To ask GP for Valium for dentist?

[toaskgpforvalium]

I have PTSD, fairly recently diagnosed but been a problem for several years . Don’t want to go into big details but it was to do with long term illness and multiple operations and poor care during and after . NHS have since apologised profusely and are giving me very good counselling .

A very big trigger point is lying flat (I won’t even lie back for eg eyebrow waxing - sit bolt upright) and the smell of medical places and being instructed to do things . Usually end up blacking out with eg simple things like blood tests, smears, hospital appointments . If it’s completely necessary I’m given diazepam first . I’m absolutely terrified of medical things . Therapist is talking me through it all very gently but I suppose it takes time .

I’ve not been to the dentist in a few years because of all this . However I’ve got a filling that’s fallen out totally along with half of my molar . I’m also grinding my teeth in my sleep so the top two are getting a bit worn and one of my teeth clicks at times . I am wearing a cheap night guard . Went just before Christmas and told that I will need a bit of work done .

The dentist has said they anticipate either whipping my molar out, or a filling, and asked me to ask GP for a script for Valium so I can lie still long enough for the appointment . They won’t prescribe anything themselves although did refer a more complicated

I’m not sure if I should - surely that’s a bit unfair on the GP and a waste of their time? Dithering over cancelling dentist yet again but think if I do that’ll be me flung out of the practice .

Diazepam is no longer licensed for use for dental procedures unless they are done in hospital. This follows a series of deaths of people sedated for dental procedures

That simply isn't true. If you look at the UK dental formulary in the link below, you can see it can definitely be prescribed.

bnf.nice.org.uk/dental-practitioners-formulary/

Perhaps you are confusing it with general anaesthesia for dental procedures. They must be done strictly in a hospital setting. It has been that way for 22 years.

As my post below explains more fully, we dentists can prescribe, but are hesitant.

There are plenty of other options for you, but firstly I would return to your dentist OP, explain your anxieties snd ask for the options to be laid out clearly for you. These options are most likely- oral, inhalation, or IV sedation ( usually referral), referral to an anxiety clinic, or referral to hospital for GA. Hope you get it sorted

Whereabouts do you live? In some cities you can refer yourself to a dental hospital.

I have PTSD and massive dental fear too. You can ask your dentist to refer you to your community dental team who can either give you intravenous midazolam (you're conscious but aren't aware and remember nothing) or general anaesthetic.

Huge hug.

@suspiria777

my GP wouldn't do this and would insist the dentist prescibes it themselves. Why should your GP service have to pay for what the dentist is doing?

Dentists are massively restricted in terms of what they can prescribe and afaik controlled drugs aren't on their list.

Dentists are massively restricted in terms of what they can prescribe and afaik controlled drugs aren't on their list

My dentist prescribes diazepam for me when needed.

That's a shame your GP's unwilling to prescribe OP, they probably think that your dentist should prescribe it. Would it be worth broaching it with them again?

I have PTSD and medical procedures are a trigger. My dentist prescribes diazepam but I already get if from my GP for a movement disorder.
Anxiety management is for people who are nervous of the dentist, not PTSD. DS used it and managed to have a wisdom tooth extracted with an injection, I was there with him and it would have done nothing for me.
Tell your dentist in writing that you have PTSD and that medical procedures are a trigger. Ask them to add this to your notes, and to check with your GP if they need confirmation.
Say if they refuse to prescribe diazepam and sedation you'll be unable to access treatment, and ask them to refer you elsewhere.

I had a traumatic dental epidode once and i just got the shakes which made dental work a challenge. I then worried even more about the shaking. My husband took me for a champagne lunch before the appointment. I think I had maybe 1 and a half glasses plus lunch. (I'm quite small.) I flossed and gave my teeth and tongue a very thorough clean in the ladies (took toothpaste with me.) I confessed all to the dentist who was just pleased to have a non-trembling patient. I had to do this one more time and then I was okay. I've never used alcohol as a crutch for any other occasions. I can't take valium as it gives me panic attacks. In your case I'd be inclined to change doctors or get a second opinion.

I think its very difficult for GPs to prescribe in situations like this where they won't be monitoring you. It truly is an unpredictable drug. I've had relatively high doses do nothing but make me a little tired, and seen much bigger and heavier people be profoundly affected by just a few mg.

@MissLucyEyelesbarrow
That's not correct information, you're conflating that with GA for dentistry.
The bulk of my work is sedation dentistry, so I do know what I'm talking about.
What OP's dentist should be doing is liaising with her GP by letter etc, obtaining a full medical history and taking it from there. If the dentist still doesn't feel confident in prescribing oral diazepam, then OP should be referred appropriately.

My gp has prescribed it for me every time over the last5 yrs without question10x5mg tablets..(I have extreme dental phobia)i take 2 the night before,then 2 an hour before and the rest if my next few nites are ropey.
I hope you go ok and get what you need when you need it🙂

Thanks all, will phone today and ask them for advice/what to do next . It sounds silly but I’m not using to being given help, or asking for help, normally I’d just try and push through it and deal with the flash backs later, but the last time I did that (hospital appointment in September) I came home and had a horrendous panic attack that saw me dialling 999,I’d never had one before and thought I was dying . Had to be given diazepam then to calm down in the end as it happened four times that weekend . I really, really want to avoid that happening again if I can .

I have had problems with midazolam in hospital (the paradoxical excitement thing, was given it ironically for the op that’s caused the PTSD and had a horrible time), so recognise it can go wrong yep . I’ve been given diazepam since a handful of times and always OK, but yes am proof it can go the totally opposite way , unfortunately . I can understand GP not wanting to prescribe something that she can’t monitor .

I’m on the list for general anaesthetic for wisdom teeth removal anyway but they did say that’s several years long , won’t be anytime soon .

[quote l2b2]@MissLucyEyelesbarrow
That's not correct information, you're conflating that with GA for dentistry.
The bulk of my work is sedation dentistry, so I do know what I'm talking about.
What OP's dentist should be doing is liaising with her GP by letter etc, obtaining a full medical history and taking it from there. If the dentist still doesn't feel confident in prescribing oral diazepam, then OP should be referred appropriately.
[/quote]
Read the licence in the BNF. There is no licence for sedation for procedures, except in a hospital setting. This did not used to be the case, but it is now.

You are an expert in sedation dentistry, so you can prescribe off-licence. A GP is not, so should not.

@enjoysun

Diazepam is no longer licensed for use for dental procedures unless they are done in hospital. This follows a series of deaths of people sedated for dental procedures

That simply isn't true. If you look at the UK dental formulary in the link below, you can see it can definitely be prescribed.

bnf.nice.org.uk/dental-practitioners-formulary/

Perhaps you are confusing it with general anaesthesia for dental procedures. They must be done strictly in a hospital setting. It has been that way for 22 years.

As my post below explains more fully, we dentists can prescribe, but are hesitant.

There are plenty of other options for you, but firstly I would return to your dentist OP, explain your anxieties snd ask for the options to be laid out clearly for you. These options are most likely- oral, inhalation, or IV sedation ( usually referral), referral to an anxiety clinic, or referral to hospital for GA. Hope you get it sorted

But I'm talking about GPs, not dentists.

I'm not offering an opinion on whether or not a dentist can/should prescribe it. It is still off-licence if a dentist prescribes it (outside a hospital setting), but a prescriber with the right expertise can prescribe off-licence.

I do suggest that you and the other dentists telling me I'm wrong review the BNF guidance though. I don't mean that sarcastically - licences change all the time and no one can keep up with every change. I happen to know a lot about diazepam because of my forensic work, but I'm sure there are lots of BNF updates I have missed. But, as you are now using diazepam off-licence (by the sound of it), this should be part of the consent info you give to patients.

So sorry you're dealing with this OP. I am a very nervous patient due to past medical issues and have lucked in with a dentist who gets it. A lot of it is do with with trusting your dentist understands, it make a world of difference. So I say definitely speak to your dentist first and make them fully aware. Apart from dealing with the problem by using sedation another thing that can help is the type of local they use when carrying out treatment. Generally dentists use lignocaine with epi which is ideal for the dentist to get the job done and keep you pain-free but the epi can make your heart race and increase blood pressure which if you are anxious can be awful. You can have anaesthetic without epi. I think dentists carry it anyway as the non-epi one has to be used for certain medical conditions. (any dentists on here may be able to explain what I'm describing better - or disgree!) This was a game changer for me and I'm now much calmer about going, including having a root canal. TBH I think if you are having sedation of any kind it probably doesn't make too much difference either way about the local but maybe it's helpful. My dentist uses the non-epi local with a lot of nervous patients now as standard.

I think some posters are confusing IV diazepam used for sedation with the 2 - 10mg you can take for anxiety and PTSD.

Sedation dentists use IV midazolam never heard of any sedation dentist ever using IV diazepam.

If I'm working in hospital and it's anaesthetist led IV sedation, they will use Iv Propofol. But dentist sedationists use only IV midazolam.

@MissLucyEyelesbarrow

Eh? What are you talking about? Did you read the link to the Dental practitioners formulary that I posted? This is published within the BNF.

Just in case, I will cut and paste the section regarding diazepam. Dentists can legally prescribe "

• Diazepam Oral Solution, BP, 2 mg/5 mL
• Diazepam Tablets, BP "

There is nothing remotely off licence about that.

Also please note that IV diazepam is not on that list, and no dentists on this thread have ever suggested it is.

@Thelnebriati

I think some posters are confusing IV diazepam used for sedation with the 2 - 10mg you can take for anxiety and PTSD.

Again, check the BNF. These are the current licensed indications for diazepam for procedures, covering both oral and IV administration:

Premedication
By mouth
For Adult
5–10 mg, to be given 1–2 hours before procedure, for debilitated patients, use elderly dose.

For Elderly
2.5–5 mg, to be given 1–2 hours before procedure.

By intravenous injection
For Adult
100–200 micrograms/kg, to be administered into a large vein at a rate of not more than 5 mg/minute, immediately before procedure.

Sedation in dental procedures carried out in hospital
By mouth
For Adult
Up to 20 mg, to be given 1–2 hours before procedure.

Conscious sedation for procedures, and in conjunction with local anaesthesia
By mouth
For Adult
5–10 mg, to be given 1–2 hours before procedure, for debilitated patients, use elderly dose.

For Elderly
2.5–5 mg, to be given 1–2 hours before procedure.

Sedative cover for minor surgical and medical procedures
By intravenous injection

For Adult
10–20 mg, to be administered into a large vein over 2–4 minutes, immediately before procedure.

[quote enjoysun]@MissLucyEyelesbarrow

Eh? What are you talking about? Did you read the link to the Dental practitioners formulary that I posted? This is published within the BNF.

Just in case, I will cut and paste the section regarding diazepam. Dentists can legally prescribe "

• Diazepam Oral Solution, BP, 2 mg/5 mL
• Diazepam Tablets, BP "

There is nothing remotely off licence about that.

Also please note that IV diazepam is not on that list, and no dentists on this thread have ever suggested it is.

[/quote]
I don't think you understand what off-licence means. A drug can be in the BNF, and perfectly legal to prescribe, but still be off-licence. Off licence/off-label means that you are prescribing outside of the recommended indications for the drug - more info here

It is legal and ethical to prescribe off-licence, as long as you have the required expertise to do so. However, if you prescribe off-licence, you take personal responsibility for ensuring that the drug is suitable for the indication you are prescribing it. GPs are not experts in dental sedation, so should not be prescribing diazepam off-licence for it. Dentists with the requisite expertise can.

MissLucy you say you know what you're talking about, but say that denying oral sedation for this won't stop OP accessing dentistry work sedation. It very definitely WILL screw her options in that direction if dependant on the NHS, and you know it. She'd be waiting forever. People who can pay, that's perhaps a different matter, but for many people the sums involved with the work on top are just impossible.

dentistry with sedation*

Well it’s gone form bad to worse tonight - ‘clicky’ tooth is now bleeding quite heavily after brushing - ie still bleeding twenty minutes later . Biting down on paper towel trying to decide what to do .

@MissLucyEyelesbarrow

I get what you are saying now. Think there were a few crossed wires. Basically you are saying that that a GP would have to prescribed the diazepam for a dental procedure "off licence" as it's not in their remit. But a dentist could as it's within theirs.
I understand now.

Sorry if I derailed the thread a bit OP. I think you need to go back to your dentist. Make an actual physical appointment and discuss your options again. Hopefully they will agree to prescribe some Valium for you.

Hi I know this thread is old but can I ask how much was the prescription charge as I need to pay for one myself for same reason