Dental phobia and extraction - gas and air or medication or both?

[MountainDweller]

Hello, please don't laugh - I have a severe dental phobia. I had a great dentist who retired at 54 and have been limping along without her. Then during Covid I lost a filling and was too scared to go till I'd had my two vaccines. Now the tooth (wisdom tooth) is beyond repair and has to come out.

I've seen two dentists, the second of whom is supposed to work with nervous patients but ended up shouting at me (to get my attention apparently when I was having a panic attack). Unfortunately I was hit in the face a lot as a child and I'm not over it... In my head I see shouting as a precursor to hitting. I also had a bad dental experience when younger. Anyway I explained (I actually shouted back that it wouldn't work!) and after that it wasn't too bad... but I'm going to need knocking out as much as possible! (I do have a psychiatrist and a psychologist and am getting help with trauma and current pain situation).

What I want is conscious sedation (midazolam in an IV) - I had two wisdom teeth out with this 15 years ago and it was OK. Unfortunately I'm not in the U.K. anymore and it's really expensive here. So instead I could have gas and air, and/or a cocktail of as many sedative drugs as I have at home. I'm on opiates and pregabalin for pain relief plus propranolol (actually for BP, but helps with anxiety), a sedative antidepressant, alprazolam, doxylamine and Zolpidem. I usually get a decent nights sleep with that lot! I am really tempted to just take everything I have on the day, with or without the gas and air. I've read that gas and air isn't as effective as oral sedatives... has anyone had it for dentistry who can comment on this? Dentist is looking into potential reactions between the gas and other meds, and will call my doctor. I've looked too and can't see anything - they may potentize each other a bit.

I have another appointment with this dentist to actually try the gas when I'll start by taking a small dose of alprazolam to see if it's enough (I need something to get me through the door).

Or should I just keep looking for another dentist? About £65 for a consultation. Plus at least 4-500 for the extraction with gas and air... (or £2000 with the sedation).

God I hate teeth!

Many years ago I had an extraction with just sedation (valium I think)
I knew nothing about it but I still had to get throught the door.
What concerns me is the list of drugs you already take. Is your dentist happy to proceed with sedation on top of those?
I would have been terrified of gas and air having been forcibly held down as a child to have gas at a dentist. However I had it it childbirth and was fine. It didn't really help much though.

MountainDweller I'm a dentist please be really honest with the dentist. Don't mix a cocktail of sedatives with IV or inhalation sedation, some of the drugs you have are respiratory depressants and mixed with Midazolam could give very unpredictable sedation, this is so dangerous.
I'd be concerned about your response to IV sedation as it sounds like your body is used to high levels of sedatives. In the UK Dentists are not permitted use more than one sedative at a time for safety.
A trial of inhalational sedation sounds sensible, I can understand you just wanting to get sedation and it be over with your history but mixing sedatives all with different ways of working and half lives is dangerous. Please be safe.

@MillyMollyMardy

MountainDweller I'm a dentist please be really honest with the dentist. Don't mix a cocktail of sedatives with IV or inhalation sedation, some of the drugs you have are respiratory depressants and mixed with Midazolam could give very unpredictable sedation, this is so dangerous. I'd be concerned about your response to IV sedation as it sounds like your body is used to high levels of sedatives. In the UK Dentists are not permitted use more than one sedative at a time for safety. A trial of inhalational sedation sounds sensible, I can understand you just wanting to get sedation and it be over with your history but mixing sedatives all with different ways of working and half lives is dangerous. Please be safe.

I'd follow this advice. GPS here would be cautious with the mixture of medicine you're on.

I'm coming back to this a bit late... didn't actually think there were any replies! My dentist said she'd call my doctor to check if there were any counter-indications for the drugs. A lot of them are ones you can't give up abruptly so I don't have much choice. Plus I'd be in excruciating pain and wouldn't be able to walk from the car to the dentist or sit in the chair.

Had that's what I'm afraid of, that the gas and air won't really work,and I'd be better to take extra anxiety meds.

Anyway I haven't had a call to tell me to stop any of the meds. I'll just go for the trial having taken my normal anxiety meds and painkillers, I won't add anything else. If the nitrous oxide doesn't work and I can't add to my medication I'm not sure what I'll do. I need it to be over as I'm so afraid I spend every day wishing I could go to sleep and never wake up. Trial is on 3 August and extraction on the 10th.

IV sedation was great... totally relaxed and only remember bits of it (enough that I know I really need to be sedated!).

@MillyMollyMardy With your dentists hat on, I wonder if you have any experience of dentistry with sedation in patients on a PARP inhibitor? I have dental phobia and when I do go used to have sedation prior to cancer treatment, Only problem I have ever had with that is getting someone to take me and bring me home !

@thereisonlyoneofme I hope you find a solution

Follow up question for anyone still reading - is respiratory depression really likely to be a problem, given the physical symptoms a dentist trip brings on? Last time (no treatment, new dentist just having a look) my heart rate reached 200, my resps must have been about 50 (panic attack) and I earned 40 exercise minutes on my fitness watch while sitting in the dentist's chair. I took all my usual meds that day. My BP regularly goes up to 195/120 when I'm stressed (on meds for that too, normally stable at rest at around 140/70). Surely anything that calms all that down is a good thing?