Too many extractions at once?



My doctor recommends that I have 10 teeth extracted, including four wisdom teeth. I am very nervous about having this kind of surgery. I know I have bad teeth—that is why I avoided going to the dentist for too long. But having 10 teeth removed at once sounds like it would be very traumatic and painful, with a difficult recovery. Some background information: I am 25 years old and in good health, except for my teeth. Is it dangerous to have this many teeth extracted at once?


Rita from Lexington

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Should an oral surgeon do this extraction?


I’m embarrassed to admit that my anxiety and fear about dentists has kept me from getting proper dental care and maintenance, but now my situation is serious. A few years ago, I had a filling come out and the tooth later broke. After the pain became unbearable, I finally went to the dentist and had a root canal treatment. That dentist did not follow up with me and, with the pain gone, I was in no hurry to go back for treatment, so I just never returned to have the cap but on. The temporary filling has now fallen out and half the tooth is pretty much gone and is also infected. I am seeing a new dentist, one who was recommended by a friend, and he has advised that the tooth needs to be extracted. He has warned that this would be a very invasive procedure, cutting gum and bone, and that I could have it done by an oral surgeon under general anesthesia or by him with just a local. Because of the cost, I would prefer *not* to use an oral surgeon, but am worried that this is really not the way to go. Is this a procedure that would usually require an oral surgeon or is a regular dentist qualified to handle the job safely?

– Abby in Lowell

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Categories : Sedation dentistry

Novocain not enough


I have problems with the numbing medications commonly used by most dentists. It’s not a physical allergy, but, for some reason, the drugs do not work for me the way they do for most people. I have, after several horrible experiences, come to the conclusion that the only way I can tolerate dental procedures is if I am completely unconscious. Have you ever heard of a case like mine? I have to add that this is not a case of simple discomfort or inability to handle pain. I have had several surgical procedures and other medical interventions over the years, but nothing affects my like when I need to undergo a dental procedure. Please let me know what you suggest.


Jeremy in Boston

Dear Jeremy,

Many patients, particularly those with a history of painful or traumatic dental experiences, have trouble getting numb from the normal administration of Novocain. It’s a real biochemical phenomenon, in which the patient’s anxiety affects their body chemistry to the extent that the nervous system does not respond to the effects of the numbing medication and they are unable to become numb.

For many of these patients, administration of nitrous oxide prior to administration of the numbing medications is enough to alleviate the extreme anxiety that is interfering with their physical response to the Novocain. However, some patients need stronger sedation.

Rather than undergoing general anesthesia, however, I recommend seeking out a qualified sedation dentist. These dentists practice a technique known as conscious sedation, also known as “sleep dentistry,” which is a procedure that is less expensive, safer, and more convenient than general anesthesia. Most patients who undergo conscious sedation have no memory of their dental visit. I would investigate this route, first, before pursuing general anesthesia.

You can learn more about conscious sedation on our main website here.