Conscious Sedation… A True Oxymoron?

I recently needed an extraction owing to a pesky wisdom tooth hooking under the tooth in front and killing the nerve. Judging by my last recollection of an extraction where the dentist tore my gums, I suffered extensive bleeding, agony which painkillers barely touched, and a month to heal a mouth full of ulcers, I gave Conscious Sedation a try. This is also apparently the only form of sedation a dentist outside of a hospital may administer these days, and, should I ever need the wisdom tooth out, I’m forewarned it will be ‘a bit of a bugger’. So… Conscious Sedation to dampen my dread, and to test how well this works.

First, credit where it’s due. I’m grateful for the care provided by the dentist and all the staff with sincere gratitude for their understanding, and for working and offering treatment in these Covid times. The extraction was professional and nowhere near as bad as I feared. Was, in fact, nothing like my previous dental experiences; this time there was little bleeding and I’ve managed the post-extraction discomfort with no problem. Within 5 days I was off the painkillers. Though I hate to say it, this is either the difference between private and NHS dentists, this being my first experience of paying privately (with pain radiating up into my cheekbone and round to my teeth on the other side, I had no choice but to do whatever I could to hurry an appointment along), or simple potluck in trying to find a good dentist.

Unfortunately, the Conscious Sedation didn’t work. Let me repeat: The Conscious Sedation DIDN’T WORK.

I had been told ‘if aware I wouldn’t care’ and ‘I wouldn’t remember’. I thought I would have at least felt drowsy or as though I was in ‘happy land’, but I didn’t even feel relaxed. I kept thinking, ‘When is this stuff supposed to kick in?’ Then the ultrasonic cleaning began (which I had also agreed to), and I thought maybe by the time this finishes, but I still felt no different. I recall being asked if I was okay several times, to which I felt confused and wasn’t sure what to say. I was ‘okay’ but nowhere near relaxed. In retrospect, I can’t help feeling the sedation influenced my agreement. Several times I argued with myself over saying something vs just getting it over with.

Next thing I knew, I was receiving injections and silently started swearing. I was, after all, not meant to ‘care’ by this point, and had paid £250 (£720, including the assessment and all the subsequent work) for the privilege. I was nowhere close to ‘unaware’. At the time of the extraction, I recall being asked if all I could feel was pressure, and saying no, I felt a little more than pressure at which point I received another 1 or 2 injections (while wishing I’d metaphorically kept my mouth shut to avoid them). Then the incredible alternating left/right pressure of the extraction and finally hearing, “That’s all done.”

I recall them bringing my husband into the room (with sedation someone has to take responsibility for you) and everything said. When I said I felt a bit ‘out of it’ the dentist remarked, “Like having a G&T.” I would frankly have preferred the G&T. I only felt as if I’d gone too many hours without sleep. I can’t help thinking all Conscious Sedation does to some people is to get them to cooperate and then they’re supposed to go home and sleep whereby they forget everything. But I didn’t sleep. I spent several days struggling with insomnia. I returned home and dozed in the afternoon for 10 minutes during a 30 minute programme of which I missed the middle. After going to bed that evening, I woke at 2am through to 4am. The next night I woke at 3:45. The following night I couldn’t sleep until 1am, though I’d not slept during the day.

I have spoken to others since, for which it both did and didn’t work, so I’m not alone. At least I’m now forewarned not to accept this form of sedation again, though that leaves me with a potential predicament should I ever need major/painful work. I certainly wouldn’t look forward to a root canal or that predicted problematic wisdom tooth removal. It’s since been suggested to me they design these drugs to trick the mind, so it’s possible I’d be someone not easily hypnotised.

Even worse, it appears Conscious Sedation is gaining popularity in all medical circles with it being used for surgeries. And though statistically, it’s a tiny percentage of people for whom it doesn’t work, it’s not foolproof. After some research, this quote stands out: “With Conscious Sedation, I think physicians recognize that quite a lot of the time their patients will actually be distressed, but they’re relying on the fact that most are not going to remember it…”

I don’t know about you, the one reading this, but I dislike patients being distressed but that being ‘okay’ because the patient won’t remember. They’re also looking into whether patients may subsequently suffer PTSD complicated by the fact they won’t know the reason for it. Patients at least need to make a truly informed decision.