Unexpected Gratitude. . .

[iDent]

I am new to this forum. I first discovered dentalfearcentral.org in autumn 2011, but since I was not yet having obvious problems, I was not ready to visit a dentist at the time. However, having recently cured an early-stage cavity with baking soda and peroxide, I knew my days of avoiding dentistry were very likely numbered.

The reasons for my dental phobia are multiple. I have had anxiety disorders since kindergarten, and as an adult was also diagnosed with ADD and "sensory integration issues." In addition, I was prone to frequent dental decay. My first dentist, "Dr. No," was not especially patient with children or sensitive to their needs. Although he never actually said, "You have bad teeth and it's your fault, therefore you deserve to suffer," this was certainly evident in his subtext. I was not physically aggressive with Dr. No but often cried, usually due to ineffective local anesthesia. Once when he ordered me to stop crying, I replied, "I can't help it," meaning both that I could not help crying and that I could not help having bad teeth. His response? "Yes, you can." When I was eight, Dr. No dismissed me from his practice.

My next dentist, Dr. Maybe, had an improved chairside manner compared to Dr. No, but his anesthesia technique was no better. Unlike Dr. No, he used nitrous oxide. My first experience with N2O at age nine resulted in a classic "bad trip." Shortly after the mask was applied, the dental assistants turned upside down and the room quickly spun around 2-3 times. I thought I was losing my mind, but stayed silent because my mother had warned me that if I did not "behave" with Dr. Maybe, I would have to start seeing a pedodontist, and the closest one was located over 50 miles away. Although I never had a bad N2O trip again, it never helped me relax, either.

Every time I saw Dr. Maybe for a "routine" checkup, he found at least one new cavity. This, of course, meant drilling, which in turn meant inadequate pain control and sometimes a fear of drill mutilation and/or suffocation. Whenever I had a dental appointment, I started worrying at least two days in advance. The night before, I dreaded tomorrow and often had trouble sleeping. On the way to the appointment, I would look at people in other cars and envy everyone who was going anywhere else. Headed toward Dr. Maybe's office at age 11 or 12, I made a promise to myself: "When I grow up, I'm never going to a dentist unless I absolutely must!"

After leaving my parents' home, I did not see a dentist for several years. A portion of an upper first molar broke in my early 20s, but within days, the sharp edges wore down and I learned to live with the damage. When I was 27, the same tooth broke again and abscessed. Because it was a weekend and I had neither dentist, dental insurance (I live in the U.S.), nor courage, I treated myself only with OTC painkillers and a topical oral analgesic. After the infection cleared, I grew a pair of. . .ovaries and made an appointment with Dr. New, a nearby dentist who advertised herself as specializing in phobic patients. Dr. New extracted what remained of the broken molar and identified 4-5 other teeth that needed drilling. Over the course of the next few weeks, I let her.

Dr. New was friendly and said I was generally well-behaved for a phobic patient. Noting that I was prone to cavities but had minimal plaque accumulation even after years away from dentistry, she suggested that I had acidic saliva (take that, Dr. No!). However, like Drs. No and Maybe before her, pain control was an issue. At one point she suspected I might have variant anatomy. I liked Dr. New, but not well enough to begin going for regular checkups. Two years later she moved her office from downtown to a suburb that was inconvenient for me (I don't drive), and eventually she moved out of state.

Over the next 16 years, I occasionally considered visiting a dentist for preventive care. . .and always decided against it. In my life, I never had a preventive visit that didn't lead to drilling, pain, and fear/anxiety. I practiced what I considered aggressive oral hygiene. In 2003 I eliminated most sugar from my diet in order to maintain moderate weight loss, but knew this also helped me stay out of dental offices.

Autumn 2011: Once again, it's time for benefits enrollment at work. For a married couple, the dental premiums are high with a questionable cost/benefit ratio, over $500 per year with a maximum per-person annual benefit of $1,500. Due to my recent self-cured cavity, I know I will probably need dental work in the coming year, and if I do, $1,500 is unlikely to cover it, especially considering that the dental plan has a reputation of not being generous when anything more than a routine checkup or amalgam filling is needed. I search the internet for alternatives and learn about Brighter.com, a new dental-discount plan that received media coverage from some reputable sources. As a phobic, I certainly wouldn't let just any dentist touch me, but based on their websites, a few Brighter dentists in my area seem like people I could trust. I am particularly impressed by the biography of one Dr. Yes, whose office is located reasonably close to where I work. Brighter's enrollment fee is low and membership can be activated at any time, so I decide to forego my employer's dental plan and enroll in Brighter should the need arise.

May 2012: Eating lunch at my desk, I lose a large filling from a first molar which has been broken for several years. There's no alternative now: I must visit a dentist. Later that day, I purchase a Brighter membership. The next afternoon, I call and make an appointment with Dr. Yes, warning his office assistant that I am phobic.

Unlike some phobics, sitting in the chair and having x-rays does not particularly bother me (nor do needles, as I am a regular blood donor). What worries me are the images and where they will lead.

"Welcome back to dentistry!" Dr. Yes's introduction is not what I expected, nor is it unwelcome. In general, he is
professional and friendly without being condescending, and I am grateful for his sense of humour. Some of the news from the x-rays is bad, but Dr. Yes communicates results in a manner that is direct, succinct, and casual. In brief, I need three crowns and one filling, and have gum recession in one area from aggressive brushing that requires the services of a periodontist.

After a brief discussion, I agree to two crowns, one on the broken tooth and on a tooth at risk for serious infection. With Dr. Yes's approval, the third crown and the filling can wait for now. As for periodontal treatment, this may need to be delayed several months, both for financial reasons and because I will need to gradually adjust to the idea of having a portion of my soft palate grafted onto my gumline while I am fully conscious.

To be continued. . .

[Steve In Cleveland]

Contgatulations iDent! Having recently returned to dentistry myself, I can imagine the relief you must feel having finally made the first step.

For me the greatest change is this: before I finally saw a dentist, I used to dread each little (or big) thing that happened in my mouth, and almost every bite seemed like the one that might lead to the inevitable. Now I feel like I've got someone to go to and it's not terrifying. If I lose a filling or chip a tooth now I don't feel the need to avoid it or self-treat.

Great job on getting yourself cared for while your teeth are still fairly healthy. And thanks for sharing your story. Welcome back to dentistry!

[chickenjen]

Hi, ident and !
I love how you've named your dentists, Dr. No, Maybe, and Dr Yes !!
I've had a whole lot of Dr maybes and no's, but only one Dr Yes, that's my current dentist.
I really don't understand this $1,500 a year for dental work. If you have dental problems at all, that $1,500 gets eaten up real quick!!
Like Steve said, "Welcome Back to dentistry". Glad you found your "Dr. Yes"!!!!
Lots of !!!!
I look forward to reading more of your story!!
Many's,
Jen

[iDent]

Prepping for the Crown Prep: Remembering Blue Skies

I first saw Dr. Yes days before a holiday long weekend, so when his office manager asked when I wanted to return for a crown prep, I had a convenient excuse to delay it a week: "After Memorial Day, please!"

Leaving Dr. Yes's office in the Architecturally Significant Medical & Dental Shrine (a very beautiful old professional building; for an "architecture snob" like me, every little bit helps!), I was relieved that my first appointment was over and that the BIG appointment was a week away. I knew I was less likely to enjoy the upcoming holiday weekend with major dental work looming, but I also knew there was absolutely no way I would be ready to have it performed by Friday, especially since I wasn't in pain. The early-morning appointment I'd scheduled was an absolute necessity for managing some of my fear, and my daily mild antianxiety medication, taken at the optional maximum dosage, would also help. However, these two things would not be enough. I needed to psych myself up, but how?

I work in an office at a major medical center. My medical knowledge, while nowhere near the level of a healthcare professional, is often above average when compared to the general public. Having had three surgeries as an adult, I anticipated each procedure with scientific interest and relative calm, knowing that things usually go as planned. Ironically, I am well aware that what makes medical surgery something of an adventure for me rather than a source of anxiety is what makes it most dangerous: general anesthesia. . .exactly what is missing in dentistry.

Thinking of my crown prep, I knew my pre-surgery skills wouldn't work. I made feeble jokes with coworkers about my first midlife milestone, saying that I'd probably rather have the colonoscopy that's still a few years away!

Considering what was on my horizon, my husband and I made plans for a quiet Memorial Day weekend. On Saturday, cool, rainy weather encouraged us to stay home, catch up on sleep, spend time with our companion animals, and listen to music. At this point, I wasn't questioning my music choices. On Sunday I had more energy, both positive and "nervous," which I converted into housework and yardwork. The music I was playing was beginning to make sense. On Memorial Day, I knew very well what I was doing, but it wasn't working. With my appointment now less than two days away, I told my husband, "I'm beginning to freak out. . .I know I have to do this, but I don't think I can." I regretted not calling Dr. Happier, my psychopharmacologist, for a one-time dosage of a more potent antianxiety medication to be taken the morning of my crown prep. I'd wanted to be "strong." Fool, and not a Shakespearean one, either.

Intellectually, my husband knows very well that I'm a dental phobic; it's a fairly frequent source of gallows humour between us. However, in the years since our first date, he'd never actually had to deal with me visiting a dentist until my first appointment with Dr. Yes. . .it had been that long since I'd seen one. Watching me, I think he really understood the extent of my phobia for the first time and was powerless to help. Desperate, I tried to explain the music.

Although I lack both the talent and the income to seriously train, I have had some aviation adventures in my lifetime. I have been skydiving more than once, and have also flown ultralight open-cockpit aircraft several times. The music I had been playing during the weekend was not necessarily all about flying, but it was all music I associate with flying. I was preparing for my crown prep as if it was something a bit frightening yet absolutely sublime that I actually wanted to do. How many people love flying through the blue without barriers but are terrified to visit a dentist? We probably number in the hundreds.

On Wednesday morning, I boarded a transit bus to my "doomsday appointment." In my messenger bag was the book I was rereading, written by an experienced skydiving instructor and pilot with training in psychology and Buddhism.

To be continued. . .

[iDent]

Since Part II was only my second post, I couldn't include the links I wanted. Here they are:

http://www.transcendingfear.com/book.html#transfear
http://www.transcendingfear.com/quotes-brian.html

Thanks for reading and commenting!

[carol999]

Thankyou for sharing your story with us ident, the forum is a great source of support for me and I hope it will be for you too! look forward to hearing the rest

[iDent]

How to Have a Crown Prep without Being a (Drama) Queen

My father received his first crowns when I was in fifth grade. Why did he have to give his dental-phobic child a fairly detailed description of the process? I still remember it.

Riding a transit bus to Dr. Yes's office, I pretend I am on my way to work. Which works. . .until we pass my regular stop.

Dr. Yes's office is located downtown, about three miles farther away. Blocks from the appropriate stop, I give myself permission to stay on the bus and continue riding, knowing this may be the only way I will force myself to get off. Once off, I give myself permission to walk in a direction that does not lead to the Architecturally Significant Medical & Dental Shrine. . .to enter a different building. . .to take the elevator to another floor. Too soon, I am in Dr. Yes's reception area. His office manager, Hope, is on the phone when I come in but encourages me to take a seat. Before I have time to open Transcending Fear, Dr. Yes's calm, friendly assistant, Serena, is leading me back to The Chair.

I wish I could unscrew my head, leave it there for service, and pick it up in an hour or two.

For a dental office, Dr. Yes's is actually fairly pleasant. The reception area is attractively furnished without being pretentious, the sound system plays classical music, and the procedure rooms feature his children's artwork (one of his daughters appears to be fairly talented for her age). Aside from the obvious, the only thing I don't like is the color of the walls, which I consider too bright.

Dr. Yes enters the room and asks how I am doing. Though I am certain my pulse, blood pressure, and adrenaline levels are higher than normal, I answer, "Better than I expected," which is true. After all, I didn't have a serious anxiety attack or have to cancel the appointment due to psychophysiological illness (which happened twice when I was a child). He and his staff are aware that I work in a hospital, know a fair amount of medical terminology, and have access to professional journals online, so I explain in more detail.

"My prefrontal cortex (the part of the brain that controls higher-order thinking) and limbic system (the emotional or "reptilian" brain) have been arguing for days," I say. "If this is painful, I know it isn't deliberate and can't be done any other way. Also, I ran a PubMed search on dental phobia yesterday, so I also know anxiety reduces the efficacy of local anesthesia."

In The Chair, I have always advocated a "mouth open, eyes closed" approach, and am grateful when Dr. Yes encourages the same. He knows I have a long history of ineffective local anesthesia and offers an extra amount, which I decline unless needed. Before starting, he advises that we will take frequent breaks (probably as much for his benefit as mine), and encourages me to use a stop signal if needed.

Showtime. Considering the nature of this forum, I'll spare everyone the details, except this one:

For the first time in my life, restorative dentistry was somewhat unpleasant but NOT painful. Not at all.

Dr. Yes uses the Wand (which I saw in his procedure room during my first visit), and has apparently mastered the art of iatrosedation. I am still phobic, but leaving his office, I know I have had an experience that may eventually be as life-changing as skydiving or flying, both of which opened doors that I was not aware were even closed, much less locked. This is quieter, yet also profound.

Instead of an adrenaline rush, two words describe everything: unexpected gratitude.

To be continued. . .

[iDent]

Dental Core Buildup (without) Human Core Meltdown

During the two weeks between my appointment for Crown Prep #1 and Coronation #1-Crown Prep #2/Core Buildup, my unexpected gratitude lingers, a surprising stretch of good weather. I am always grateful to leave a dentist's office, of course, but grateful to have been there and wanting to send my own white flag, perhaps a single Peace rose? Very strange indeed. . .but not unwelcome.

Despite my change in attitude, I know I am not "cured." The real test will come before my next procedure. For the first time in my life, I do not have pre-appointment anxiety the night before, but when I awaken on Appointment Day, it is back, although only at 75% power.

The closer I come to the Architecturally Significant Medical and Dental Shrine, the more I realize I have a new problem I absolutely cannot ignore: very simply, I need to go to the loo!

After a brief reign on The Throne I report to Dr. Yes's office, where I am seated almost immediately in The Chair. Some fear is justified. Previously, Dr. Yes forewarned me that Crown Prep #2 will be more difficult than #1. Access will be harder, and even though I am not in pain, he will not know until he drills if the tooth is seriously infected and needs a root canal. If it does (due to tooth structure and location), he will need to refer me to an endodontist. Having made peace with Dr. Yes and his staff, I am wary not only of the dreaded RTC, but of having to deal with another dental team.

First, coronation of Crown Prep #1: removal of my temporary and insertion of my permanent porcelain crown would be entirely uneventful were it not for the fact that this tooth still has a living, apparently very healthy nerve which is temporarily exposed. The overall sensations are more unusual and unpleasant than overtly painful, but if I never feel them again, it's perfectly all right with me!

Once again, Dr. Yes demonstrates skill with the Wand. With Crown Prep #2, I am actually worried less about drilling than about potentially needing RTC. At one break in the drilling process, he asks me if I remember when the tooth's side fillings were placed: difficult to remove, they must have been challenging to restore the first time. I honestly don't remember if this was 16 years ago (the most recent possibility), 32 years ago after orthodontia, or even more remote. Regardless, I'm sure I've repressed the whole experience!

Finally, Dr. Yes is finished. "That was close," he says. If I understand him correctly, sometimes damaged dentin partially regrows, preventing deeper decay. This appears to have happened with me. However, caution is necessary, since post-procedure infection could still develop. If I experience significant pain within the next few hours or days, I need to notify his office ASAP. . .and prepare to deal with an endodontist.

One week post-procedure, I am still pain-free at the site of Crown Prep #2. . .and grateful.

To be continued. . .

[iDent]

Core Buildup 1.1: View from a Plateau

My goals, I think, are simple: avoid anxiety the night before, and maybe, just maybe be calm enough to eat breakfast the next morning before my dental appointment, something I have yet to accomplish.

Once again, I sleep fairly well but awaken 75% anxious. Most of my body apparently knows something my conscious brain has chosen to ignore.

Arriving at Dr. Yes's office without breakfast, I learn that what I thought would be a relatively easy appointment will be quite the opposite. Under the impression that today would be mostly about impressions for Crown #2, there is still much drilling to be done.

I am disappointed, but not with Dr. Yes and his staff. . .with myself. It's possible they explained the need for more drilling last time, and that I missed it: people with my ADD subtype are practically notorious for receiving incomplete verbal instructions. However, my long-term memory is usually above average, and I am almost positive I would have remembered mention of additional drilling! Logically, it all makes sense in retrospect. Last time they drilled out decay; there was no point in finishing a complete crown prep and core buildup if I was potentially going to need RTC performed by an endodontist and new dental team. Since that risk is past, more drilling is now on the agenda.

There's only one thing to do, and that's deal with it. Despite the unpleasant surprise, I am still grateful that I don't need a root canal, and once again thankful for Dr. Yes's technique with local anesthesia. For the third time I experience some general discomfort, mostly related to second-molar-access oral positioning, but do not feel overt pain in The Chair. Like before, Dr. Yes encourages the use of a stop signal (which I appreciate but fortunately do not need), and takes frequent breaks. Breaks are my opportunity to breathe normally; even though I learned diaphragmatic breathing years ago as an adolescent theatre geek and have practiced it consistently ever since, my respiration during drilling remains sporadic at best.

Waiting for an impression to set, Dr. Yes does something that weeks ago would have sent my anxiety levels over into the red zone: he begins testing his drills, which, as I will soon learn, he is not quite finished using on me! I decide to consider this a sort of exposure-and-desensitisation opportunity, and am somewhat successful.

Finis. Last time, even after the local anesthetic wore off, I experienced no pain at all. Dr. Yes warns me that this time, due to difficult access, pain is nearly guaranteed, and within hours, his prediction is fulfilled. I've never been hit in the jaw, but suspect this is what the aftereffects would feel like!

Unaccomplished goals: Reducing my morning anxiety to less than 75%. Eating breakfast. Breathing more normally in The Chair.

As much as I want to ascend another step on a marble staircase toward my long-term goal of overcoming odontophobia, I need to accept that sometimes hanging from a rope ladder is the best I can do. Swinging out, I land solidly on a plateau that is barren of all plants and wildlife, but will offer a view that is panoramic and stunning once no longer obscured by fog.

To be continued. . .

[iDent]

A Message from Mission Control & My Current Mission

Does technology rule us, or do we rule technology? Hoping to keep it the latter, I usually check my personal e-mail twice a day and often turn my mobile phone off while at work, except on rare occasions when I give someone the number for business-related purposes. Therefore, when I check my mobile voicemail the evening after Core Buildup 1.1, I am surprised to have a message from Dr. Yes. Apparently he's received a "Houston, we have a problem" report from the dental lab, and needs to discuss it directly with me. Though I don't lose any sleep, I decide to call his office as soon as it opens the next morning.

At one minute after opening, I make the call (how many other people on this forum are currently such frequent fliers that they have their dental offices programmed into their mobile phones?) and am immediately connected to Dr. Yes. As he explains, my situation is unusual but not unique: apparently based on my impressions and their computer simulation, the lab says I need more clearance space between teeth to ensure adequate strength in a porcelain crown. Either the tooth awaiting crowning needs to be reduced even more, or the corresponding tooth below (previously filled but currently stable) needs height reduction. Not wanting to alter a relatively healthy tooth, I ask Dr. Yes what he would do if he was the patient, and am actually relieved when he recommends Session 1.2. Nonetheless, I can't believe I'm signing up for a third drilling episode on the same tooth. In the course of conversation Dr. Yes refers to the drill as the "handpiece," and I wonder if he's read the "Tips for Dentists" section on DFC! Do all dentists now use this term, just as surgeons call nearly every operation a "procedure?" Even after years of working with MDs and often using the term myself, the euphemistic nature of "procedure" still makes me laugh! Maybe someday "handpiece" will, too.

My next scheduled appointment is two weeks away. The only earlier options are today and tomorrow, but after serious consideration, I realize I cannot do it. Both are midday timeslots, and even if anxiety wasn't an issue, a midday appointment would break up my workday too much. Between dental and medical appointments, I've taken two full days off during the last month and arrived late twice. . .almost unheard of for me. Also, tomorrow I have a lunch date with a colleague who's moving out of state that I'd have to cancel if I went to the dentist around lunchtime. Most important of all, my jaw still hurts from the maneuvering during Session 1.1, and I want it to recover completely before the next round. Have I rationalized the situation enough?

To date, this summer has meant four dental visits with at least two more on the agenda. I know I don't have anyone to blame but myself: after all, one cannot avoid dentists for 16 years and expect things to be repaired in 1-2 sessions. My unexpected gratitude is extended not only to Dr. Yes and his staff, but also applies to what is becoming an unusual opportunity for personal growth. Imagine it on a resume’:

Overcoming Odontophobia: In Process
Expected Graduation Date: June 2013

While overcoming dental phobia is not the first path I would choose, for now, it is the one I must travel.

To be continued. . .