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Dental surgery, dental medications, tooth discoloration

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Karma   
Karma

I am planning on having oral surgery to perform two implants where I have missing teeth.  Fortunately these teeth are hidden at the back of my mouth so cosmetically not really an issue, but my bigger concern is maintaining normally healthy teeth throughout my life.

 

First I consulted my regular dentist and he advised me that I am a candidate for either dental implants or bridgework.  They look at bone structure and proximity to nerves running through the mouth. 

 

Next I requested a list of the medications prescribed in association with the procedure and researched them against my current medications.  Since I am also taking a benzo I went to the benzo site and researched each of the meds there.

 

In my case the following prescriptions are given:

  • Amoxicillin/Cephalexin as a prophylatic antibiotic to prevent infection
  • Chlorhexidine 0.12% as an oral antibiotic to help prevent any chance of secondary infection
  • Vicodin/Percocet as narcotic pain medication
  • Ibuprofen 800 mg as prescription strength pain medication
  • Medrol Dospak as a corticosteriod to reduce post-operative swelling

Next I met with the oral surgeon and explained that I am hypersensitive to medications.  We discussed my drug history and the problem I had with Cipro back in fall 2011.  I also told him how albuterol causes me to shake all over and that I am concerned about epinephrine.

 

He recommended that I go with what is called twilight anesthesia.  Twilight anesthesia is an anesthetic technique in which the patient is not unconscious, but sedated.  The patient is sleepy, but able to answer questions and follow simple directions from the doctor. 

 

In this process they use a combination of midazolam, fentanyl and propofol.  Midazolam (versed) is called a dissociative, it keeps nerve sensations from reaching the brain.  Fentanyl is a potent, synthetic opioid analgesic with a rapid onset and short duration of action.  Propofol is a hypnotic/amnestic agent (puts you to sleep and causes you not to remember).  He will also use a local, but since I will be sedated he only has to use about half as much of the local as he would if I wasn't sedated.

 

I read on the benzo site where someone over there had this procedure with just the local ... and they used carbocaine rather than novacaine and did just fine.  Not sure I'm that brave ... I think I'd rather be slightly knocked out and not remember the procedure.

 

My procedure is scheduled for about 3 weeks from now.  I'd be interested in any comments from members who are withdrawing from antidepressants and who have either had implants or used any of these meds while in the process of withdrawing or after withdrawing.  I am going to do some more research, but if all goes as planned I will update this thread with my experience for other members who may plan this type of procedure in the future.

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Barbarannamated   
Barbarannamated

I must have had the twilight anesthesia though it wasnt referred to by that name. It contained those same drugs. I thought Versed (midazolam) was a very short acting benzo that acts as an amnestic, but I may be wrong.

 

I seemed to do ok with the drugs.

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Karma   
Karma

I was hoping you'd drop by this thread, Barb :) .  Based on the description in your thread I think it may be the same anesthetic ... the patient is sedated rather than unconscious.  You are correct about Versed, too ;) it is a very short acting benzo.

 

From the research I've done if I was just having one implant I would probably be fine with just a local anesthetic ... but I'm having one on the top and one on the bottom so he will be working on my mouth for 30-45 minutes. 

 

It is encouraging that you did ok with the drugs.

 

Karma

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Karma   
Karma

Update - day 1 after the surgery ... no ill effects from the twilight sedation, from percocet or from the antibiotic. 

 

I will tell you that although they call it "twilight sedation" I felt like I was completely out.  One minute I was chatting with the surgeon and feeling all warm and cozy from the sedation meds and the next minute someone was calling my name and I was opening my eyes.  It was all over.

 

They said the pain would be its worst about 6 hours after the anesthetic wore off and they were correct ... I needed a double-dose of pain meds last night.  I didn't need anything more than a single advil today. My surgery was performed at about 2:00 PM yesterday afternoon and it took less than an hour.  I had two implants, one on top and one on the bottom.  (Also note that I did not need to have teeth removed, these teeth had been missing for over 20 years).

 

I did not need a medrol dospak and I haven't taken Ibuprofen because my pdoc was concerned about possible interactions with effexor.  I did apply ice packs to my cheek last night to help minimize swelling and there is virtually no apparent swelling today.

 

They did use local anesthetic that I believe contained epenephrine, but they monitored my heart rate through the whole procedure so if I got the shakes I didn't know about it.  The surgeon had previously indicated that since we were using twilight sedation that he only needed to use half the local anesthetic of what he would have used if I had been awake.

 

I'll monitor my symptoms this week and continue to report, but it appears to have been a very uneventful surgery.

 

Karma

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Rhiannon   
Rhiannon

Thanks for this, Karma. I'll be getting a couple of implants some time in the next year myself so this is very valuable info to me!

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Karma   
Karma

Update Day 2 since surgery - Last night and this morning I had a little nerve pain in my left lower leg and foot ... the kind where your skin feels like its burning.  I did take another percocet last night because I think I'd had slight pain all day and by last night it just seemed to build up.  This morning there is slight swelling and a little pain so I took some asprin.

 

I forgot to take my neurontin last night ... so if I start to have depression or anxiety symptoms, let's keep in mind that I missed a dose of my normal meds.  Since I've been so stable on my Effexor decrement I really don't expect the missed dose of neurontin to have an effect, but will continue to monitor it.  (The nerve pain started yesterday before I missed a dose of neurontin).

 

I read something interesting ... it seems that the titanium screws they use for implants can set off the metal detectors in airport security ... so we should self-declare to security that we have metal implants and indicate where they are in our bodies ... and it is likely airport security will do a separate wanding. 

 

Karma

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Barbarannamated   
Barbarannamated

Karma,

 

I'm glad to hear things went well with your surgery.

 

I know you're dealing with osteopenia (osteoporosis?) and wondered if you'd heard the warnings about bisphophonates causing necrosis of the jaw bone? A dentist I went to recently mentioned this to me and I thought I'd pass it on. She said that dentists have been noticing that patients on these drugs (Fosamax etal) are having more problems with the jaw bone holding onto implants. There is quite a bit in the medical literature.

 

http://www.mayoclinic.com/health/fosamax/AN01379

 

Just an FYI. Sorry for the tangent!

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Karma   
Karma

I had heard about this, Barb ... and I refuse to take bisphophonates or anything like them.  I am addressing my bone density by eating a highly alkaline diet, supplementing vitamin K2, maintaining a good level of estradiol, and exercising with additional weight to stimulate bone growth.

 

My dentist was only concerned if I was on bisphophonates ... since I wasn't we went ahead with the implants.

 

Karma

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Karma   
Karma

It is the evening of day 2 after the surgery:

 

The asprin took away the nerve pain and the discomfort in my cheek/jaw as well as the swelling.  If there were problems from missing my neurontin dose last night they passed.

 

So far so good.

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Karma   
Karma

Update day 3 after surgery:

Woke with neuro anxiety.  Something went wrong at work late on Friday and interestingly enough I was able to ignore it all weekend.  But I woke Monday morning with an over reaction to the thing that went wrong at work.  It caused me to doubt myself and lose my confidence.  It wasn't debilitating and I was able to work and take action to minimize the impacts of the thing that went wrong.  Felt off balance and insecure. Had difficulty figuring out what to focus on. 

 

I was able to fall asleep easily Monday night.

 

No pain from the implants.  My tongue does want to play with the pokey parts of the stitches ;).

 

Update day 4 after after surgery:

Still woke up with some morning anxiety thinking about the thing that went wrong at work.  However, today I was able to put the thing in its box and start to look at what we could do to minimize the impacts of it.  I also realized that we made the best decisions we could make early on and it is no one's fault - yesterday I was blaming myself for not doing some things that could have prevented the thing that went wrong.  There was nothing I could do - I acted on the best information available to me and that is all there was.  I have a lesson learned now that I can use in the future.

 

By this afternoon my ability to concentrate had returned and I was quite productive at work.

 

I'm feeling more confident and less anxious tonight ...

 

Since I missed a dose of neurontin over the weekend that could be why I had neuro anxiety ... this may have nothing to do with the sedation or medications.  But I am still taking the amoxicillin through the rest of this week. 

 

I will keep posting updates so others can get a feel for this.

 

Karma

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Karma   
Karma

Update a week after my oral surgery

 

The excessive anxiety disappeared a day or so ago.  Not quite back to joyful, calm and completely balanced, but feeling pretty normal.  I will be finishing off the antibiotics over the next few days ... I think they gave me 10 days worth.

 

I'll report out again once I've finished the antibiotics.

 

 

Karma

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Karma   
Karma

Over the weekend of Aug 3 I started to feel normal again.  I finished the antibiotics and have felt pretty normal since then ... able to feel joy and not experiencing much excessive anxiety.  I think the anxiety issue I had was related to missing a dose of gabapentin.

 

Saw the dental surgeon for my 2 week post-op.  The bottom implant is healing beautifully, the top one isn't as far along.  The tissue wants to grow over the healing cap on the implant and he said I can just keep pushing it back around the implant.  Rinsing with salt water tends to help it heal.  He said the worst scenario is that the tissue heals over the cap and if that happens he will use a little topical anesthestic and a laser to clear it away.  That was a relief.  I was afraid I would need more stitiches and that would be more numbing shots ... happy I can avoid that.

 

My recommendation to anyone planning on this kind of procedure would be to hold for at least a month prior to the anesthesia, make sure you are getting an antibiotic that doesn't interact with your AD or benzo and don't make any changes until you are 2 weeks on the other side of the surgery.

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Skylarblue75   
Skylarblue75

Hi all,

I'm hoping someone can give me some advise. I have to have 3 wisdom teeth removed sometime this month. 2 are partially impacted try to come through, the other is completely through but has cavity. I really don't want to be put under or sedated in anyway and I won't touch benzos. i really want to white knuckle it and just have a local-just numbing. I don't even want any narcotics for pain management, I have become so hyper-sensitive to medications, supplements etc. Anywho I have a consult with an oral surgeon on July 7 th, but I wanted to get some in-site and arm myself with a little info before the appointment. So if anyone has any info they would like to share on this topic, please share

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picchy   
picchy

Hello there,

 

I have been in a severe withdrawal for over six months and am housebound completely (also have ME/CFS). I think I may need to see a dentist for a filling and am terrified of having an injection for the pain - since I react so much to everything now that I can't even take a vitamin pill.

 

Does anyone know about what drugs to ask the dentist to avoid, and if there are any we are less likely to react to?

 

Hope so as terrified!

Many thanks,

Picchy

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compsports   
compsports

Hello there,

 

I have been in a severe withdrawal for over six months and am housebound completely (also have ME/CFS). I think I may need to see a dentist for a filling and am terrified of having an injection for the pain - since I react so much to everything now that I can't even take a vitamin pill.

 

Does anyone know about what drugs to ask the dentist to avoid, and if there are any we are less likely to react to?

 

Hope so as terrified!

Many thanks,

Picchy

Hi Picchy,

 

During withdrawal, I had alot of dental work, including fillings and never had a problem in spite of being hypersensitive to meds.   I did avoid epinephrine based products since that was contraindicated since I was taking a stimulant.   But just to be on the safe side, I kept avoiding it even when I no longer took these meds.

 

If you are concerned, you might want to tell the dentist that due to being med sensitive, which local anesthetic would he advise giving you.  Not sure how helpful that will be but it is worth a shot.

 

Best of luck.

 

CS

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JanCarol   
JanCarol

Hi Picchy,

 

Wow, do you have someone to go with you?  

 

I think for just a filling you will only have local anesthetic, like CS said.  It's not as invasive as general anesthetic, and less likely to knock you for a loop.

 

But having a rotting tooth is problematic and should likely be dealt with.  It could cause more problems than the local anesthetic.  I had a boyfriend with a rotten tooth & it exploded and poisoned his blood, and he had to go to the hospital - that would be much worse than getting a filling.

 

I don't think there are any stimulants or steroids in local anesthetics. I'm not gonna lie - some people have reactions to lidocaine.  But the ones I know of are drug interactions - and you are off the drugs.

 

It's a trade off - you will have to decide which is worse:  the risk of local anesthetic?  Or the risk of a rotten tooth going septic?

 

Sorry I don't have anything more definitive.

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Annie3   
Annie3

Hi picchy,

I too am sensitive to all vitamins except magnesium oil. I just had a filling two weeks ago and cried on the dentist chair because I was afraid of a reaction from the needle. I explained how sensitive I was so she used the one without epinephrine and I had no reaction.

 

I do understand every situation is different, but I hope this helps since I was in a very similar spot just two weeks ago and all turned out okay for me and I cannot tolerate most meds or vitamins.

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indigo   
indigo

 Not sure about dedrugs dentists use but I'm also extremely sensitive to pain and any meds.

Also, I grew up in the fifties in Britain and had severe dental abuse as a kid. 

( held down while ether mask jammed on face etc, sometimes 5 teeth out at a time)

so have severe dental phobia. I'm also dealing with SSRI withdrawal. When I needed 

a lot of dental work done, I found a dentist online who specialized in patients with dental 

phobia. Whole staff were very sensitive. Put me under general anaesthetic for four hours and 

did all the work at once while I was under. It might be worth looking for such a dentist in U.K.

They do have a dental phobia website/blog in U.K. recommending dentists.

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picchy   
picchy

Thank you so very much for all the responses. I'm finding it very hard to use a computer ie look at a screen, so it's great to read these responses. The advice about avoiding that adrenaline drug in particular is very helpful. I've located a dentist here in Edinburgh that does home visits for housebound people, although I doubt they would do fillings at home! Still, perhaps a checkup at least.

 

Thanks again for all your useful help - this forum is the only place I could get this type of help.

 

Picchy x

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blackhill4   
blackhill4

I may need to get a tooth pulled before I fully recover (could be a while yet). The tooth isn't bad yet but if it gets infected I know those meds are bad for wd. Has anyone had a tooth removed during this process?

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katieb   
katieb

I'm struggling with infection and pain after a dental cleaning ???? This is not usual for me .Just wondering if wd is hindering my healing

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katieb   
katieb

Just to add , after being in pain after the clean for way over a week I went back, to see the hygienist who said nothing to worry about it will settle down. Guess what ....It didn't!

3 days after the clean I was scheduled for re doing of an old filling.Not my idea but it was an old filling so I thought why not, little did I know all hell was about to be let loose.

Pain was horrible,so back again to the dentist.By this time I was beginning to feel like a neurotic hypochondriac. After so much pain the dentist recommended an extraction.I was devastated and shed a tear in the treatment room but couldn't cope with the pain anymore. Next day went for the extraction ( the tooth which was refilled and all ready paid for the week before)

 

So after the extraction I was hoping to be pain free. Ohhhhhhh NOOOOO! Even more pain, how can this be there was no more infected tooth?. Back again in distress to the dentist. Pain in all my mouth not just the extraction site. X rays were taken and he came to the conclusion of infection of extraction site, and suspected infection of the other side of mouth in a tooth with a root canal. Concluding another re root canal or another extraction. Again sheer devastation 2 teeth in 2 weeks. Again emotional in the treatment room (happening quite frequently at this stage of withdrawl). I questioned different things ...was he sure etc etc, he sent me for a 2 opinion 2 days later.By this time I am a complete nervous wreck , feeling fragile in withdrawl and thinking I'm going to loose 1 or even 2 more teeth. .yet another emotional episode retelling the new dentist my story. She again X rayed and did some tests on teeth with ice , tapped on teeth, felt around gums and jaw.Her conclusion was no infection .In either side, if the extraction site was infected it wasn't anymore.Also there was a little bit of irritation/ inflammation above the non extraction side which did not need any treatment.I was in disbelief. She said the pain was probably from the cleaning a and from grinding my teeth and would hopefully settle down In about 3 weeks.

 

After all that I was wondering if any one else has tooth , jaw, face pain throbbing and shooting pains as she said also the paroxatine could be causing get some of the pain.

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mammaP   
mammaP

Merged similar topics. 

 

You might find some similar experiences in this thread KatieB, I hope things settle down for you soon, it's good that there isn't any infection. 

Pain does seem to be more acute in withdrawal, like all nerves are on edge and the slightest pain is amplified, if that's the right word! 

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katieb   
katieb

Thanks mammap.

I guess I have to try and relax and just let whatever is happening heal.Stress won't help me one little bit.

IM no good with pain and on top of horrible muscle pain which I have had now for 4 months this happens.It just seems that I never get a break,whenever a pain or sympton goes or reduces up pops another one immediately to take its place.Just feel so deflated and worn out at the moment

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InvisibleUnless   
InvisibleUnless

im not in a great state for writing, but i wanted to put up a post asking about peoples experiences with dental agents.

 

 

ive had at least one filling since i was on meds/in withdrawal from meds, and it wasnt a concern that past drugs involved with that might come back to me.  but in 2014 i had to have a filling done and i told the dentist i was in a hypersensitivity from withdrawal and he dialed back the doses and maybe held back on one of the heavier things entirely (i dont really recall).  when he injected me, i had a lot of trouble breathing and my face sort of collapsed, but i evened out after a while.  there was a forming cavity and he said he had to deal with it before it became too late to preserve the tooth in ideal shape, which is why i risked a procedure when the outcome seemed a bit unpredictable (though he gave me assurances when i confronted him about my specific peril beforehand).  this was before i had verification that psychotropic withdrawal of the sort i was imagining even existed, and before i came onto here, i believe.

 

anyway, i started feeling a numbness in my lower jaw, on the right hand side, and it began spreading, just an hour or so ago.  it felt just like dental anaesthesia.  it made me curious, but i was going to wait it out and see what happens (as maybe it was a dyskinesia, or my teeth moving again, or who knows what).  after a minute or two, i began tasting the pre-numbing agent that is spread to mask the needle entry of the venal intoxicant, and salivating abnormally for minutes and minutes.  finally, it got to the point where my smile was one-sided, like in a stroke or bells palsy.  i called the dentists office for my records, asking if there were any procedures done during the period i was on meds (as i figure im in the 2006-2007 range right now, in terms of re-experiencing past medication clusters).  after a lot of digging and questioning, it turns out the most recent procedure in late 2014, which i hadnt recalled any of the specific details of until i was told, is the one where i had a filling on my lower right side.

 

 

the entire right side of my face is radiating a numbness, and i am still tasting the medication.  its hard to even keep my head straight, and my lips, cheek, and face are experiencing an induced numbness and laxness.  even my right eye is feeling wonky.  i dont imagine this will persist more than a few hours, as these are short acting and has always dissipated during the initial treatments (even if i never had such a severe susceptibility as 2014 and presently), but i hadnt thought it would come back to bite me in the ass in the same way as the psychotropics.  so i was wondering about the experiences of other members who have noticed such correlations or had after-effects of dental procedures while in withdrawal.  i am curious as to the rate of storage, release, and metabolism for the common anaesthetic agents so i can figure out why this is happening 9 months later.  i may inquire elsewhere as to those specifics.

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erer   
erer

I need to have some dental work done that would require a local anesthetic injection. 

 

I am so frightened by people having paradoxical reactions  to even pseudoephedrine that is in cold medications - could the anesthetic injection done at the dentist's office be a threat to the nervous system when in withdrawal?

 

If yes, what can be expected?


 

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Petunia   
Petunia

Topics merged.

Erer, please read through this topic from the beginning, you will find your questions answered here.

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erer   
erer

Topics merged.

Erer, please read through this topic from the beginning, you will find your questions answered here.

 

Thank you, but I don't think my question was answered here. I am still unaware whether to be cautious of any local anesthetic or not etc.

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Petunia   
Petunia

From the research I've done if I was just having one implant I would probably be fine with just a local anesthetic ...

 

They did use local anesthetic that I believe contained epenephrine, but they monitored my heart rate through the whole procedure so if I got the shakes I didn't know about it. 

 

I'll monitor my symptoms this week and continue to report, but it appears to have been a very uneventful surgery.

 

 

During withdrawal, I had alot of dental work, including fillings and never had a problem in spite of being hypersensitive to meds. 

If you are concerned, you might want to tell the dentist that due to being med sensitive, which local anesthetic would he advise giving you. 

 

 

I think for just a filling you will only have local anesthetic, like CS said.  It's not as invasive as general anesthetic, and less likely to knock you for a loop.

 

 

Please read through the topic.  No one is able to predict how a local anesthetic will effect you because everyone is different. But this thread contains examples of how dental work has impacted others who were in withdrawal.

 

The first few posts by Karma detail how she had extensive work done, including local and general anesthetic and she had some reactions which resolved within a week.

 

You will most likely be fine, but if you are concerned, you could do as compsports suggests.

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brassmonkey   
brassmonkey

This year I had a broken tooth, root canal, post and crown and a full deep cleaning all of which required heavy locals on seven different occasions.  Other than feeling beaten up by the work itself, I had no lasting effects from the drugs.

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Martina23   
Martina23

I feel I should go to the dentist as I think I have some cavities. But I am so much afraid of this local anesthetic that it will make my intrusive thoughts worse. Without anesthetic it pains too much so this is not the way too. I can not avoid the dentist forever because if something goes wrong the people can get even the blood poisoning. How is it, can this local anesthetic make intrusive thoughts worse?

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erer   
erer

Sharing my experience of having a tooth done with local anaesthetics and there was no reaction. 

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Karma   
Karma

Some local anesthesia has epinephrine in it.  Epinephrine in higher doses is what they inject into people who are having an anaphylactic reactions.  It is adrenaline. Even in the small amounts used in local anesthesia, I can't handle it.  It makes me shake and feel uncomfortable.

 

Your adrenal glands are part of your hypothalamic–pituitary–adrenal (HPA) axis.  They produce cortisol (that the body needs for normal cellular activity) and adrenaline (for you flight or fight response).  The interactions among these organs (hypothalamus, pituitary gland and adrenal glands) constitute the HPA axis, a major part of the neuroendocrine system that controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure.

 

If the local used includes epinephine that might be why it could make intrusive thoughts worse.  That is why I made sure to hold my wean long enough to feel stable.  You can also have the conversation with your dentist that you are highly sensitive to medications and ask for something that does not contain epinephrine.  Carbocaine may be an acceptable alternative.

 

What I have learned is dental health is important to overall health.  Don't ignore your dental health out of fear.  Take control, explain your situation and hold your health care professional accountable for helping you through the process.

 

Karma

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compsports   
compsports

As one who waited way too long to see a dentist and will be having tooth implants as a result of my actions, don't put off seeing a dentist due to fear.   Please follow Karma's advice so you don't end up in a similar position to mine.

 

CS

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NJJ   
NJJ

Hi,

 

My filling came out yesterday and I'm very reluctant to go to the dentist, not because of the Procedure itself as I've had many before but the fear of yet another drug interaction. I know I probably sound paranoid but I'm finding now I'm sensitive to everything. I'm thinking that the cavity is to deep for no drugs. I do suspect that I may have a slight reaction to the needle drug, because every time I get it, I get this rush of adrenaline and my heart beats fast. I think there are alternative drugs. Has anyone had a filling without drugs?

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bubbles   
bubbles

I have, but it was a small filling with minimal drilling.

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