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Can you advise me about oral sedation?

Hello Dr Pinder, I hope you don’t mind me messaging you but after spending hours online looking for advice, I came across this site and wondered if you could help? I don’t really know where to start…
When I was in my teens, I read an article somewhere that said that people who suffer with M.E can react to silver fillings. Suffering with M.E myself, I discussed this with my dentist at the time, who agreed to give me a white filling. Unfortunately for me, he carried out my filling without giving me an injection and as a result of this, he drilled too low and I’m guessing, caught my nerve…he even carried on when I screamed out and started crying. Until that point, I had never been scared of the dentist but because of what happened, I never went back to a dentist for about 10 years and only then because I was in extreme pain. Luckily, I found a really nice dentist who is really patient with me but even now, all I can manage is a check up. He referred me to a surgery that carries iv sedation and I was so happy knowing that I wouldn’t have a clue what was being done, I jumped at it. The first lot of sedation went really well, I woke up in the recovery room not remembering anything but unfortunately, the staff were unhappy that i had taken a long time to wake up. My mum explained to them about my M.E and it was normal for me not to wake up even without being medicated but still they weren’t happy. Since that time, I have had to go back for sedation several times for further work as my teeth break really easily but my happy, relaxed experience has been replaced with worry and anxiety. I started to become ‘aware’ of what was happening to me during further visits. I could hear the dentists talking to each other and hearing the drill (which really scares me.) In one sedation session, I was told to stop crying and calm down. Since then, I have come out of every session crying. I have had three different adults accompany me to the clinic and they have all said that the staff have been really impatient with me crying. On my last visit, they told my friend that the Government have changed their rules and they have given me the maximum dose of sedation they can give and if I continue to be that upset, then perhaps I should go to the hospital for any more treatment. To be honest I don’t think this is really fair as, in a consultation I once had there, I apologised to a different dentist there who assured me that it didn’t matter that I got upset, he explained that some people have no reaction to sedation, that some people get angry and some people cry but not to worry.
In December 2012 had two sessions there, the first was for root canal treatment and the second, I thought was for a crown to be fitted but when I got home and looked, all he had done was filled what was left of my half tooth. Part of my tooth has now chipped off, I have rung my dentist and he said that I have to contact the clinic myself to see if they will fit a crown on the NHS or if I will have to pay for it. I am worried about this as I currently am receiving Employment and Support Allowance and they haven’t charged me before but what really is worrying me is having to have sedation again and that they may be impatient with me again. They are the only clinic who deals with sedation in my area and my local hospital only deals with extractions so unless I can have the work carried out with my normal dentist, I have no choice but to go back. I was wondering if you could give me some advice regarding sedation please? I have looked online to see about sedation doses but all I can see is that normally one drug is given in a titrated dose but in some cases a second drug may be used. I couldn’t see anything about a maximum dose. I just don’t understand why the sedation sessions have changed so much. I hope you don’t mind me asking but I really need some advice as don’t have anyone I can turn to. Thank you for taking the time to read this. Yours sincerely.

Hello, No problem getting your feelings out to me .
There are some issues here that need airing .
It sounds as if you have to have NHS treatment because of your income situation .
It sounds as if you have high treatment needs necessitating multiple sedation sessions .
My experience has been that some people have a successful first sedation , but on subsequent ones they are less sedated , particularly with the single drug sedation .
Hypnovel is the single drug , it is given in one hit , and the depth of sedation gradually wears off over about half an hour . There Is a maximum safe dose , and once that has been given then no bigger dose can be given even if it is not effective enough . Its usually given by a dentist .
However multi drug sedation is often given by an experienced anaesthetist , and is given as a continuous infusion over the length of the appointment so that the depth of the sedation is kept constant . Even with this There are some patients who are restless and cry , but remember nothing and the treatment can be completed to a reasonable standard
This is often required for patients who have had failed sedation with one drug .
BUT that is hard to find on the nhs , and may only be available for extractions at a hospital .
Your long recovery time should not be a problem for the staff , and are you sure that they really found that a problem and were cross with you , or is that what you thought they were thinking ?
However it may now be necessary for you to consider trying to have treatment without sedation , perhaps with oral sedative medication . Also you may now have to have simpler treatment than root canal treatments and crowns .
I dont have the answer but I hope this helps a bit

Answer provided by: Dr Jennifer Pinder Retired
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