I have Lupus (autoimmune rheumatic disease). Which anesthesia can be used safely during a dental surgery?

I have been to the dentist (a very good surgery specialist) only once since I was diagnosed with Lupus. It was the pure horror, the anesthesia they used stopped working in the middle of the surgery and I started screaming from pain. They did not wanted to believe me, only eventually, after 30 minutes of crying and begging did they let me go!


I was not to the dentist since then (for several years). But my teeth are not really good, not to mention this surgery which was stopped before they could finish. I have frequently tooth ache and pains, but what can I do? I fear this will happen again, and if they use 100% anesthesia I may die in the process? It seems I get one of the typical Lupus reactions due to the medicaments used.





But if I do nothing my health will become worse rapidly. I have sometimes fever at night and all my teeth ache. I am getting weaker and weaker, please help! Even my doctor does not know what to do and my dentist never heard about Lupus!

I have Lupus (autoimmune rheumatic disease). Which anesthesia can be used safely during a dental surgery?
Are you talking about general anesthesia or local? Are you there for oral surgery or for fillings? General anesthesia would only be indicated for oral surgery such as bony impacted third molars (wisdom teeth). The anesthetic of choice in this instance would be Propofol.





There are numerous choices for local such as novacaine, lidocane, etc..





None of these medications is a problem with a Lupus patient. In fact, I highly doubt that your first reaction to the anesthesia that you had was related to Lupus at all. It seems that maybe you just had an allergic reaction to the drug. In this case, you'll have to be very careful about going under general anesthesia as most of the drugs are under the same classification and if you are allergic to one there is a possibility that you're allergic to others. This is why anesthesiologists ask if you've ever had an adverse reaction to anesthesia before.





So to answer your question, patients with Systemic Lupus have no more difficulty with anesthesia than the general population. There complications from your Lupus such as high blood pressure, Antiphospholipid Syndrome, higher risk for infection, etc. that can create problems for any dental work but Lupus alone doesn't have anything to do with your reaction to the anesthesia.





If you have any more questions please feel free to ask.
Reply:You can try nitrous oxide on top of an injectalbe painkiller to help with the pain. Or you can see if they can just put you to sleep for the surgery
Reply:I believe you. What you need to do is find another dental surgeon. The one you have is, I'm sorry to say, an idiot. For a Dr. not to believe a patient is having pain is unconscionable. There are many fine dental surgeons out there, you will have to look and may have to travel some distance to get there.


Before allowing the new dental surgeon to work on you, meet with him/her and discuss your Lupus with them. Also tell them what occurred during the previous surgery. If this Dr. does not know what Lupus is, or asks something that sounds dumb to you, find someone else. The new surgeon should be VERY sympathetic to you, and your previous history. Leave NOTHING out when talking to them. Tell them your fears. I have an absolutely wonderful dental surgeon.


And I allow nothing less from a Dentist or a Doctor.


The next thing I will address with you is not to scare you, but to inform. If you allow dental issues to go on too long, you could develop cardiac problems, and/or a systemic infection called septicemia. Both these can be life threatening. And with the information of the fevers and progressing weakness, you are in trouble now. As to your regular Dr., ask him for a referral to a specialist in Lupus. That specialist should be able to help you find a dental surgeon. The added bonus is that a specialist can help you manage the Lupus better than a GP can.


I hope this helps.
Reply:Because of your lupus, I'd recommend that you have your dental surgery done in a hospital under the anesthetic care of an anesthesiologist.





In my hospital we do that, usually for kids, but it can be done for others with special needs.





Any general anesthetic has the risk of worsening your lupus, but we will give stress doses of corticosteroids, and will definitely keep you asleep and comfortable for he duration of the procedure.





You will need to get this approved by your insurance company ahead of time, and might need a letter from your rheumatologist stating that your lupus requires that you be monitored more closely than a dentist's office will allow. You might find that with better dental care, your lupus will be easier to manage.





And DEFINITELY find another dental surgeon. Yours sounds like an idiot.





Good luck.