Tooth Extraction and Implant: Nitrous Oxide vs. General Anesthesia

There will be more on this later YOU CAN JUST BET ON IT, but for now I will just say that I am finally having a top front tooth pulled and an implant put in, and I am conceptually horrified by this whole thing, and soon I will need to choose between having laughing gas during the procedure or being knocked out (I’m saying “knocked out” because I’m not sure what it actually is: on the estimate it says “deep sedation / general anesthesia”). Either way, it all takes place right in the oral surgeon’s chair (no hospital or anything). Either way, the procedure takes about the same amount of time. Here are the considerations, for me:

1. Anxiety. I’m not worried I’ll freak out to a can’t-do-the-procedure extent, at all. But the concepts involved are, as I said before, conceptually horrifying: it’s a front tooth, and it will presumably be removed from my mouth using some degree of force, and then a METAL THING will be SCREWED INTO THE UNDERLYING BONE, but maybe first they will need to DRILL OUT SOME BONE or else ADD SOME BONE. There would be some comfort in thinking I can just check out of the whole thing. See you when it’s over, let me know how it went.

2. After-effects/recovery. When I am put under, I usually have trouble afterward with nausea/barfing. I hate that. (And when I had my wisdom teeth removed, I threw up blood. BLOOD. Without knowing ahead of time that that would happen. It was a memorable experience.) I know there are pills/medicines for that, but still. There’s a waking-up time that I hate, and the whole thing is much more complicated. With laughing gas, they just turn it off and I’d be back to normal in a few minutes.

3. Risk. Going completely out is more dangerous.

4. Expense. Going completely out is much more expensive. This is my least concern—except I think that afterwards, when it’s all over, I might feel differently. Also, it feels babyish to pay so much more for such a relatively minor procedure: I’m not having a LIMB amputated. In earlier times, people used to just drink a pint of whiskey, maybe swab a little more of it on the gums! (The oral surgeon says that is no longer one of the options.)

 

I was basically set on the knockout until my friend Jillian heard the story and said that she personally would go with the laughing gas. “I LOVE that stuff,” she said. She says you can still feel things and hear things, and you’re basically aware of what’s going on, but you do not care one single bit. Everything is just PEACHY. Like, “Oh! I think there is some pain happening over there! Neat!” She says it takes away allllll the anxiety and stress, and that it’s a good thing it’s not available on the open market or she’d be on it constantly. Well. That sounds like what I might need.

But then I think of how nice it would be to just skip this, mentally. There are so few unpleasant experiences that include the “Wake up when it’s all over” option; perhaps I should go ahead and take this one. But then maybe I’m just postponing the unpleasantness to AFTER the procedure.

Or perhaps I should do the laughing gas to get a better story out of the whole thing, and because Jillian’s review really did make it sound pretty fun. I could do some added incentive thing, like, “If I save $X by going with laughing gas, I can spend $X on _______.”

Plus, I had two permanent teeth pulled when I was about 10 years old, to make room for the rest of my teeth. I didn’t have laughing gas OR get knocked out for that, and I don’t remember it being a huge deal. (To be fair to my current quaking self, back then I was at an age when having gaps in my mouth was familiar, and also looked normal to other people.)

I am leaning toward the laughing gas. I would like to know what you think, especially if you’ve had experience with this.

88 thoughts on “Tooth Extraction and Implant: Nitrous Oxide vs. General Anesthesia

  1. Britni

    I also get sick from being put under (and am a cheapskate). I would definitely go with the laughing gas! I think it will be better than you think and then easier recovery.

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    1. Jessemy

      I’m with Britni. I hate post-anesthesia nausea so much. Post-anesthesia anxiety and panic. Yuuuuck. Of course, it’s still a daunting decision because DRILLING while you are AWAKE. Good luck, whatever you decide will be the right decision!

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    2. beep

      Me three. I hate hate waking up from anesthesia with nausea and existential dread. And I think the recovery will be better with laughing gas.

      Reply
  2. A N

    Laughing gas does nothing for me except make me nauseous. I had my wisdom teeth pulled with just laughing gas and remember every second of it and it was very unpleasant. Not sure I could do it again for something like the procedure you are talking about.

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  3. DiaryofWhy

    I had my wisdom teeth removed twenty years ago. They were impacted and required surgical removal, and I was knocked out for it. It wasn’t even an option, just one second I was counting backwards from ten, and the next I was waking up in another room wondering how and when they had moved me to another room. (Did I walk? Did they carry me? No really, HOW?) And yeah, I was barfy after, but never once have I thought, “You know, I really wish I was awake during that whole thing.”

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    1. Swistle Post author

      No, definitely, for impacted wisdom teeth I’d be knocked out. In fact, I WAS out, when I had that very procedure. But when I had other adult permanent teeth pulled at age 10, I was not out, and I hardly remember it so it must not have been a huge deal. Whereas I have strong negative memories of the wisdom-teeth experience two years later.

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    2. Natalie

      My exact reaction when I was sedated for wisdom teeth removal. How did I get here? And then they inexplicably showed me my teeth and that was unfortunate. I didn’t barf though.

      Do they really mean general, because I thought that indicated you had to have a breathing tube and whatnot? Or just IV sedation? I have had a couple of different procedures (wisdom teeth and also a kidney thing) with IV sedation and found it very nice. I don’t think I would enjoy the gas and being aware.

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    3. Jeanne

      I had my impacted wisdom teeth extracted in my regular dentist’s office with just novacaine and gas (30+ years ago). I was fully aware of what was going on, and there was a moment of discomfort, but the just took deeper breaths until I no longer cared.

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      1. yasmara

        Yes, I would definitely equate this more to wisdom teeth removal, for which I had IV sedation.

        My son had 2 teeth extracted with laughing gas and he reacted sort of like a drunk 8yo frat boy after (a lot of giggling & swaying, a little nausea), but his extractions were pretty easy/straightforward.

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  4. Brittany

    I would go with the laughing gas for all the reasons you listed for it. It seems simpler, less risky, and an easier recovery. Plus, I like to know things so generally I prefer to be more aware. As if something would go wrong and I could just step in and help the dentist if I was awake… But seriously, the being completely out of it is a drawback for me, rather than a plus. I would choose gas unless I was a wreck about it.

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  5. Kelly

    Personally, I don’t notice a huge effect from laughing gas, but I DO have dental anxiety to an extreme extent, so possibly I can just override the effects with sheer force of panicked will.

    Additionally, I would prefer to be knocked out for any of life’s unpleasantness. Dental procedure? Knock me out. Chatty hairstylist? I’ll sleep through, thanks. Long plane flights with several close connections (YESTERDAY)? Just put me out and strap me to something with wheels, I’ll be pleased to wake up on the other end.

    Given the option of getting through unpleasantness vs skipping it entirely, I am absolutely a skipper.

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    1. heidi

      I love that you are a skipper. I too am a skipper. Only once have I regretted it (and I didn’t have a choice). That was the birth of my 2nd son by c-section. Epidural didn’t work and it was the only option left. Waking to being in a room with 2 nurses, no husband, and no baby was awful. However, the baby was fine and I got over it. But wisdom teeth – SKIP. The thought of pulling and drilling? SKIP.

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  6. Rae

    Anesthesia all the way. I use laughing gas just to get through a crown at the dentist. It’s good, but I still get anxious. For removal of a tooth and screwing a new one in I’d go under. I had a recent root canal and I got an in between choice. They gave me some major drugs that didn’t require an anesthesiologist but really knocked me out and I didn’t remember a thing. It was amazing.

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    1. yasmara

      I can’t believe this is really general anesthesia, though – it seems like it would just be IV sedation. Definitely something to clarify with the dentist/oral surgeon.

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  7. BRash

    What happens if you pick the gas but then it turns out the gas does nothing for you, like another commenter. Is the other option immediately available or does the whole thing just stop and you have to go back another day?

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  8. Ginny

    I had my wisdom teeth out as an adult, and I went with laughing gas. They were impacted, which I didn’t know when I made the decision, but I had already eaten that day so they couldn’t put me under. (They otherwise would have strongly urged it.)

    It was a longish procedure, I guess, and I could feel a lot of tugging and pulling and hear lots of machine noises, but like your friend said none of it bothered me and it didn’t hurt. I remember thinking a lot of thoughts and being like, These probably won’t make sense when I’m fully conscious, I’m going to have to try and remember them so I can see. It was an interesting experience, and I didn’t at any point wish I had gone under.

    In contrast, my brother got knocked out for his, and he had a rough recovery from the anesthesia. He got really paranoid and asked me to stick around when our mom had to go out. So I feel like I had the easier time by far… I was affected for less time and it was a mildly interesting experience.

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    1. rlbelle

      It seems like it would depend on whether you have dental anxiety and how severe it is. Like, are you bothered having to sit through multiple fillings or root canals with just Novocaine? I’ve always been more interested than anxious about what was going on in my mouth, even (especially?) when I couldn’t feel it. I had all four wisdom teeth surgically removed with only Novocaine (my choice at 16), and it was a loooong procedure but I didn’t find it particularly unpleasant. I’ve had multiple root canals, one of which took forever (I got an “I’ve never seen anything like it” about my canals, which are apparently very deep and twisty), and that long one was uncomfortable, but I was more tired and bored than anxious. So I personally would go with the laughing gas, because I don’t find the dentist’s chair unpleasant enough to warrant dealing with the possible risks and side effects of anesthesia, not to mention the cost. (I have actually, at times, looked forward to having dental work done because it was literally time that I could spend lying in a chair, absorbed in my own thoughts, far away from my children.) But my answer might be different if I found a lot about going to the dentist anxiety inducing or unpleasant.

      I will say, my husband had the same procedure you will be having and he did local anesthetic only. It was fine for him, he doesn’t have any unpleasant memories. Just make sure you take whatever pain meds are recommended/prescribed asap after the surgery. I think my husband waited until the Novocaine started to wear off, and at that point, turned into a total bear. People who don’t periodically fall victim to the Man-Cold may react differently.

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    2. Kalendi

      Yes laughing gas all the way! Love that stuff. All four wisdom teeth out at once. I was directing music with my feet and encouraging the dentist “just pull it”. When it was over I was a little “drunk” but otherwise quick recovery.

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  9. Lindsey

    I had two wisdom teeth pulled in another country with only local anesthesia. I still have a lot of vivid memories of the procedure but if it was doable with only my gums being numb I would think that you would probably be okay with just laughing gas. Dental procedures are just so unpleasant, aren’t they?

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  10. Teresa

    I have some anxiety when it comes to dental work, so much so that I had a panic attack when getting a root canal. It was severe enough that the dentist couldn’t continue because I couldn’t get a breathe until she promised to stop.

    But the root canal had to be done, so I ended up going with conscious sedation, which was in between just laughing gas and fully being knocked out. I took valium the night before and the day of and got some laughing gas once I was at the endodontist. I was conscious the whole time, but I very much didn’t care about anything. They didn’t get started until I was in that state.

    The only downside was cost and the fact that I couldn’t drive myself to and from. For that reason, I might go with just the laughing gas next time, but I think it would be easier now that I know what to expect. For an implant, where I didn’t know what to expect, I’d be tempted to go with conscious sedation again, if it were an option.

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  11. Kate Kerin

    I used to get sick (like hours/days of vomiting) with any genera anaesthetic/ sedation in the 80s/ 90s.
    However I’ve had lots in the last 10-15 years (including a dental extraction and implant last year) and no sickness at all. I always tell them that I get PONV and don’t want any opiates. Fentanyl works just as well as morphine with much less nausea.
    My dental procedure last year I don’t remember any of, and I was home 2 hours afterwards, and just a bit sleepy for the afternoon. Absolutely no big deal.

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  12. Kate

    I am a person who thought I would like the laughing gas but actually the associated sense of detachment from my person made me feel extremely panicky. But I think that sensation is perhaps specific to a certain type of person, so it may not apply to you. Similarly, I had two c-sections, one with anti-anxiety medication added to the IV and one without, and I vastly preferred without, for the same reason. I like to be in touch with whatever is happening to me physically.

    But that is not to say that general anesthesia and general anesthesia recovery is better! My preference is good local anesthesia and I will manage my own feelings of anxiety. Maybe that’s not an option? I know, though, in my own impacted and infected wisdom tooth extraction, my wonderful dentist recognized that the gas needed to be turned off/way down and then life was much better.

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    1. heidi

      That is so interesting. I had 4 c-sections. The 2nd one I went without the anti-anxiety meds and freaked the fuck out. Never again. It is so interesting how we are all so different!

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  13. Alexicographer

    Hmmm. So, I had 3 (4th was absent) wisdom teeth out and I swear it took HOURS (were they impacted? Don’t remember.) and the dentist (who was about 70 years old and had been in practice for many, many, many years; I am not exaggerating for effect) told me after the fact that he had “never seen a tooth in exactly that position,” after the fact (he had to break it to get it out). And all I had was Novacaine and honestly it was no big deal. I mean — not fun, but eh, I couldn’t feel what he was doing. My son had two cavities filled at about age 8 and we went with laughing gas and he was cheerfully oblivious, to the point of insisting he hadn’t HAD laughing gas, for heavens sake, he’d just been there, but hey, no worries, because fillings aren’t so bad, what’s the big deal? (his perspective).

    My DH has had the whole extraction/implant thing (plus a bone graft!) but not on a front tooth. My recollection is he chose twilight sedation or whatever they call it for the extraction part, and was glad he did, but he is totally a “better living through chemistry” kind of guy, making that unsurprising and perhaps uninformative.

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  14. Tina

    The only time in my life that I had nitrous oxide for a dental procedure I was 12 and having a couple (maybe 4) teeth pulled for orthodontic work. I had a very scary out-of-body event that made me feel as if I was up on the light fixture looking down at myself and wondering if I had died and was experiencing a Reader’s Digest “Back from the brink of death” story of my own- so I have chosen to never use that since!
    I would choose an IV- conscious sedation- very easy to just drift away and wake up feeling like no time has passed. No nausea for me both times (separate wisdom teeth extractions)
    Either way, good luck and I look forward to hearing about your experience since the dreaded Implant word was mentioned to me about a molar that has a very concerning area of (possible) decay at the root level. So far I’m still in denial.

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    1. Susan

      I agree with Tina. I had a similiar 12 year old experience. I think I am still freaked out, 40 years later. All that post procedure blood, I felt so yucky for a few days.

      Oh and to make matters worse, we stopped at the Hostess factory outlet on the way home. My siblings ate it all before I was better. Still mad! I vote knock me out. And save me a cupcake, jeez.
      Good luck and speedy recovery with your procedure.

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  15. M

    I would definitely pick the anesthesia. I had it for my impacted wisdom teeth and it was great to just go to sleep and wake up when it was all over. I have had laughing gas multiple times for cavities and things like that, because I’m a wimp. If you have a low tolerance for pain like me, go for the anesthesia. Also, you might want to find out if nausea is a common side effect with the type of anesthesia they use. Medications have changed a lot and you might not get the nausea with this type of sedation. To me, risk and expense would not be important factors.

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  16. APo

    There might be more than two choices available. I don’t want to complicate your life, but Valium or Versed (or similar drugs) are often given in combination with nitrous. The pre-dosage reduces anxiety, evens out your blood pressure and other secondary effects of being (appropriately) nervous, and for many people allows a more consistent pain relief, without the barfing. No reason not to ask your dentist for their preferred protocol – although they don’t often bring it up, I’m not sure why.

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  17. shin ae

    I think I’d want anesthesia. I was a little nauseated when I woke up from my oral surgery (impacted wisdom teeth), but they gave me a soda and everything was fine after I had a few sips. I love that I have no idea what happened during the surgery. So, that’s me.

    However, when is this procedure taking place? Is there another, less dramatic, procedure you can schedule first and get laughing gas to see how you feel? Is that over the top? It is, isn’t it. But, if I was undecided between the two options, the idea of a trial run would be very, very tempting.

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  18. Rene

    I used to get laughing gas for fillings as a kid in the 80’s and it was kind of like your friend described, where I just didn’t even care about the sound of the drill or hands in my mouth or whatever, I remember I’d just sort of look at the light or have my eyes closed and that if I breathed in more deeply from my nose I’d feel even more relaxed and out of it. My dentist always made sure I was feeling the effects before starting and checked in along the way, I really never felt any pain. As an adult I had a couple of fillings using novacaine and it was no fun, and I would still feel pain and need additional shots, so one time I asked if I could get the gas instead and it cost a little more and took the additional time it takes to sit there waiting for the gas to fully kick in, but it was totally worth it. Haven’t had dental work in years but in my mid-40’s I do still have a baby tooth with no adult tooth under it so someday I’ll finally lose it and need an implant, so I suppose I’ll get to have gas for that! Good luck with your tooth!

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  19. Here in NJ

    I have never had the laughing gas, so I can’t comment on that. However, I was knocked out & had all 4 wisdom teeth extracted. No nausea whatsoever afterwards (same with my son, when he had that done). Had arthroscopic knee surgery & WAS nauseous afterwards & actually did get sick one time. I have since kept Ginger Root around at all times. Had wrist surgery after a fracture & was not nauseous at all. I will need to have all of my remaining upper teeth extracted, whenever I can come up with the $$, & probably dentures (less expensive than implants). I definitely will opt for being knocked out, even tho I’m told it would cost $500. Best of luck in whatever you decide!!

    Reply
    1. yasmara

      I tell them in advance I’m prone to nausea & they give me meds immediately & send me home with an anti-nausea prescription as well. Interestingly, for my hand surgery they asked if I was prone to motion sickness (answer = yes). I guess there might be some statistical correlation to post-anesthesia nausea & motion sickness. I can’t even take pain meds beyond NSAID’s without anti-nausea meds.

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  20. BG

    There was a middle option when I got my wisdom teeth out. I don’t have a strong reaction to laughing gas, and this was called something like twilight sedation. I was too out of it to follow much about the tooth pulling, but found the whole drug intensely pleasant. Afterwards I perked up pretty quick.

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  21. Jeanette

    I’ve had this procedure and my strong recommendation is to go with the anesthesia. When I had my implant placed I didn’t have any money at all so I had to go without a general anesthetic. That is a bell that you cannot unring. I still shudder when I think about it and it was nearly a decade ago.

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  22. Barbara

    Laughing gas: is there anyone in your immediate family who has a bad reaction to it? My mother, my nieces (daughters of my sister), and myself: laughing gas is no laughing matter (I really couldn’t resist that pun. I apologize).

    My mother had the most extreme response: she hallucinated, and saw monsters leaning in to attack her. Most awful experience in her life, she says.

    For me and my nieces, laughing gas is better described as sad gas. Crying gas. Overwhelming sadness gas. I had never used laughing gas before I had a wisdom tooth extraction several years ago. While it’s true that I felt relatively little pain (some of the procedure did still hurt. A LOT) and absolutely could not have cared less about what what going on in my mouth, I could not stop weeping. At no point could I have ascribed my grief to any rational impulse. There was literally no reason for it, either rational or irrational. But I couldn’t help it and couldn’t stop it. If I ever need another dental procedure, I’ll be going under. I was crying so hard that they nearly had to stop the procedure midway, because I was clogging up my only source of oxygen.

    I think what happens in my family is relatively rare, fortunately. But maybe find out first if anyone else in your family has used laughing gas, and what their experience was like. I wouldn’t wish overwhelming sadness gas on ANYONE.

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  23. Meera

    I had gas for labour pains when I was induced, and it did sweet FA, and I finally went with an epidural. So for me, laughing gas did not block out strong pain or stress at all. I’d definitely go for full knock out. Had that recently to remove a melanoma and the recovery was pretty good (although I would not get KFC on the way home again!).

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  24. Jan

    I only had nitrousers once and it was horrible. Most closely resembled having “the spins” from overimbibing.

    Of those two options I would probably choose anesthesia, but I think there are other options. Valium or Ativan and regular lidocaine seems like a possibility? You won’t be able to see them taking the tooth or any of the rest of it.

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  25. April

    I have had both. I usually do laughing gas for crowns or fillings (because I have some pretty major anxiety about dentists). But I had a tooth extracted recently and I did conscious sedation (they said they could wake me up and talk to me throughout the procedure but I have no recollection). Because of my dental-anxiety issues it was the right way to go for me. As much as I love nitrous, I’m a little too conscious for a procedure like an extraction with it. For the record, the dentist could charge me quadruple what they do for any sedation and I would pay it without pause!

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  26. Kyla

    Definitely definitely definitely sedation. I’ve done it, the recovery is very quick. I use nitrous for all my dental work because I hate the dentist so much and it’s pleasant, especially with music, but you totally know what is happening. You feel drill vibrations and with the pulling off a tooth, that’s intense stuff. I really really recommend sedation. Really. Did I say really?

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    1. Carolyn

      Yes! I second this. I have bad teeth and have had several extractions and implants. On two occasions I did general anesthesia in which I was awake but felt no pain. The sounds are horrible and the shot to numb your hard palate is…indescribable. it’s awful. Then I needed another extraction and implant so I opted to go with sedation. Such a difference. I woke up what felt like seconds after they put me under. No nausea, not much pain (I took ibuprofen) and the bleeding wasn’t too bad. They give you instructions on how to change the gauze and rinse your mouth. The aftermath is worse if you’re already traumatized by the sound of your teeth cracking. I really really wouldn’t recommend anything other than sedation

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  27. kate

    An anecdatum: I used nitrous oxide during labour and it made me feel really out of it but in a bad way (my face went super numb and I felt out of control of my body – I couldn’t squeeze my hand into fist, for example). But not everyone has that reaction.

    Seconding the commenter above who wondered what happens if you try the laughing gas and don’t like it.

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  28. Sesame

    Hello Swistle! I’m a dentist (in Australia). Obviously I don’t know all the details of your procedure BUT extracting a front tooth is (almost always) sooooo much quicker and more straightforward than extracting multiple wisdom teeth that I wouldn’t recommend comparing the two. Occasionally, extracting a single upper wisdom tooth can be just as quick and simple, but lower wisdom teeth rarely so. And then, while I understand that the procedure of the implant placement is pretty gruesome, the experience is MUCH less so from a patient perspective…unpleasant sounds and sensations but no pain due to the local anaesthetic and minimal pain post-operatively. Again, very different to surgical or complicated extraction of wisdom teeth. I think your comparison to straightforward extraction of erupted permanent teeth at age 10 is a better experience to go on. Good luck with whatever you decide, I’m confident it will be easier than you think. :-)

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  29. Sam

    Is versed an option? I would pick that plus the gas. If you don’t know how well the gas works on you, and you know you are an anxious type person, I would definitely not go with just gas. I also wouldn’t wanted to go under general anesthesia, because of the risk and your barfing.

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  30. Melanie

    As someone who has a mouth full of dental nightmares and adverse reactions to anesthesia, I would go with the gas. I live in a fairly posh area and it is hard to find dentists and oral surgeons who don’t put you under. There is even a guy here who does sedation cleanings. Which is nuts. I had a tooth pulled last year (massive abscess) and had to fight for the gas. It is a quick procedure. The noises are the weirdest part – so bring earbuds.

    I know that I am tougher than most people. I have had dental work done with no anesthesia (blood pressure/cardiac issues), but I would never increase my risk of dying because I was worried about a few minutes of discomfort.

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  31. Carrie

    I had two of my wisdom teeth surgically removed with just stuff to numb me–no gas or anesthesia (I was nursing at the time, so that’s why I went without both, and my surgeon was wonderful about it all). I just did all those calming/breathing techniques learned thru childbirthing classes. Slow breathing–picked a corner of the room to focus my eyes and NOT focus on the pulling and rooting around in my mouth. I was ok with that.

    That said, I need to have an implant done soon, and before I’ve even talked to the oral surgeon, I’m anxious about THIS question. And my 12-yo also needs some oral surgery, so I’m already anxious on her behalf before we’ve met the surgeon. Most parents I know around here go with the gas.

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  32. Anna

    My lay understanding of general anesthesia vs sedation is that they are not the same thing. General anesthesia would require a hospital and an anesthesiologist and $$$$. Sedation is stronger than laughing gas in terms of the knock-out factor- I had IV sedation when I had my wisdom teeth out and it basically put me to sleep. It did take an hour or so to come out of but I had no unpleasant side effects. I’ve never had laughing gas but if you know it works for you, do it! And maybe stock up on the whiskey for later.

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    1. beep

      I am a doctor (though not an anesthesiologist) and I’ll chime in to agree. An office-based (as opposed to ambulatory surgery center) procedure is not going to be done under true general anesthesia, which requires an operating-room level of people and equipment. Under general anesthesia, you don’t breathe on your own so you need a ventilator. Probably the “knocked-out” option they are talking about is moderate or deep sedation. This is generally a combination of meds to decrease consciousness (and formation of memories) and control pain, but you can still breathe on your own and there’s less risk than with general. Probably for your purposes the distinction is not that meaningful, but thought I’d put it out there in case you care.

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  33. ccr in MA

    My experience with laughing gas was for fillings, nothing more serious, so I don’t know about that. But I LOVED it. This was in the 80s-90s, and I remember the dentist putting the thing over my nose, and I would start drifting, and in a few minutes he would ask how I felt and I’d say, “Mmmmmmmmm?” and he would start. And yeah, I knew there was pain somewhere, but it didn’t reach me. Then when it was done and he took the gas thing off, I was back to feeling like me right away, though with a slightly sore jaw.

    When I had my wisdom teeth out, I was very anxious about it, so having to wait while the novocaine took effect was very hard to do. The teeth popped right out, so that part was easy. (The doctor looked at my expression and said, “Oh, were we expecting more?”) Then my face felt weird all day, and later swelled up to half-a-grapefruit size … made me nostalgic for the laughing gas!

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  34. Kimberly

    If you go with general, can the doc prescribe you some sweet, sweet Zofran or other anti-nausea medicine?

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  35. Hillary

    I had trouble with general anesthesia the one time that I had it (so much barfing!) but I’ve had the twilight sleep anesthesia multiple times with no trouble. Have you asked the dentist what they would recommend? I went in to have a tooth pulled one time and they looked at the x-ray and flat out said “You do not want us to pull this tooth without anesthesia. We recommend you reschedule for a day when we can do that.” And since they said that, it was actually covered by my insurance! Although that probably varies by the plan.

    I have never had laughing gas, so I have no idea what that’s like.

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  36. Carmen

    I’m not a dentist, but I think that the kind of knock-you-outing that they do is quite different from the hospital. When I had my wisdom teeth out (all 4 horribly impacted and had to come out in pieces), I had just a Valium IV (I think dentists tend to use Versed now). It was just like sleeping, not the same as coming out of general anaesthetic at the hospital. Do you know if that what your dentist is proposing?

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  37. AnnabelleSpeaks

    I’ve had both versions of dental procedures – knocked out and laughing gas – and both do give me nausea after, but the laughing gas is WAY less. Way less. If you do that just make sure that you take extra time lying down where they switch off the gas and just give you oxygen, that helps a ton and I never throw up when I do that, just a tiny bit queasy. Tell them before hand that you’ve been sick from anesthesia and want to stay horizontal a little longer than average after and you should be okay.

    But your friend’s description of the laughing gas generally matches my experience. I just really, really don’t care about anything and ALL anxiety is gone. And I am an astonishingly anxious person, generally. For the things I’ve had (four crowns) I can of course feel the pushing and pulling and hear the grinding but I don’t care one bit, it’s great. Also my gag reflex, normally very high, is basically gone. Oh! And my dentist let me wear headphones and listen to music from my phone which greatly decreased the amount of unpleasant noises I had to listen to. I could still hear some of what was going on, since it was all in my mouth, but the music took the edge off the grossness of that.

    Reply
  38. WL

    Have had more dental crap done than any human I know. I have implants. Honestly the implants are one of the easiest dental things I’ve had done. I did Novocaine, no laughing gas or anything. I mean this completely – any questions just email me. Been there, done that.

    Reply
    1. Tia

      1000% Yes! Me too, and I totally agree. I’d go as far as saying any dentist that routinely recommends sedation for extraction/implant should be considered for malpractice. There is NO reason for it.

      Reply
      1. Swistle Post author

        I think that goes way too far. From my research, it appears standard for oral surgeons to offer it. And as you can see even from just this one comments section, your experience is not universal.

        Reply
  39. Monica Gasper

    I’ve never had any serious dental work done, so I say this without any experience or authority whatsoever: Use the laughing gas, close your eyes, and then after it’s all over spend the cost difference on something fun for yourself.

    Reply
  40. Jd

    1. Front teeth are easier than wisdom teeth. Lots easier.
    2. People mix medical terms and that makes decision making harder. It’s worth getting clairity:
    – general anesthesia where you feel nothing anywhere
    – local anesthesia with IV sedation
    – local anesthetic with NO2 for anxiety. Often given with versed or whatever.

    I’d go with versed and gas. Or just gas. Easier recovery. The combo will insure you are relaxed. You will feel nothing and less risk.

    Reply
  41. J

    The closest thing I’ve had to this was getting my wisdom teeth pulled. Both my bottom ones were REALLY. FREAKING. STUCK. Like, had a cramp in my jaw for more than a week after because the surgeon put their whole body weight on my jaw for 20 mins STUCK. I only had some injected local anesthesia. And it hurt. But I lived. I had Major anxiety beforehand, just like you, but to be honest, I think the anxiety the whole week before was worse than the pain the whole week after (and did I mention it got infected?). So yeah… I’d go with the gas and stop worrying. You’re a strong grown ass woman who’s had 5 babies and you can handle 1 little tooth being pulled!

    Reply
  42. Mary

    I’ve never been offered laughing gas, but I would take it in a heartbeat. I had a molar pulled as an adult and it sucked big time. They gave me nothing for anxiety at all, just numbed the area. It didn’t hurt at all but the noises and yanking were scary enough that I cried…. But I’m pretty such laughing gas or even a pre procedure benzo would have been adequate.

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  43. Megan

    I had to get crowns on my front teeth and even just numbing the front tooth area was INTENSELY painful. And I swear I’m not a wimp, but if I ever have to have anything done to my fronts again I’m begging to be put under.

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  44. E

    I would ask for more info about the anesthesia. Propofol is a glorious, glorious thing. Versed makes me hysterically emotional, but propofol just gives me the best sleep of my life. Speaking as someone who has had 3 of the type of procedures (colonoscopies) that COULD be done awake-with-no-real-feeling-and-semi-awareness OR could be “wake me up when it’s over”… OH MY GOODNESS wake me up when it’s over! I have anxiety too and would not be able to relax even if I could feel nothing.

    Long story short: ask if they use propofol.

    Reply
    1. Jenny

      Very very late to the party here but I think I had a similar reaction to Versed the day after I had my tooth pulled. “Hysterically emo” is strikingly accurate to my experience. And it turned out that I needn’t have taken it anyway because my tooth was so far gone that it basically fell out. : /

      For me, getting an implant was a long, expensive, annoying-but-not-excruciating process but I was extremely lucky to have family financial support. I will say it’s been worry-free ever since.

      Reply
  45. Casey

    I had the exact same procedure done, except with two front teeth and two implants. This was almost 20 years ago, when implants weren’t as common. I had Valium and laughing gas for the procedure and it was GREAT. Like I actually have FOND memories of it. #valiumforever

    Reply
  46. Rachel

    When I had my wisdom teeth removed, they gave me the option between nitrous oxide and sedation. I chose nitrous and then the day before had a panic attack and called to ask if they could do sedation instead. They said it was too late to switch. The nitrous turned out okay. I could feel what they were doing, but I didn’t *care* — like it wasn’t really my mouth. I was drowsy enough to doze off a bit when they weren’t drilling. But it took a long time (all 4 teeth, some very impacted) and I seem to remember even with nitrous feeling like I really wanted it to be over. I would choose nitrous again but only if they were confident that it wouldn’t drag on for so long.

    It is possible to feel panicky even with nitrous, if you’re so nervous you can’t relax enough to let it do its job. (I had this happen once during another, scarier, procedure.) If that seems likely maybe ask about doubling up with something like Valium beforehand, or opt sedation.

    Reply
  47. Jen

    I do not do well with anesthesia so the laughing gas would be my choice. I had a gum graft done with laughing gas and it was fine. I don’t even really remember the procedure (I was 27 at the time, am 36 now). I do distinctly remember the recovery so for me the laughing gas was highly effective.

    Reply
  48. Mary

    I have nitrous when they clean my teeth, because my mouth is very sensitive and I get very anxious about it. It helps, but I wouldn’t count on it for an extraction. Ask the person who does the anesthetic about the ickiness after. For the first twenty years of my life, anesthetic was horrible, I was sick for days after. Then I didn’t have any for about 20 years. When I had some minor surgery that required it, I asked if there was anything they could do, and there was! And it’s wonderful! And I just wake up and don’t feel sick anymore! My husband has had the same experience. So I would go with general, FWIW.

    Reply
  49. Kara

    I don’t deal well with dental work in general, so whenever I can be knocked out, I choose that option. I paid extra for my daughter to get her teeth pulled when she needed room in her mouth for braces to work, because I thought it would be easier for her to recover from, if she didn’t remember it. I did not go under for a root canal, and wound up freaking out mid procedure and it was bad (trays were kicked, hyperventilating occurred). Never again. All of my root canals from here forward will be done while I’m out.

    Reply
  50. P-Mum

    I have had experience with both, from fillings to extractions and implant. Nitrous is fine for the small stuff, you’d be aware but just not care. It does not hide the pain, novocaine is a good idea along with the nitrous. But being under all the way is definitely my method of choice for extractions, etc. They can give you something for the nausea, take it. You’re asleep, then awake before you realize anything has happened. I wouldn’t put it in the category of luxury, but if cost is not the deciding factor, why remember it?

    Reply
  51. Katie

    I would definitely go with general anesthesia. I have dental anxiety too, and use the laughing gas for everything, even a checkup and cleanings! You will hear and feel everything they are doing if you only use it.

    Reply
  52. Ariana

    I have had an implant put in on the second to last tooth on the upper left. As someone mentioned above I did it with only novacaine and I didn’t feel a thing. Getting fillings/a root canal has been more uncomfortable. For me the cost difference was the tipping point. Good luck :)

    Reply
  53. jill

    I had fentanyl for a colonoscopy and it was the best thing. I don’t come out of anesthesia well, can’t do the twilight thing, so I had fentanyl, which is short acting. I woke right up without any problems. Your response to anesthesia and trouble waking up is a conversation worth having. Also, if you tell them you get sick from anesthesia, they pre-treat you and most people do fine.

    I’ve never had laughing gas, so I don’t have anything to compare to.

    I have had a couple of back teeth pulled due to fractures, with only shots for numbing. It was okay. But there wasn’t any bone grafting or anything.

    Thinking of you as you make this decision.

    Reply
  54. Joanne

    I was knocked out a LONG time ago when I had my wisdom teeth pulled and I really really hated the after effects of it. In more recent history, my son has to get knocked out for dental work, he has autism and is kind of – well, I mean he has to be knocked out. But it is SO TERRIBLE for him to come out of it. Right after he had his last knockout, my three year old had to get cavities filled and they wanted to knock her out, but I talked the dentist into just doing laughing gas so that it went okay and it was just fine. It was, like you say, less expensive, such a better wakeup procedure, and it worked! She didn’t mind having that work done at all! I wish you lots of luck!

    Reply
  55. Megan

    I’m just here to say that front tooth stuff is way different from other tooth stuff. For me at least. I’ve had many fillings and other crowns and those are easy peasy with just novicane and laughing gas. I’ll say laughing gas doesn’t do much for me. Makes me feel like I had one glass of wine. I am alert! I see everything! I feel pain! But when I had them file down my fronts to put on crowns – that is the only rreason why I have dental anxiety now. Not pleasant. Right under your nose.

    Reply
  56. Maggie2

    I had laughing gas postpartum for a tear repair and I can attest that it was basically useless. No calming, no not-caring, no nothing. So I agree that you might want to determine if it actually works for you before depending on it for pain relief in a procedure involving bone and drilling. (I would take the strongest longest drug they can give you and hear all the gory details afterwards. But I have sensitive teeth and all things dental are nightmarish.)

    Reply
  57. Jana

    I had molar removed a few months ago and had a bone graft at the same time. The metal implant post will come next month after six months of healing. I am a super anxious dental patient (eight root canals [one with very little painkiller due to being 7 months pregnant] will do that to you) and I opted for the sedation. I’ve used laughing gas for fillings, but I’m so glad I opted for the sedation for this procedure. I, too, woke up sick as a dog after my wisdom teeth extraction (with sedation) twenty years ago, but I didn’t have any nausea this time, probably because there wasn’t as much blood and just general yuck (how’s that for a medical term?) draining into my stomach during the procedure. I am generally a cheapskate, but the sedation was money well spent.

    Reply
  58. Jane in Pa

    I have ALOT of dental anxiety so when I first read this, my immediate thought was KNOCK OUT! Having read most of the comments, I am now convinced I would do laughing gas with perhaps an anti-anxiety med for the night before or morning of. And someone mentioned ear buds–yeeess! Music to offset some of the unpleasant sounds.

    In terms of the knock out, I think there are some pretty good anti nausea drugs. I had a surgery in December and that was under general…no puking or nausea at all. I actually felt really good when I woke up. BUT, I think with dental procedures, where you are going to swallow blood, the nausea thing is more of a problem. Dental work + Post Nausea sounds horrible to me.

    So I vote laughing gas with an anti anxiety prior (if you get nervous about dental work).
    Hope things go well :)

    Reply
  59. Alice

    I know you have way too much advice here already, but just one more personal anecdote for you: I’ve done laughing gas several times for various tooth extraction scenarios.

    1. if it’s just an extraction (your as-a-10-yr-old pull out some teeth example) I agree that laughing gas is fine and totally will work!

    2. if you need anything metal screwed into your bone good lord get knocked out. I had my impacted wisdom teeth done while I was awake and this sounds like a similar level of trauma: being awake to know that they are drilling into your bone or something like that? NO NO NO you will not want to be awake. They gave me laughing gas for that, but guess what, once you start sobbing because the experience is super terrible, your nose gets stuffy and blocks additional laughing gas from getting to your brain.

    In summary I would get knocked out :P

    Reply
    1. Tia

      Having had a bone graft and an implant rod, they are not even in the same league as an impacted wisdom tooth (which I’ve also had). The implant is so much easier.

      Reply
  60. Erin

    So I did not read all of the comments but will add this in… I had an extraction done earlier this year (implant a few months later but still waiting on the crown piece) and they did not offer to put me completely out but DID offer the “happy pill” which they explained was like Xanax. It completely relaxed me to the point that I was falling asleep in the chair during the procedure (I did have a gum graft done at the same time). The only thing that I had to do was have someone drive me to the appointment and drive me home. It was no added cost and if that is an option I would highly recommend. They still did the usual numbing cream and shots but I was much less worried throughout the whole procedure.

    Reply

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