When I was in my late 20s, the time came to have my wisdom teeth removed.
I knew this only because an upper molar had developed a deep, black hole in the side of it. I had no pain associated with the tooth, and it took a surprisingly long time to realize that the enormous cavity was even there; I'd grown so used to cleaning food out of the area by scooping my finger between the back molar and my cheek that I thought nothing of feeling something odd in that tight space. Not until my tongue noted the hole's sharp edges did I even begin to be alarmed.
Thanks to an excellent dental program through my job in Chicago, who carried Blue Cross Blue Shield at the time (late '90s), I found a dental surgeon in Evanston who not only agreed to remove my wisdom teeth for a more-than-acceptable amount, but he also scheduled a timely appointment for the procedure. I think he had me back in to his office within a few days after my initial off-the-street appointment. (And, oh, I can only wish that I had such excellent insurance coverage now!)
But here's the thing. This is where the dentist did what I consider to be the smartest thing that has ever been done for me in a dental facility.
He did not suggest that I undergo general anesthesia.
Instead, the dentist gave me a local anesthetic to numb the area, then proceeded to extract the teeth. Yes, that's right--I remained fully awake the entire time. I didn't feel pain, per se--more like a strong pressure as he cracked and wrestled two of my wisdom teeth out of my mouth. I gripped the armrests and had my eyes squeezed shut, but in all honesty, the noises made during this procedure were actually worse than the pressures in my mouth. Afterwards, I left the office, picked up my antibiotics at a nearby pharmacy, went back to my apartment and spent the next several days obediently taking my pills and keeping the gauze clean around the two gaping holes in my gum line.
About a week or two later, I went in and he removed the other two wisdom teeth in the same fashion. The second procedure went easier than the first, partly because I knew what to expect that time and partly because the dentist removed healthy teeth (the damaged tooth had broken under pressure).
When I read stories on the news of people dying from being under anesthesia in a dentist's office, it makes me wonder why anyone would want to choose that option... it also makes me wonder if they are even given a choice, or if the procedure is simply laid out as-is and without variance.
For the dental staff, I can imagine it's much easier to knock a patient out rather than listen to them complain, moan, cry or perhaps even scream as the dentist is working on them; worse yet, the staff run the risk of having a physically-violent patient, or one who who refuses to stay in place during the procedure. For the patients, I can also imagine that they would be eager to grab for that escape hatch, to let their consciousness drift away rather than deal with any possible pain, discomfort or unpleasant experiences.
But is it really worth the risk? For either party?
Doctor Henry Rosenberg of Thomas Jefferson University published an article on "Mortality Associated with Anesthesia" which is an insightful look into the history, uses and complications that can arise from anesthesia. Give it a read. Then look up some statistics. Know what you or a loved one might be faced with before you're put in a position of having to decide on whether or not you're obligated to use general anesthesia for a given medical procedure.
If you've never been put under general anesthesia before, you don't know what it will do to you. Are you allergic? Do you have other medical issues that could complicate things? If something goes wrong, are you in or near a facility that can begin resuscitation procedures right away?
(However, note that even picking the right location is no guarantee of personal safety. Last year, while in a hospital office building in West Hollywood, California, I passed out during a clinical trial. It took a full thirty minutes for an ambulance to come and transport me on what was otherwise a minute-and-a-half walk to the hospital's emergency room. Luckily, I was only out for less than a minute and never stopped breathing, though because of the delay, I was tempted to just walk myself over to the E.R. for treatment. Oh, yea, and aside from the long wait, the charge for the ambulance ride was $1,500--just to transport me around the block. Afterwards, I also went through months of wrongful billing from the hospital as well as the L.A. Fire Department for the ambulance ride, even though I had the clinical trials doctor right there with me to explain that all the billing had to go to her office.)
I suppose that it can be argued that my dentist screwed me out of money by having me come back twice for the same surgery, and then again for a follow-up--that's a total of four visits, counting the initial examination. And, of course, even local anesthetics are not without risks... but I'm alive. I experienced a difficult medical procedure and only had to deal with the same after-care issues (a slight fever, jaw pain, etc.) that anyone experiences after having their wisdom teeth extracted.
Maybe the process wasn't "clean" or "pleasant" or "quick." Maybe it put a cramp in my schedule, having to schedule repeat visits. But we cannot always escape things we don't like or that we're afraid to face... and in some cases, trying to do so could be deadly.