I haven’t put a blog post here for a long time, but it seems like a good location for a permanent record of a recent experience. I hope it’s useful for anyone facing having a common but often feared surgery that’s usually the province of much younger people. The short version is that – at least for me – it’s been nowhere near as bad as many of the horror stories you sometimes hear.
background – a painful New Year
I’d known the time for this might come for my entire adult life, but I’d tried my level best to avoid it – by a) staying away from dentists for nearly twenty years, and b) being extremely careful with my oral hygiene to reduce the risk of having to go near said dentists. And I got away with it, looking back, until mid-2013, when a friend noted my breath was “terrible” and that I should see the dentist. I ignored that advice, and therefore let a low-level infection slowly multiply away in my lower left gum for months.
Sod’s Law of course ensured that the infection chose the silly season to manifest itself as a painful abscess. Riding from Omeo to Dinner Plain and back on the 29th of December with a sore mouth was a bit of a grind; driving 200 kilometres across a (beautiful) mountain pass with a very sore mouth was worse, and another 300 kilometres home the next day was getting pretty bloody tiresome.
Finding a dentist open on New Year’s Eve took a couple of phone calls, and the diagnosis was pretty much as expected. An x-ray showed a tooth abscess, for which the immediate treatment was antibiotics, OTC painkillers (straight Nurofen worked amazingly well; I avoid codeine because constipation is not a good thing for somebody with a bit of leftover damage from now long-dormant Crohn’s disease), and the quietest New Year’s Eve I’ve had in many years. The upshot was, however, a referral to an oral surgeon, whom I was assured by the dentist I had just met was “good”. Twenty years of avoidance had – almost -ended.
A full dental x-ray made the problems obvious – a right lower molar sitting horizontally, and the left lower molar that had caused the problem on an almost as silly angle and creating a big gap to collect food in. The upper teeth looked less problematic; the upper left looked fine to me and the upper right hadn’t emerged but was pointing straight down; it didn’t look to be impinging on much. Clearly one, maybe two had to go, but I was hoping that might be the extent of it.
A Noirish initial consultation
A rickety, slow old lift. Narrow, twisty corridors with well-trodden wooden floors. If the chubby-cheeked teenagers and their parents filling the waiting room were replaced by femmes fatales, you’d have something from a 1940s hardboiled detective novel rather than your typically swish neutral-colour doctor’s consultation rooms. The anachronistic impression was not helped by the sounds from what appeared to be a dental surgery room. First, the distinct sound of a motorised cutting tool of some kind – enough on its own to unnerve a jumpy potential patient bereft of parental moral support. Then, astonishingly, the unmistakeable sounds of a man groaning in discomfort. It stopped quickly enough, but it certainly left an impression.
And to the appointment, the surgeon, after glancing at the provided info, immediately launched into a thirty-minute discussion of my research work, followed by a two-minute discussion of my teeth. Aside from exhibiting the typical surgeon’s cockiness (hint: no matter how bright you are, without a little bit more time understanding what I do you’re not going to offer a particularly insightful critique of my work), he clearly thought that despite serious levels of impaction, my teeth were pretty unremarkable targets for his extraction skills, with the key teeth still away from the important nerves. I was keen to minimize the amount of fuss required, hoping that just the one that had caused the problem could be extracted with a local anaesthetic. But, no. In his view, all four should go, under a GA at a hospital. He offered to do them within a week – which was considerate but impractical for me. My scary upcoming work schedule made me very keen to postpone the operation at least until teaching had finished. He confirmed that there shouldn’t be any major additional risk of long-term damage from the delay, but that there was a chance that they might cause another abscess before then which would then require urgent removal.
I chose to take that risk, and so June 12, 2014 entered the calendar as T-Day.
Everybody’s horror stories
The next five months were a stressful time; the upcoming operation was one source of stress, but not the only or even the largest one. However, under real pressure at work, the prospect of extended convalesence, even after teaching had finished for the semester, was becoming increasingly scary. And it seems everybody had a horror story to contribute. Not only anonymous people on the internet, but good friends, had a rich and colourful set of anecdotes.
Weeks of discomfort keeping enthusiastic cyclists off the bike. A week of being unable to eat anything but soup and ice cream, endless painful mouth rinsing. A “world of pain” after the operation. Extended periods off work. Days of grogginess after the general anaesthetic. Painkillers that wore off too quickly. My cousin, who swelled up so badly so that she could only get food and drink through a straw – a particular worry for me, as I’ve got a perpetually blocked nose and breathe through my mouth far more than I should.
Particularly pertinently, and equally worrying, my sister mentioned another issue – a couple of unpleasant experiences with general anaesthetics. Before the op, I’d never had a GA, just a bunch of colonoscopy sedations, so this was a real concern. She told me that she’d been “groggy for a couple of days” after her wisdom teeth extraction; worse, she’d been “sick as a dog for two days” after another more recent operation.
I wasn’t completely irrational. I wasn’t concerned about dying on the operating table or anything like that; the odds of a very fit adult with no active underlying health problems dying in a routine tooth extraction is negligible. But days of serious discomfort, or, worse, a protracted convalesence intersecting with tight work deadlines and no cover – yes, that bothered me a great deal.
In the weeks leading up to the operation, my girlfriend’s support was invaluable. I must have been a real pain at times, with the combination of work and this making me a right nervous wreck. But if she was exasperated, she never showed it, and her calm support ensured I got a lot more sleep than I otherwise might have. I’ll always be grateful for that. Unfortunately, though, she had an overseas work trip at the same time as the actual operation. My support person for the day was going to be my mother.
The fun didn’t stop in the leadup to T-Day, waiting on paperwork to ensure a crucial work project could go ahead, and to top it off, my car decided to break down. On the Tuesday and Wednesday, I’d had it. I played the guilt card shamelessly, on a number of occasions, to get people to pull their finger out before my operation. It was slightly underhanded, but it worked – and I’d wholeheartedly recommend it as a tactic…By Wednesday night I had a particularly nice dinner in the knowledge that just about everything I could get out of the way before the teeth, had been gotten out of the way.
One benefit of booking so early was that I was first cab off the rank on the 12th; Mum and I arrived at the small private hospital in pitch black before 7am, and I went in quite quickly.
After filling in the forms, popping on a hospital gown, and reading a bit of The Rosie Project, the anaesthetist came in for a chat about my “very detailed” description of my personal and family history with his profession. In any case, he suggested given my sister’s bad experiences, and my own repeated unremarkable encounters with propofol sedation for Crohn’s related colonoscopies, that the same combination of drugs used for a colonscopy sedation – medazolam, fentanyl, and propofol – could be used for my dental anaesthesia. It would be “a bit more fiddly” for him, but reduced the risk of nausea and would be no major problem to do. I am obsessive enough to have had a look at the medical literature on anaesthetic nausea. The articles I read suggested a substantially lessened risk of post-operative nausea from propofol compared to flourane gas-based anaesthetics, so if an anaesthetist who has presumably read much more of that literature and actually has the background knowledge to interpret it properly was happy with this, I was very happy.
He also had a brief discussion with me on post-operative pain relief. Given my lack of experience with codeine, and the likely level of discomfort if it didn’t work (as it doesn’t in a minority of people who don’t metabolize it into morphine in their liver) after the extraction, he suggested the use of Endone (aka oxycodone or “hillbilly heroin”) as the strong painkiller to take home. That was fine with me, though I was hoping not to need too much of a headspinning painkiller like that. I asked whether I needed to preemptively take the Endone after the surgery, and if so when. He replied that there was no great need. Intead, I could take painkillers when the local anaesthetic injected into my mouth wore off and it just started to hurt, relying first on paracetamol and ibuprofen, and take the Endone to “top up” the pain relief only.
Then there was a succession of nurses with some well-practiced but nevertheless welcome patter who got me into a hairnet and – a novelty for me – a temperature-controlled heated bag around me, and through several identity checks. The recovery nurse introduced herself as “Nikki”, but from what I’d read I was doubtful I was going to remember seeing her again.
I met the anaesthetist again, who inserted a cannula. At this point, thinking he was about to administer a preop, I mentioned that I hadn’t yet signed the consent form. The thought of waiting an hour in a daze, unable to have the surgery because I hadn’t consented and now couldn’t, didn’t exactly appeal. He quickly replied that he was keeping track of that, and wasn’t going to give me any juice until I’d seen the surgeon and finished off the necessary paperwork.
The surgeon showed up, asked me what I was having done, and after hearing “four wisdom teeth out”, replied “thanks, I just needed to hear you confirm it.” The consent form was signed and I was wheeled into theatre.
The anaesthetist grabbed a rather large syringe full of clear fluid, told me “here’s the medazolam and fentanyl”, connected it to the cannula, and pushed it gradually into my arm. I remember finishing a sentence that I was actually surprised to be reasonably calm before having it, and that as expected I felt even more relaxed as the sedative and painkiller took effect. However, that was it. Unlike previous colonoscopies where I was woozy but had intact memories until the propofol was administered, I don’t remember anything after that sentence was completed. I was later told I made it from 100 down to 98 when the propofol infusion commenced.
Back in the day bed
As is apparently routine, I have no memory of the recovery room at all, and my next memory was of the day surgery ward. I felt pretty good, really. No nausea at all, and my head felt reasonably clear – clearer and less sedated than when my memory typically kicks back in after a colonoscopy. Maybe the fentanyl and medazolam had had longer to wear off than for that shorter procedure – I believe it was about an hour gone from my memory banks; the bill from the anaesthetist says the actual procedure took a total of 26 minutes. No residual sore throat from the breathing tube, either.
As expected, I had a wad of gauze in my mouth, but this wasn’t uncomfortable as I’d feared. I’d been given a stretchy bandage and some icepacks, which after a bit of fiddling had fitted around my face and which comfortably held a pair of cloth-wrapped ice packs in place. My entire mouth was numb from local anaesthetic, and so there was no discomfort. And, to my surprise after a warning from my girlfriend, chatting to the nurse and then my mother, wasn’t difficult, and became even easier when the nurse removed the gauze. I was a bit hungry, and ate the supplied jelly and ice cream; I couldn’t taste a thing, but the texture of the icecream was pleasant on my numbed tongue.
Mum supplied my mobile phone, and the nurse was perfectly happy to leave me to amuse myself with it for a little while. A post-operative selfie posted to Facebook, a few smart-arse comments on said selfie. Then, importantly, a very relieved and happy text chat with my girlfriend via Skype.
The anaesthetist and surgeon came in, to check on me. I was ready to go home. The taxi driver gave me a few funny looks with the ice packs and bandage, but I was going to wear it as directed in the hope of keeping swelling under control.
An amazingly productive afternoon
And so, home. I’d thought that T-Day would be a total writeoff of confusion and lethargy, but here I was, with only ice packs resting against my jaw and a very numb mouth to remind me I’d just been in surgery. So what do you do with a completely unexpected afternoon with your Mum?
In my case, I:
- Waited nervously for the local anaesthetic in my mouth to wear off
- Sent a pile of work-related emails and hopefully managed to not offend anyone.
- Sorted out which clothes, towels and sheets should be retained and which should go to charity.
- Waited nervously for the local anaesthetic in my mouth to wear off.
- Sent some more emails.
- Marked a few student assignments (with the proviso that they were to be reviewed for “drug-fuelled insanity” by another marker later).
- Waited for the local anaesthetic in my mouth to wear off, particularly in one area which still felt very numb. Had the surgeon bruised a nerve?
- Cooked dinner for Mum – the post-operative instructions specifically recommended against this, but I was feeling fine and asked her to supervise carefully and stop me if I looked like I was about to do anything stupid.
- Finally noticed the local anaesthetic starting to wear off, and took some nurofen and paracetamol.
- Ate some soup and, amazingly enough, a small amount of teriyaki chicken with rice!
- Went upstairs to do some more marking.
- Noticed that despite the OTC painkillers, my mouth was getting distinctly sore.
Hillbilly heroin, a user guide
The pain in my mouth at this point was by no means unbearable, nor was it nearly as bad as the abscess. But it was real, and would have made it very difficult to sleep later that night. I wanted to avoid taking Endone and its associated risks of constipation (among other things) as much as I could. But the discomfort was a more immediate problem.
So I split a tablet in half on the basis that that might be enough, and swallowed.
Now, maybe it was purely psychological, but around 30 seconds later I felt unsteady on my feet for an instant. Just for an instant. After that, I didn’t notice anything except a reduction in the amount of pain. It wasn’t absent, but it was reduced.
After about an hour and a half of TV watching with this reduced but not absent level of pain, I decided to take the other half, in the end giving roughly the same dosage as recommended by the doctor. Again, soon after I had a moment of unsteadiness, but was then back on an even keel, and I felt little pain and otherwise fine. The only annoying side effect was the inability to urinate properly, which I later found out is a very common side-effect of Endone.
So, it seems like there’s not much point splitting tablets…are you even supposed to? It turns out that, indeed, you aren’t. While Endone tablets aren’t coated, you apparently aren’t supposed to split them. Maybe the split encouraged sudden absorption of more drug than normal, and thus the headspin. I don’t know.
After a night watching another entertaining stage of the Criterium du Dauphine, it was time for bed. I’d waited long enough to be able to take another Endone tablet; whole, this time. I left the full set of OTC and prescription painkillers next to the bed, but didn’t need to take any more in the night. I slept well; as is typical for me, I woke up briefly around 4 in the morning, but without any pain and got back to sleep soon after.
Day T+1 and feeling good.
The next morning, I awoke to some minor discomfort in my mouth, which was quickly eased by some more Panadol and Nurofen. There was no need for the Endone. Mum and I ended up having a really useful, productive day. I ate reasonably normal, if soft food, ran errands in the car, and was really pleased to be able to take her shopping for a birthday present. I was great; all I had to do was keep on washing my mouth out with salt water and the supplied disinfectant, and taking some more OTC painkillers every so often.
I saw Mum off on the train that evening, enormously grateful for her help but very surprised how little of it I’d actually needed.
I considered taking another Endone that night but found that Panadol and Nurofen were again enough for a pain-free, good night’s sleep.
Day T+2 – a quiet day
After two big days I wasn’t sore so much as tired, so I had a quiet day in today. My major project for the day was, in fact, this story.
The feared bruising and swelling has come to a load of not much – one side of my face looks slightly bloated, but it’s hardly the chipmunk look I was expecting.
I was feeling sufficiently good, and curious, to try backing off the OTC painkillers entirely this afternoon. Perhaps I’m a little perverse, and my mouth is a bit sore now. But I managed to eat a solid (if soft) dinner without any pain relief at all. I wouldn’t recommend it, but it was perfectly doable for me.
Concluding thoughts – for now
As I write this, the dull ache in my jaw is enough to remind me that the healing process isn’t over. But, by all reports, after two and a half days I’m through the worst of it. I can eat. I can, with the aid of non mind-bending painkillers, get at least regular chores, and many work tasks done. I can drive. I can look after myself. I’m fully expecting to be physically present at work by Tuesday, T-Day+5. And, something I’m particularly excited about, I’m going to be able to thank my girlfriend for all her emotional support with a kiss – albeit a rather careful one – when I pick her up from the airport tomorrow morning.
There’s some plain dumb luck involved here, sure, but also a great deal of skill involved in that outcome. I’m very grateful for the skills of the surgeon, anaesthetist, and their support staff, and have already taken the time to send them a thank you note.
I can only speak of my own experience, of course. And the specifics of my teeth and other aspects of my medical history might be similar to your situation, but then again they may not.
But, at least for me, having four wisdom teeth, some fully impacted and some partly impacted, pulled at a comparatively advanced age has been an unexpectedly benign process.
Postscript: T+3 and T+4 – more nothing
I took a couple of OTC painkillers during the day yesterday, but could have easily gotten away without them. I ate virtually normally; the only unusual thing I did was cut up a hot dog so I wouldn’t have to open my mouth too wide.
And, most important of all, I kissed my wonderful girlfriend.