Going to medical doc for dental problems

Hi there
I am going to be writing a short article/letter for the British Medical Journal to raise awareness in medical doctors about dental phobia. I believe that many family doctors are probably prescribing antibiotics to people with dental phobias without realising they have a phobia. I would be interested to see what the experiences of people on the forum are. I'd also welcome any comments for advice to give doctors as to how to help (I will certainly be recommending that they point anyone they suspect of having a dental phoia to this website!!)
Thanks in advance!
Dr Mike

Hi Mike,

I talked to my medical doc about my dental phobia at my routine physical in November, the reason it came up was she asked if I was under stress due to some of my blood work results, hemocystine levels up, Vit B levels down, white count up from abscess, etc... I was under extreme stress related to my teeth, not sleeping and crying everyday. She asked what was going on and it all poured out...

Anyway, I know this isn't what you are looking for, maybe my point here is medical doctors don't always look for dental causes for what is happening with the rest of the body. It turns out she is dental phobic too, she understood, so we had a nice discussion. I got a referral from her for the dentist she goes to. The jury is still out on whether or not I am going to stay with him.

Rhonda

This probably does not answer your question Mike, but my honest opinion is probably the opposite of most folks on here: I'd rather go see my dentist (who I can't say enough good things about ) anyday than a medical doctor. I hope to one day get to the place of feeling secure and comfortable with an MD but it has not happened yet.

I think if you (person on here ) are lucky enough to have a positive relationship with your MD, then that certainly could be a great avenue for discussing dental issues. Perhaps, if doctors took more (in some cases had more) time per patient, a stronger bond could develop to where patients might more honestly, openly, talk about other areas of their life (including the dentist) that they'd like some help with or merely a friendly, non-judgemental listening ear.

In any case, IMO, all comes down to trust, and feeling a sense of not only power during any type of doctor visit but that the doctor truly has your best interest (overall health) at heart. And, big "and," views you as not merely "another patient" or "x type of problem" but a real person who he/she is fortunate enough to be trusted to treat.

Not quite the simple answer, I know but maybe a grain of worthwhile thought anyway.

Mona

This is an issue which I feel very strongly about. I firmly agree with Mona in that for me, medical doctors are just as scary as dentists and in many ways more so now that I have taken steps to conquer my dental phobia. This is because I have built a trusting relationship with my dentist whereas when I do muster the courage to see a GP, it is a different person every time who has only minutes to spare and therefore we are unable to get to know each other and therefore overcome the trust issue which is probably the single biggest barrier facing any dental/medical phobic.

Anyway, one of the few times I have actually visited a doctor in the past few years was to do with my dental phobia – when things got so bad that my entire life was affected and I was in desperate need of help I was persuaded to speak to a doctor. Having plucked up so much courage, I was severely let down by a doctor who said she had “never heard of such a thing” and that she didn’t believe dental phobia could have this effect. When I told her about upcoming treatment and how it was making me feel – couldn’t stop crying, couldn’t work, feeling almost suicidal she said there was an easy solution – just don’t have the treatment! Well that didn’t help at all! She did send me off with some diazepam (because that was what I “seemed to want” even though she didn’t think I needed them). After a while and with the situation not getting any better, my husband persuaded me to try again. This time the doctor I saw couldn’t have been more different – non-judgemental, interested in the problem (and me as a person), kind and allowed me time to gather my thoughts and explain (through tears) what the problem was. He also straight away hit on the fact that the phobia was probably affecting me being sat in a doctor’s office. After talking things through, he really took on board that I was trying to overcome the phobia and had already overcome huge challenges to get to the point I was at. At his suggestion I was referred for CBT and that is one of the most useful things I have ever done. Unfortunately he was only working at the practice for a short time and since then I have been back in the usual fear-inducing parade of different doctors.

Anyway, coming back (eventually) to the question. The most important thing a GP can learn about dealing with dental-phobics is to respect the condition even if they don’t understand it. Do not be dismissive or laugh at the patient and understand just how debilitating this can be. Determine whether it is solely a dental phobia or is likely to affect the patient’s future GP appointments and if so, try to accommodate that patient as much as possible. Be aware of techniques and sources of help (CBT, hypnosis, counselling, anti-anxiety medication, this website etc). Perhaps offer a follow-up appointment to monitor the patient’s progress (my only complaint was that I felt the 2nd doctor, although very nice, send me off for CBT assuming that would be the end of it and after those sessions were over, although I did have much better control over my anxiety, I did feel a bit cut-off from further support). I suppose the advice is the same as it would be for new dentists or those wishing to improve their patient relations – just be nice, listen to what the patient is saying, allow them to trust you and treat them as an individual.

In terms of recognising dental phobia, I suppose the question is whether the patient presents with pain or anxiety. Obviously it may not be as simple as that and if pain, they may have come up with lots of excuses as to why they are seeing a GP and not a dentist (cannot get an appointment, cannot find a dentist, cannot afford, will do next week but need something until then…) . Although these may be true, the GP should be sensitive to body language and may have to ask the outright question – “Are you afraid to see a dentist?” and not just accept these reasons at face value. It should be remembered that in seeing a GP, the patient is actively seeking help and is doing so from the source that they feel most able to trust at that point.

In the days when I was really phobic, I visited my GP on several occasions to get antibiotics for an abscess. For some reason I've always felt comfortable with medical doctors - perhaps spending seven years working in a hospital had some bearing on that. None of my GPs were ever in the least judgmental about the fact that I was consulting them rather than a dentist, in fact none of them even asked me whether I had a phobia.

I wouldn't do this nowadays unless I really had no other choice. If I have a dental problem now I'm straight on to the dentist like a rat up a drainpipe, regardless of whether it's anything that needs attending to urgently or not

John

I'm petrified on dentists and not keen on medical doctors either. I think if embarrassment comes into play due to the condition of teeth, there is no way I would go to medical doctor or dental doctor. (speaking from personal experience) I have gone through sleepless nights thanks to pain from teeth, gums etc and wouldnt dare ask anyone for medication for the problem as it basically embarrasses me so much and I am sure there are many people in the same situation.

I think many people with a dental phobia believe that medical doctors and many dentists see them as inferior due to their problem, this all comes from the attitudes of some of these doctors, maybe this is where things could be changed a bit. It takes a bit of courage to admit to another person that you have a fear of something that is pretty darn normal for most people, perhaps if doctors were more approachable, patients could build up some trust with them and these sort of issues could be dealt with. Surely doctors should have a list of dental offices that deal with nervous patients in their area?However, it's a awesome idea to help medical practioners see the problem of dental phobia...it's a real issue that should be highlighted to as many people as possible. Also i am of the opinion that trainee dental doctors should be made more aware of the problems and issues of dental phobia. The popularity of this forum highlights the extent of the problem.
It's comforting to see someone who is acknowledges the existance of this fear and it actively trying to help!

excellent feedback guys- thanks to everyone so far to respond- these are exactly the type of experiences that I was hoping to hear about. i will incorporate many of these points when i put something together to increase awareness of dental phobia in medical doctors.
keep the comments coming!!
regards
dr mike

Gettingthere, I'm sorry you also feel likewise about medical doctors. I was very lucky to have never had a bad dentist experience with the exception of once during college (I meant as a whole). So I was never a dental phobe. As a lot of you know what got me coming to these boards was needing a root canal a year ago due to my own negligence at having a once tiny cavity filled. Why did I wait if I was not, am not, a dental phobe? I have always been terrified of needles and until coming on here never knew of the numbing gel. (FYI to anyone interested there is both a Spray and Topical cream for medical shots--something I sure wished I had been aware of as a kid). The comfortable (enough) relationship/history I had with my longtime dentist, apparently did not result in my feeling as secure of her as I thought. But I certainly take full responsibility for never broaching the subject and lol this story has already been told. I am now beyond lucky to have a (new) dentist, who as I've said many times before, I think the world of.

Medical Doctors, I'd rather not go into detail, just suffice it to say experiences as a child both at the doctor and in general (abuse history) led to my not always feeling too powerful or in control. The doctor's office is a very easy place to feel trapped! Again all about trust and knowing the provider cares about you as a person and patient.

I look forward to seeing the finished article, Dr. Mike.

Mona

thanks for the replies and 'voting' on the poll- please keep the responses coming!

I've only ever been once, when I had a small hard lump in my jaw. The dr asked me if I had a toothache and I explained that I had a broken tooth on that side but hadn't been to a dentist due to fear. The doctor didn't actually do anything though, no offer of antibiotics or referral to community dental or valium, just sent me away.

Real helpful!

Mike, I already answered the poll but I have a whole new perspective for you. I am currently consulting in a busy Emergency Room (200 patients/day) and we are seeing anywhere from 1-5 people per day, mostly in their young 20's and 30's with the chief complaint of toothache. There is a dentist on call, but typically patients leave with a prescription for antibiotics, pain pills and a referral. The free clinic in the community has dental services but it's backed up 6 months and does not see emergencies. I know that the nurses I am working with have no clue that these patients may be phobic, I'm sure it never enters the docs' mind so I am doing what I can toward awareness. As you reach out to the medical community, don't forget the ER docs.

rp

Mike, your poll didn't address this, but once I faked a sinus infection to get antibiotics because I had an abcessed tooth.

I don't do this any more because I'm facing my phobias and going to the dentist, but at one point, I'd have done almost anything to stay away from the dentist.

I think that finding a Dr. who really understands dental phobia is like finding a dentist who understands it.

Many years ago I went to my Dr. hoping to be given something to take just to get me to the dentist because a broken tooth and my phobia was taking over and even effecting my work. He said he understood because he didn't like them either and gave me the address for a dental teaching hospital who apparently dealt with phobics. The professor I saw sort of understood but didn't have alot of bedside manner and the actual dentist that manged to do my filling (after 6 months) didn't have a clue ...... I never went back!!

Medical stuff is just as big a problem for me as the dentist. I couldn't get out of it when my first baby was born - hideous experience - managed to have the other two with just a midwife. It meant being prepared to trade pain relief for privacy. I was dragged into the deep end when my sister needed a kidney - I did it but I still feel mugged by the experience. (I woke from surgery to find that the epidural was numbing the wrong side. Was only offered Panadol.)

My dentist-fear is a reaction to not being numb before work was done, the dentist not stopping when it hurt and being rude/condescending when I said it was hurting. Based on repeat experience I have good reason to worry about going to the dentist. Thinking about it now, I reckon my poor dental experiences have added to my distrust of the doctor.

I guess I just got unlucky but the caring professions have left me feeling uncared for and prepared to put up with a lot to avoid them. I'm sure there are others like me and maybe worth their knowing that if we do turn up asking for help - we're desperate yet easily dismissed. It could be an opportunity to make a difference in someone's life.

I have no problems with any other medical people, just the dentist.

I'm extreemly lucky that I've only had one abcess, as that is the only time I've needed something stronger than OTC pain releif to cope with toothache.

I did go to the doctors that time and told him that I thought I had a tooth abcess. He wanted to look before he would prescribe any antibiotics, it was then that he found out that I was phobic, as I really struggled to show him the inside on my mouth. One glance was all he needed to see I needed help.

He pescribed two antibiotocs for the abscess and told me he was willing to pescribe me something to calm be down, to enable me to get to a dentist if I wanted him to.

A few years ago my gp wouldnt give me antibiotics for an abcessed tooth and told me to see a dentist.........not much help when you are phobic!! I have also faked an illness to get antibiotics to treat a dental infection, even tho I knew it wouldnt be the correct antibiotic, but at the time..... something was better than nothing.
In my opinion, Gp's should be aware of dental phobics and be able to give advice, and refer us for specialist help.

When i need to have dental treatment now, my gp will subscribe diazepam to calm me down before any dental appointments.

For many years I was needle phobic so a doctor as well as dentist dodger.

To make it worse, I had a heart condition (VSD) which meant I needed antibiotics by needle just even for a dental exam. The VSD involved a certain amount of enforced encounters with the GP and cardiologists and their bedside manner, wherever I went, left a lot to be desired so I would never have had confidence to then brooch the subject of phobia on top of it all.

Once I was over the needle phobia, then there was the embarrassment. I used to live in dread of going to the doctor and having to open my mouth for anything - the shame of what s/he'd have seen... which led to me avoiding doctors even after I no longer was bothered by needles.

So various factors come, go and interplay.

Now the doctor and the dentist don't worry me greatly. I think if a GP seems approachable you'd probably be more likely to screw up the courage to approach the subject of phobia.

I hate going to my Dr but will go because of my children (for my children) My eldest is now at an age where she is confident to speak to the Dr herself with me there of course and I encourage my son(8) to speak up too.I have had upteen sore throats etc which probably could have done with seeing a Dr but I have managed to self treat.My worst nightmare(other than seeing a dentist) was to see a Dr.I would come out in a cold sweat just worrying about becoming ill and having to go to A&E, or my kids getting really sick and having to take them.A big factor here for me is the shame and acute embarrassment.I felt that they wouldn't understand and judge me negatively.I have struggled with what I feel is depression for years not being able to face seeing a Dr.I have put off having a smear test and other tests because of this but I will get my self sorted out I promise, I need a medical overhaul I think .

I realise that my previous answer – although I hope it to be helpful – was more about going to a doctor due to the problem of dental phobia rather than choosing to see a doctor rather than a dentist for a dental problem due to the phobia. As I noted previously, I am just as scared of doctors as I am of dentists (in fact more so these days as my fear of dentists has abated, the other remains constant) and a few years ago when suffering the most horrendous toothache, I was faced with this very dilemma; couldn’t bring myself to make a dental appointment (I had started seeing a dentist at this point but was still in the initial very anxious stage) but also couldn’t face going to my GP. I eventually went to my local chemist to speak to the pharmacist about getting some serious pain relief and yes, I made up excuse after excuse about how I really wanted to see my dentist but just couldn’t get an appointment until next week, yes even in an emergency, in fact it was my dentist who suggested going to the chemist in the meantime… The pharmacist was unsurprisingly sceptical and although she was friendly, I just don’t think it crossed her mind that my lying through (very painful) teeth might be down to phobia/anxiety issues. Instead she kept trying to press on me contact numbers for emergency NHS dentists who would sort me out right there and then. Eventually she gave me some great, strong pain relief with advice on combinations of medication that I could take as a stop-gap only until I managed to get to a dentist. Which I did. Eventually.

Looking back, I think that in some ways I wanted her to realise what the problem was and couldn’t really believe that she seemed oblivious to the fact that her talking about the emergency dentists was really stressing me almost to the point of tears. So I guess this really just backs up my earlier point that medical docs need to be aware of body language etc and not just the black & white of what the patient is actually saying.

Also, and I wish I could find a link to this, I remember reading an article a number of years ago. I remember it clearly because just reading it really upset me at the time. In response to one of these fairly regular articles about the lack of people registered with an (NHS) dentist in Britain, a group of GPs were invited to give their opinions on the increasing “problem” of patients coming to them with dental issues. All were quite nasty about it, seeing it as “not their job” to deal with oral matters and saying that they wouldn’t even look at patients who presented with dental complaints as they viewed them as time-wasters. One even said something along the lines of (I remember the sentiment clearly but not the actual words) that she couldn’t think of anything worse than looking at disgusting teeth & smelly mouths. Now I am quite willing to concede that this was sensationalist journalism and may not represent the true views of our GPs but I do think that changing attitudes is foremost to training docs on dental/phobia issues. Unfortunately, as I believe far too many of us on this forum can attest to, there are still a lot of dentists who also seem to have this kind of attitude

I've been to ER's with raging abcesses more than once. The infections sometimes got so bad I was literally flattened by the pain.

Eventually, I'd have to go to the dentist & the tooth would either be extracted or root canaled.