.detnews.com/history/story/index.cfm?id=17&category=business > that provided the hundreds of tons of salt that they spread on the roads > every year. Of course, that rock salt melted the cars too, but in the > "Motor City" destruction of thousands of automobiles was just considered > job security. Too bad the dental "industry" don't work that way... :-/ > Vaughn SP SignatureTake out the TRAASH to reply >> ... and MY Mercury Topaz is still rusting to bits.... > [quoted text clipped - 11 lines] > >Vaughn I prefer Avery Island. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > I prefer Avery Island. Perhaps, but enough about Tabasco sauce Vaughn >> I prefer Avery Island. > > Perhaps, but enough about Tabasco sauce > >Vaughn Was talking about the salt mine there. <hehe> -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >> BTW Jaguar is now made by Ford. > >Mine was made before the Ford dissolution of the company. Who would want to >drive a new Jaguar with a Ford V-8 or V-6 in it ? Yeah, you're right. I would rather have a Chevy 350 in my Jag. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > I would rather have a Chevy 350 in my Jag. That was a popular conversion in the 1970's through the 1980's. The Chevy was more reliable in the absence of proper "British" maintenance. American drivers do not like to have to open the bonnet more than once a year. Of course, once you witched the power-plant the car became more reliable, but was worth half the money. I thought seriously about getting an XJ-S that had the V-12 ripped out and a Chevy stuffed in. I knew I was too much the purist and would be getting a V-12 built up to go back in 6 months later. It was a good thing I turned away from that one. Unfortunately, the 3.4 Salon was staring at me when I turned my head. Signature/ Amatus / > >>> BTW Jaguar is now made by Ford. [quoted text clipped - 11 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com > On the advice of our dentist, my daughter is going to an oral surgeon this > week to see if she needs her wisdom teeth extracted. She had oral surgery a [quoted text clipped - 8 lines] > able to do the same. I would like to know the opinions of other surgeons > with respect to wisdom teeth removal. Thanks. I was awake when mine weres removed. I had only lower ones and they were still inside the gum but about to come out. [..] > I was awake when mine weres removed. I guess mine would be considered asleep, not awake. >I had only lower ones and they > were still inside the gum but about to come out. |
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