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Some time ago I admitted to myself that avoiding dentists for many years and wanting to cry just at the thought of going wasn't ok. I acknowledged that this might be what’s called dental phobia and that the best idea would be to find a dentist who specialises in treating nervous patients and tackle it. I thought all of my fears came from the fact that I had never had a nice dentist, and that once I found one, things would get better. I expected to be cured fairly quickly, and that all I needed was to find a dentist who is a nice person. This wasn’t the case and many visits later I found myself struggling even with the simplest dental visits.
I also familiarised myself with some common fears and found that I couldn’t relate to most of them. I could happily get through any amount of dental injections or drilling but was absolutely terrified of being tipped back and had difficulty coping even with a simple chat with my dentist sitting next to me. I also believed that once I got in the chair, I wouldn’t be able to get out. It was around this time that I found out about the link between having experienced childhood sexual abuse and the ability to cope with dental treatment. I have spent a lot of time researching and trying to find some answers and most importantly, trying to find out whether dentists themselves know about this connection. To my surprise there wasn’t much material on how it feels to receive treatment as an abuse survivor or how dentists perceive this problem.
I have come a long way in my journey and have started to feel increasingly free to talk openly about my fears and the role my past played in creating them. The best thing about this was that I got to know people who had gone through a similar thing and who felt the same way. I had some most revealing chats which in turn brought me immense personal relief. Hearing “You are not alone” and “You are not weird” can have a huge power, be it expressed by people who have gone through similar things or by caring health care professionals. I found out that there are a lot of us out there and we all feel alone. I am writing these words in the hope that all other men and women out there who have experienced sexual abuse and who feel silly stop feeling this way, and also so that all dentists out there can get an idea of how difficult things can be. If you are a dentist who offers to work with nervous patients, chances are that you’re dealing with more people like this than you might imagine.
This journey is my personal one and might not apply to everyone, but could apply to some. See it as an addition to the material and information that is already out there…
So I would like you to know that…
1. I feel disgusting and I am convinced you perceive me this way too
My dentist once told me his dental nurse usually puts her hand on the patient’s shoulder during treatment to make the chair a less lonely place. He asked me whether it would be ok with me. I said no. He then asked whether I would be ok with him touching my shoulder, for example while the chair gets tipped back. He would do this to give his patients a bit of stability while the chair was reclining. I said I didn’t know. The truth is that a touch on the shoulder can be very reassuring and I would love my dentist or my nurse to do that, but I feel so disgusting, ashamed and a bother that I couldn’t bear the poor nurse who doesn’t know me very well being obliged to put her hand on my shoulder. I literally imagine her suffering, hoping it will be over soon. Do I know that this is not true? Yes, I do on a logical level. But I do not have much access to logic when dealing with dental visits.
Why did I say I didn’t know when my dentist asked me whether it would be ok for him to touch my shoulder? Because…
2. I always have to evaluate what could be the wrong answer
Answering even the simplest questions if they’re being asked by an authority figure is really hard. You might be familiar with this one. As a child, there is always a wrong answer that results in punishment. Sometimes you get punished regardless of what your reply is, and sometimes you get punished for answers that were the right ones just recently. Any time an authority figure (which a dentist is) asks me a question, my mind goes into overdrive, analysing options and trying to establish which is the right answer and which is the wrong one, or at least which answer would have the least consequences in terms of making people upset or judgemental.
So seeing as I had said no to the nurse, I couldn’t say yes to the dentist touching my shoulder, right? This is how the analysis in my mind looked and it only took a few seconds:
Possible consequences of me allowing the dentist to touch my shoulder:
Possible consequences of me refusing to allow the dentist to touch my shoulder:
There is no solution to this dilemma so “I don’t know” was the safest option.
Do I feel crazy for making a fuss about something as simple as a question? Yes, I absolutely do. And I would love my dentist to know this because when he suggests something instead of asking questions, I feel more comfortable and less worried. This is getting better over time and the more I get to know my dentist, the more courageous I feel about replying. In time, I might even come up with my own suggestions.
3. You are not just a dentist, you are a very special person to me
A few dental visits ago, on my way home after a dental appointment that went really really well, I was crying tears of gratitude because of having found my special dentist. It felt like a dream and made me feel almost overwhelmed because I had never experienced anyone look after me or be interested in my needs in such a manner… or just anyone who would respect my boundaries, the mental and the physical ones.
These are huge things and make me feel like my dentist is somewhere between being a superhero and an angel.
Having a person who looks after you and takes care of you, who is genuinely interested in what worries you and in your fears and who treats you with empathy is a life-changing thing if you are an abuse survivor. We deal with all this self-doubt, feeling stupid, not believing in ourselves, being afraid of judgment and being very aware of how weird our behaviour can be at times. A dentist (and other health care professionals) is a person who experiences us in our most vulnerable moments and occasionally during moments of losing control over ourselves. If a dentist, despite all of this, manages to make you feel accepted, listened to and treated with kindness and patience, you will never forget it.
Fears can spread into unrelated but similar areas over time, but healing can too. My dentist is the first male I have ever worked with. I do not know why, but he gained my trust before we even met and turned out to be the first nice dentist I have ever had. All my doctors are females. I avoid mixed gyms and if I have to go to a health care centre, I make sure to call them beforehand and request an appointment with a female provider. A few weeks ago I was in the reception area of my (female) GP. It’s a mixed-sex practice and her husband who works there as well came to the reception at the same time and commented on my issue which I was discussing with the receptionist. We had a brief chat, he gave me some information and I left. Later I realised that I had just managed to stand right next to a male doctor talking about a health issue and the only discomfort I felt was slight nervousness. Just a few years ago I would have been stuttering and feeling the need to leave as quickly as possible. I can literally feel that every success, positive experience and every piece of confidence I have gained with my dentist spreads into other areas of my life as well, so in this regard he is also helping me change my life for the better.
4. My body is prepared to expect violence and humiliation every second, no matter how much I trust you
I need you to explain every single step of a treatment or check-up to me. I need to know what will happen next, which tools will be used and why and also how long it will take. I sometimes even need to know exactly where your hands will be and for how long. If you don’t keep me precisely informed, my brain will fill in the gaps and I will get very uncomfortable, waiting for awful things to happen.
My dentist checked my clicking jaw recently - at one point he took an instrument and placed it in the front of my mouth. He said he would do so but didn’t explain why and everything happened quite quickly. This almost made me cry as I didn’t know what was happening so my body started to prepare for humiliation or getting hurt. If I do not know what is happening, I always prepare to get hurt. These are automatic reactions that I have no control over whatsoever. In a normal sane world, people respect other people’s boundaries, but if you have experienced abuse, you do not believe in boundaries. You were conditioned to believe that anyone can do whatever they like to you and there is nothing you can do about it. You were also conditioned to believe that it was all your fault and once you agree to one thing (sitting in the chair) you have to take whatever comes after that. I literally feel like this expectation takes control of me anytime I experience something I wasn’t expecting during treatment.
5. I am very fixated on my appearance
Preparing for a dental visit is a ritual for me. It is a huge thing and everything has to be perfect. I need a lot of time to choose clothes I will feel comfortable in and I sometimes think about details for a long time beforehand. I think that deep within my psyche I somehow believe the dentist will treat me badly if I don’t look as nice as possible or maybe I am trying to hide the sense of being disgusting and feeling ashamed. I also have some clothes that I feel are “cursed”. These are clothes I was wearing during visits that didn’t work out too well and in my mind it was the clothes’ fault that the visit went wrong. And of course I brush and floss my teeth several times before an appointment, out of fear that there might be a spot that isn’t perfectly clean. If my appointment is in the morning, I am sometimes afraid to eat breakfast as that would make my teeth dirty and raise the possibility of me missing a spot.
I never really thought that this was in any way related to the abuse until I came across a woman with a similar history who does this, too.
The longer I work with my dentist, the less I fear rejection, which allows me to see dental visits as something normal, so with each visit I need less and less preparation and fewer rituals.
6. I will endure anything unpleasant and won’t stop you
I am used to discomfort and enduring things, and showing as little discomfort as possible is my way of doing it. I can suffer pain and discomfort and shame and fear and I can suppress it in a way that you might not notice anything at all, so it’s better not to rely on me giving you a stop signal. It’s not that I don’t want to, it’s just that I can’t.
My dentist often asked me to test the stop signal during my initial visits. He kept reminding me of this from the first visit and during every treatment. I never did. I wanted to, really badly. I was imagining doing it, I was preparing to do it, I was planning it, but I just couldn't. Raising my hand is a huge thing. Four visits later and I realised I promised to use the signal but never did and I also realised that this seemed to be really important to my dental team. I promised myself I would use the sign no matter what and if I found it difficult, I would tense every muscle in my body for that second and would just raise my hand no matter what.
I managed to do it. And it was more stressful than anything I have ever done during a dental visit. We had to interrupt the treatment and I ended up sitting there staring into space motionless for several minutes. I heard my dentist talking to me, he was asking me something and I wanted to reply but my ability to talk was blocked. I felt the urge to cry and felt ashamed, sad and literally had no control over myself. After a few minutes I was fine and we could carry on with the treatment. I needed several visits to even try to use the stop signal again. So dentists everywhere, just be aware that a stop signal is a huge deal and extremely hard to give. The good news is that I feel more and more comfortable about potentially giving the stop signal as my dentist hasn’t got tired of reminding me of it over and over again.
7. I would like to tell you and at the same time I am afraid to
I believe that if a dentist is familiar with the fact that there are abuse survivors and that they struggle with a lot of things in addition to other common dental fears, they will be able to take this into consideration and look after their patients in better way. I would love to tell you and I believe it would make the treatment easier because I wouldn’t have to explain to you every single weird thing that freaks me out. You might be able to guess which things I might feel uncomfortable with... BUT What if you do not know about this link? What if you would prefer not to treat me? What if you thought I was weird?
I recall having googled a lot before seeing my current dentist. I was trying to find a sign, just anything that would disclose whether he knew that there are people like me or not. I didn’t find any. I remember choosing words carefully in my emails to provide hints, hoping that my dentist would somehow open the door for me and make it easier to voice my concerns. He did. It was after seven visits I disclosed this to him, in one small sentence buried somewhere in a very long email - just mentioning it in as many words as necessary and to the smallest extent possible. This email (and his understanding compassionate reply that showed he understood that the meaning was far bigger for me than the actual amount of text used to express it) changed the course of my treatment immensely. Things got easier, I started to feel less weird. I was able to cope better and felt much more confident. Knowing he now knows also made it possible for me to communicate my fears more clearly and directly because I knew he would understand. So if you know about the issues abuse survivors face and are experienced or willing to work with them, try to find a way to let them know in some way.
8. Talking to you is really hard
I really like my dentist and I trust him immensely. I keep on worrying about the same things over and over again, asking him the same questions and he always treats me with understanding and kindness, never getting tired of offering me reassurance. He has been working with me for quite some time and we have made huge progress. Despite this, I am often too scared to talk to him freely. There are still things I cannot voice directly and sometimes I am not even able to look at him during our chat. The few steps from the waiting area into the surgery and meeting him at the beginning of the appointment are still the hardest part. Sometimes even talking about or stating my fears and worries is too triggering to even try. On the other hand I am really good at writing and it allows me to prepare and think about what I want to say. Having a written reply also prevents me from misunderstanding or forgetting things and helps counter all the other tricks my mind might play on me. So if you don’t mind, give your patients the option to get in touch with you via email. It will make things easier on them and may give them the courage to tell you what really worries them.
9. I believe that everything is my fault
This might sound almost egocentric, but I feel responsible for everything bad that happens around me. So if you are late, I believe it was because of me, maybe because I had sent you an email that was too long or so complicated that you needed more time to prepare yourself to see me. If we need a few minutes more for our appointment I feel guilty and will make sure to talk less next time, out of fear of making you late again and of you resenting me for it. If you look tired I may believe it’s because I was too demanding and difficult or you just don’t want to see me.
I also tend to take things personally. My dentist once told me he gets about 300 emails daily, about 150 of them are spam. What he wanted to say was “Please do not hesitate to let me know if I don’t get back to you after you have sent me an email, emails can get overlooked sometimes”. What I understood was “Don’t you dare send me an email, I already get 300 of them and I would appreciate not getting any more”. That made me feel bad and it made me think twice before getting in touch, trying to find ways to solve things in other ways. Do I know that this it just me overthinking? Yes, I do. Does knowing it’s just me overthinking help? No
10. Allowing you to touch my mouth is the most intimate thing I can imagine and it is really hard
Coping with anything being put in my mouth is really hard. Trust helps, but my self-discipline and effort is the most important thing that allows me to get through it. I personally find check-ups even more difficult than treatment, because they involve my mouth being touched in different spots in different ways. I haven’t had very many check-ups in my life so I cannot predict what exactly my dentist is going to do and why. So I am happy to hear lots of explanations and you talking to me as a distraction is very welcome. I believe that most people can cope with just lying there and letting you work but for me one wrong movement can make me freak out inside. So the more you talk and describe, and the more you forewarn me, the better I can cope.
11. I always expect you to get angry at me or reject me, even for things that are usually considered positive
My biggest worry is that you could get angry with me and I expect this to happen at any time. This not only makes asking for things very hard as I anticipate that the whole dental team thinks of me as a bother, but also it is hard for me to do things that are considered niceties. I sometimes give chocolates to the staff, as I am deeply grateful for all the effort they go to on my behalf (they changed my life, remember?). And it makes me really nervous. I will usually give the chocolate to the receptionist, hoping nobody will see me doing it and I then make myself scarce as soon as possible. I might well get a panic attack if my dentist were to suddenly appear at that point.
I have this image of my dentist sending me an email telling me to find a different practice because I am crossing a line. Every phone call, every email, I just expect them to ask me to go somewhere else or find a mental health care provider (I’ve had several of them by the way, in case you were wondering)... I am also afraid to say nice things and express gratitude because I am worried it would make them angry, feel like I was a stalker or like I lack sensitivity towards boundaries. Putting it all together, deep inside I expect rejection and negative consequences no matter what I do.
12. I sometimes believe I am making all of this up or “acting” just to get attention
Experiencing abuse means there were people in your life who didn’t believe you or who ignored what was happening to you. You might have been accused of lying and making things up. You might have been given reasons as to why what was happening was right and nothing unusual and you might not even have realised what was really happening to you until you became an adult. All of this makes you doubt your own judgement, your feelings and even your memories on a huge level.
I remember the period of getting to know my dentist. He wanted to know what my triggers were and gain as much information as possible to find a way to help me. There were triggers I didn’t mention because I couldn’t believe they were happening. For example, I know that any part of a check-up that involves the dentist putting his fingers in my mouth or even worse, touching my face to check my jaw etc. increases my anxiety in a huge way. I however never voiced that because I believed I was making it up. Sometimes I even believe that I have no anxiety at all and I’m just pretending all of this. Sometimes I believe it’s just all in my head. There’s no solution to this problem but it is just helpful if you know that even if we get to the stage of talking to you openly and telling you what frightens us, there will still be things we are not able to tell you.
13. There is a life outside the surgery (or other medical visits) and it’s pretty awesome
While dealing with a dental visit can put me into the worst state possible, regress me to a small child, make me stutter or mute, I am perfectly fine and even confident in most other areas of my life. There is joy, satisfaction and love in my life. I have a job, hobbies, goals and dreams. I even have friends and can seem outgoing. I wish you knew this because I fear you won’t ever experience me at my best or even at an acceptable behaviour level. Seeing me only in the surgery might make you think (fear of judgement, here we go…) I was neither normal nor capable of leading a normal life nor maybe mentally stable. I know you most likely don’t think of me at all when I’m not in the surgery, but if you did, I would love you to know that I am normal and can laugh, joke and feel enthusiastic... and even deal with touch or intimacy successfully.
Abuse is a topic that needs to be discussed. Dentists need to know the facts and so do patients who suffer on account of it. I have found out that starting to talk about it is the first step in getting help and gaining control over a lot of things, including dental fear. My hope is that these words can make a difference to someone out there thinking they are alone. I also hope this article helps any dentist or dental student reading it, to understand what might be happening in the minds of some unusual patients.
Last but not least: there is a way out of dental fear, no matter what its cause may be. It might take some time, but you can eventually get there.
Tips for Abuse Survivors and Their Dentists - Written by a survivor of childhood abuse, this article provides lots of tips for dentists and abuse survivors alike
Quick Info Cards for Rape and Sexual Abuse Survivors - many survivors of sexual violence find GP and dental appointments and similar situations difficult – especially when the circumstances may be triggering, but you are not comfortable expressing what you need in words. These cards have been created to use in these situations. They can be printed out, laminated and given to the receptionist, doctor or dentist when you come in for your appointment, or given to the nurse or other health care provider. You could also create your own cards using Word or Pages, if you’d like to adapt the text to your particular needs. If you’d like to laminate them at home, you can buy self-sealing laminating pouches, or use clear packing tape.
How much should I disclose to my dentist? - an article by dentist Fraser Hendrie