First dentist appointment in 10 and a half years ... yikes!

Yes, next Tuesday, I must return to the dentist for the first time since I was 19.

I'm now almost 30, and for the past 10+ years, lack of insurance has kept me from returning to that dreaded chair. At least, that's what I tell myself! Seriously, though, a HUGE part of it has just been anxiety. I'm TERRIFIED of the dentist (obviously; I'm posting here, aren't I?).

I've always had troublesome teeth -- my parents couldn't afford braces when I was growing up (I grew up in a 5-kid family), so while my teeth are not ghastly, they're obviously crooked. Also, somehow, I ended up not having a cavity until I was 14 -- but it seems like I had about a million of them in my teen years. Plus I weirdly still have two of my baby teeth! For some reason, two of my adult bottom teeth never came in. The last time I saw a dentist, he acted like one of the baby teeth was no big deal, but like the other one was on the verge of falling out any minute. (It's actually still there.) I remember he put a filling in the tooth next to it and was concerned about aggravating the baby tooth; so somehow I ended up with a Frankenstein-like screw sticking out between the tooth for what seemed like a very, VERY long time...

Speaking of that dentist, I think he's another reason I'm so anxious about going back. I VERY much remember him acting all grim and concerned, asking me if I ate a lot of sugar, and telling me to calm down, among other lectures.

So what finally made me call for an appointment? Well, in December, I had a recurrence of breast cancer (I was originally diagnosed in November of 2006). This time, it's spread to my bones, which means I get to start taking a drug called Zometa. My oncologist strongly recommended that I get a dental checkup before starting this drug. Apparently, once I'm in it, if I had a dental emergency, they wouldn't be able to take care of it -- or if they did I would be at increased risk for something called "osteonecrosis of the jaw", which sounds like something out of a horror show.

So I finally buckled down and decided to go to a dentist. Fighting the cancer is more important to me than dental anxiety. However, if you think it was easy to find a dentist who would take my DSHS ... wrong! I spent a good week calling up any dentist I could find, only to have them tell me I needed a different insurance, or that even if they would take it, they weren't accepting new patients and I'd have to wait 3-4 months...

Finally, my mom suggested calling her dentist, who happens to be the brother of (and share a practice with) ... Dr. Lecture from my teen years! They agreed to see me next week, but because I'm a former patient, I get to see the same dentist referenced three paragraphs ago. I'm torn between being grateful to him for being willing to see me (DSHS and all) especially so soon after calling him, and being terrified of what he'll find and what he'll say to me. If he lectured me back then, when I still went in for 6-month checkups, what's he going to say after 10+ years of dental semi-neglect??!?!

A few other things:

-He did give good shots. I'll give him credit for that. I remember barely feeling them.

-I take "decent" care of my teeth, but up until the past month or so, probably not as good care as I should have. Particularly with the flossing.

-I'm trying to decide/prepare what might be wrong with me. I KNOW he's going to have to do some work. Er, last time I was there, he told me I had three cavities, which were ... never filled. (I think they were small back then but who knows how much they've grown.)

I do get toothaches now and then, rarely ones that don't go away after I pop an Ibuprofen or two, but still... I have some of those white patches on my bottom teeth ... and on three of them I can see ... BROWN patches. Well, kind of yellow-ish brown (gross, I know). I'm pretty sure those are the teeth that are "aching" when I do have toothaches. Again, the pain is never severe, however I would say then when I feel it, I can feel it all the way down in my jaw.

My upper teeth don't look as bad but my bottom molars are really worrying me!

-I've been brushing, flossing, and rinsing with peroxide on a much more strict regimen than before. I think it's helped a little??

-I so want sleep dentistry, but I don't think Dr. Lecture offers it. I have some generic Xanax (.25 milligram pills) does anyone know if that might help, and how much I should take? I'm thinking about asking my oncologist if he can give me some Ativan, too.

-I'm not scared of the pain (yet) so much as what he's going to tell me might be wrong ... I'm also terrified of ending up with gaps in my mouth ... let's say he needs to do an extraction, do they put SOMETHING in there (anything)?

That's about all I guess. Thanks for reading and any input/support!

Wow, you have been through a lot. In regard to the medications.

Both Ativan and Xanax are benzodiazpines are are "cousins." The main differences:

Ativan is a sedative and lasts a bit longer. Ativan is also used as a preanesthetic and a slight muscle relaxant.

Ativan works a bit better for anxiety, slightly faster onset.

Many people have problems with Xanax. We rarely use it at our office.

Xanax has many more drug interactions and with some foods like grapefruit.

There is less of a hangover effect with Ativan.

Typical dosing for Xanax is 0.25mg three times per day.

Never mix these two medications as this can do some very strange things to anxiety, like increasing it. I would have your doctor speak with your dentist to make sure everyone is on the same page.

If you have a choice I would think Ativan is a better choice for dental procedures. Also, whenever we prescribe a anti-anxiety medication we also make sure the patient has training in relaxation techniques. The medication takes the edge off, but the real help comes from using relaxation techniques. This was buttressed by a study done by Harvard on dental anxiety is 2007. If you would like, I can get you some effective techniques. Best wishes to you.

Hi and ,
it sounds like you've been through a lot a recent years. You're amazing !! I'm so sorry to hear that you are stuck with seeing this dentist. Hopefully, he's realized in the meantime that lecturing your customers is not a good way of turning them into repeat business. I have a feeling that some dentists (more so in years gone past than now) seem to regard a lecture as a preventative measure designed to motivate people. Of course, lectures have exactly the opposite effect. Hopefully, especially under the current circumstances, he will realize that you deserve compassion rather than lectures . Otherwise, you'll have to give him the "talk to the hand" treatment - hopefully that won't be necessary, though!

With regards to your query about missing teeth - usually, they can be replaced immediately (especially if it's a visible tooth/teeth). You should make sure though that this is indeed the plan, should the situation arise (in all likelihood, it won't - it sounds as if you've been taking good care of your teeth as well).

Wishing all the best for next Tuesday

Thank you to both of you for your replies!

StressDoc (or anyone who might know), regarding the Ativan and Xanax ... I managed to get some Lorezapam (i.e. generic Ativan) from my oncologist but he only gave me four half-milligram pills. It says to take two of them before my "procedure" (really, my appointment). Do you know if 1 MG of Lorezapam would be enough to even make a difference in terms of easing pre-appointment anxiety? On the other hand, if I took all four pills, would 2 MG be too much? Or would THAT even be enough? I'm pretty sure I had a prescription for 1 MG Lorezapam at some point during the first time I went through cancer treatment, and if I took one of those, it helped a little, but it certainly didn't knock me out or anything. So based on that, I'm pretty sure I would be okay with 2 MG but it would be helpful to get advice from someone who knows the drug a little better. Honestly right now I'm more concerned that 2 MG won't be enough! But I don't want to be asleep or anything ... (actually, I wouldn't mind, but considering it's a consultation, the dentist probably would)

One other question -- if I took my Xanax today and tomorrow, to help ease my increasing anxiety, would that interfere with taking Lorezapam on Tuesday morning? Or do you know if there's a specific time frame I should give myself to make sure the Xanax is out of my system before I take the Lorezapam?

Oh, I would love to hear of any relaxation techniques!

Thank you, and thanks again to you, let'sconnect, as well!

You ask about relaxation techniques. You may get some use from Paul McKenna's downloads - one is Fear of the dentist. I have used Paul's techniques for weight loss a couple of years ago - it's effective.

Good Afternoon Russianhutton:

1mg of Ativan, in my experience, is generally enough to calm anxiety. The use of 2mg (usually standard ER dose for panic attacks) can be very sedating and can put some people in lala land. Before changing the dosing instructions contact your primary doctor first, as doctors do not like patients to change their recommendations, specially when there are other medical concerns .

The other and VERY IMPORTANT consideration is balancing the dose equalivalents between the two medications.

If you are taking 0.5mg of Xanax then you would take an equivalent dose of 1mg of Ativan. Both medications stay in the body system between 8-12 hours.

If you have been taking Xanax regularly for a while you can build a tolerance. This seems to happen a little faster with Xanax than other Benzos.

When you take the Ativan the effects start to appear at about 20-30 minutes. The maximum blood level is reached at 2-3 hours.

I will PM you with some techniques.