Any dentists with experience dealing with SI tendencies?

[shamrockerin]

This is not a question about technical/medical aspects of dentistry, this is strictly opinions about the dentist/patient relationship. I also apologize if the content of this message is upsetting to anyone, because that is not my intention at all.

The abbreviated version of my story is that when I was a teen, I had a filling done w/ no anesthetic. It was a surface cavity, and the dentist assured me that no needles or drills were necessary b/c he was going to use air abrasion. I was relieved, and I agreed to have him fix it right then. However, after a while he said he WAS going to need to use the drill, and he did. It didn't cause any physical pain, but I was so panicked and anxious that he was drilling my tooth when I wasn't numb at all that I dug my fingernails into the skin of my (opposite) arms. Following that, I have had painful RCT and crown placements, during which I actually drew blood because I gouged myself with my nails so much.

Fortunately, I have never had another dental experience that was THAT painful. However, I still use my old trick to deal with anxiety and prepare myself for any possible pain (injections especially).

Since I am searching for a new dentist, my therapist think that I should be upfront about this rather than having it discovered later. But I have trouble seeing how a dentist, knowing that the patient has these self-injury tendencies, would be willing to treat me and work with me??? I feel like most dentists would rather refer me to a place that does sleep dentistry rather than deal with me, and I am trying very hard to overcome the fear, not just go to sleep to avoid it.

Have any of you dentists helped patients with similar problems, or do you have any suggestions?

 

[Dr. Daniel]

Hi shamrockerin,

Let me share with you a very interesting research I once learned about (in my psychology studies).
The question of this research was: why does psychology work? After all, one can find in psychology so many paradigms, theories and approaches, which sometimes contradict one another. But still, it seams that generally speaking the psychological therapy (no matter which approach) works, meaning there is (again, generally speaking) improvement among patients. How can this be?
This research tried to analyse the factors and cofactors among all kind of psychology, and tried to answer the question "why does it work".
The answer is: psychology works because it tries to reach and treat the problem itself. As long as you deal wight the problem directly, no matter what is your approach, as long as you do it after enough training (meaning learning from others experience) and you do it with the intention to solve the problem and help your patient, most probably improvement will come.

I hope your therapist agrees....

Why this long explanation? If you are genuinely want to to stop with this fingernail thing, if you persist on solving it, it will eventually be solved. That is my message.

I would suggest you ask the dental assistant to keep an eye on your hands and if needed to remind you with her voice of with her hand-touch to relax your fingers. If that does not work maybe you can find something to grip with your hands to keep them occupied from imprinting the fingernails. If that does not help, cut of your nails .

In short: when there is a will there is a way. You can find what works for you.
All the best.​

 

[comfortdentist]

Hi shamrockerin,

Let me share with you a very interesting research I once learned about (in my psychology studies).
The question of this research was: why does psychology work? After all, one can find in psychology so many paradigms, theories and approaches, which sometimes contradict one another. But still, it seams that generally speaking the psychological therapy (no matter which approach) works, meaning there is (again, generally speaking) improvement among patients. How can this be?
This research tried to analyse the factors and cofactors among all kind of psychology, and tried to answer the question "why does it work".
The answer is: psychology works because it tries to reach and treat the problem itself. As long as you deal wight the problem directly, no matter what is your approach, as long as you do it after enough training (meaning learning from others experience) and you do it with the intention to solve the problem and help your patient, most probably improvement will come.

I hope your therapist agrees....

Why this long explanation? If you are genuinely want to to stop with this fingernail thing, if you persist on solving it, it will eventually be solved. That is my message.

I would suggest you ask the dental assistant to keep an eye on your hands and if needed to remind you with her voice of with her hand-touch to relax your fingers. If that does not work maybe you can find something to grip with your hands to keep them occupied from imprinting the fingernails. If that does not help, cut of your nails .

In short: when there is a will there is a way. You can find what works for you.
All the best.​

I have a few patients that need to hold something rubbery to squeeze and they are more at ease.

 

[carole]

Well you have done it again comfortdentist

 

[shamrockerin]

If you are genuinely want to to stop with this fingernail thing, if you persist on solving it, it will eventually be solved. That is my message.

I would suggest you ask the dental assistant to keep an eye on your hands and if needed to remind you with her voice of with her hand-touch to relax your fingers. If that does not work maybe you can find something to grip with your hands to keep them occupied from imprinting the fingernails. If that does not help, cut of your nails .

In short: when there is a will there is a way. You can find what works for you.
All the best.​

Thank you, Dr. Daniel for your thoughtful response.

Right now, I am not actually trying to stop the fingernail gouging. Right now, it is my only tool I have at my disposal to cope with dental stuff, and for now I am just trying to get the nerve up to go to a new dentist.

I know it's going to happen; I am just trying to figure out if I should be upfront about it before I even schedule an exam, or wait and see if they notice it on their own. If they don't even notice, then I don't see the need to mention it.

I am currently researching/emailing local dentists to try and find one to start fresh with, and my ultimate hope is that I will find a place that I feel comfortable in and I won't feel the urge to do this anymore. But the thought of telling a dentist "Oh yeah, by the way I am so terrified of you that I'd rather claw at my own skin than trust you" makes looking for one even more difficult, and I don't really envision the dentist being too welcoming after this news either.

I have gotten a nice email response from a local office, and the dentist is willing to meet with me (as in just talk) before I even schedule the exam/x-rays. . .I'm just unsure if/how to broach this topic

 

[Deejay]

I know comfortdentists sort of reasoning and I understand that doing this is your coping mechanism and you don't want to let go what I want to know is it that the pain you feel in your skin helps block out any potential pain or is it the force coming from your hands? so could the fact that you drive your fingernails into foam or something you know like memory foam that is quite thin but would lessen any potential injury but still allow a degree of the feeling work in the same way even if you had it on one side? Sorry if that sounds strange just throwing it out there to see where you are coming from xx

 

[Sparkles]

Hi shamrockerin,

I have used pain as a way of controlling my fear at the dentist as well.

I used to scratch and dig my nails into the skin on the inside of my arm and wrist. It almost felt like I was causing pain that I could cope with that would distract me from the unknown pain and fear that the dentist would cause. ....Not sure if that makes sense! I also use it if I get upset as a way to stop the tears.

Before I met him in person we talked by email for a few weeks first and then on the phone. I told him the things I was most frightened of, how I usually react and what he can do to help me.

I can understand you not wanting to tell the dentist anything about the way you cope. But, perhaps, it would be helpful for both you and the dentist. Your explanation here on this thread is all the detail the dentist would need. The only thing I would add in would be what you need to happen to help you.

So for me, I need to know there won't be pain. If there is any pain I completely panic and he knows he needs to stop and what to do to calm me down.

So, the injections are pain free and very slow. When he uses the drill he tests it for me 1-2 seconds to convince me its not painful. Then build it up 5-10 second bursts. Any discomfort and we stop. He knows the local wears off quickly with me, due to panicking, so we top up half way through just encase. He shows me exactly what he's using, what it sounds like and what it will feel like before he does it. All this helps to remove the anticipation of pain.

Sorry for the long response, but I hope this makes a little sense..

 

[shamrockerin]

Hi shamrockerin,

I have used pain as a way of controlling my fear at the dentist as well.

I used to scratch and dig my nails into the skin on the inside of my arm and wrist. It almost felt like I was causing pain that I could cope with that would distract me from the unknown pain and fear that the dentist would cause. ....Not sure if that makes sense! I also use it if I get upset as a way to stop the tears.

This is EXACTLY what I was trying to communicate. Thank you, Sparkles. I can cope with pain that I am causing myself better than I can cope with any pain being caused by someone else. During those past painful dental appointments, I was actually in tears and the dentist still didn't stop, so it was much easier to focus on my own brand of pain. From that point on, and now, I use it to cause myself a certain degree of pain in order to distract myself from any other pain which might surface.

I don't feel ready to stop yet, especially when I haven't even visited the new office yet. Maybe in time, if I feel confident that every measure is being taken to prevent discomfort, then I will be able to stop.

My counselor suggested that I be upfront about this, when I go to for the first meeting but I feel like if I am, then they're not going to want me as a patient, or they'll think I'm crazy or something. . .

 

[Dr. Daniel]

The discussion here seems to be very fruitful and beneficial for you shamrockerin, it seems to help you clear your position when coming to communicate with your (future) dentist. Allow me suggest anther idea:
When meeting your (future) dentist, I think you should concentrate on your real concern: to avoid any pain during treatment. The fingernail thing is a side thing, a symptom origined from the fear.
It is important to stay focused, adding the fingernail as something to attend will only distract the communication.
I don't mean by that not to mention the fingernail issue at all, it might be a good example of how you react to the stressful situation, but it is not something the dentist and I should work to.
Having said that, i do think it is worth while to work on the fingernail issue eventually, but not to present it to the dentist as a complain needed to be treated.

 

[Sparkles]

I'm glad my reply made sense!

I don't think by telling the dentist it would make them think your crazy or not want you as a patient.

Let them know you need time to build up trust and that pain free treatment and assurance that they will stop if/when you ask is very important to you.

Your way of coping is just that - a way to cope. It may not be ideal but it works for you just now. Let the dentist know what you need to help you feel more at ease.

 

[shamrockerin]

The discussion here seems to be very fruitful and beneficial for you shamrockerin, it seems to help you clear your position when coming to communicate with your (future) dentist. Allow me suggest anther idea:
When meeting your (future) dentist, I think you should concentrate on your real concern: to avoid any pain during treatment. The fingernail thing is a side thing, a symptom origined from the fear.
It is important to stay focused, adding the fingernail as something to attend will only distract the communication.
I don't mean by that not to mention the fingernail issue at all, it might be a good example of how you react to the stressful situation, but it is not something the dentist and I should work to.
Having said that, i do think it is worth while to work on the fingernail issue eventually, but not to present it to the dentist as a complain needed to be treated.

Thank you again Dr. Daniel. Your reply makes alot of sense and this discussion does help me consider what I might say in my "meet and greet" appointment when I eventually make it.

I am just feeling very self-conscious about this because I feel like I am the only dental phobe who has this type of problem. I have heard lots of stories about people gripping the arm rests or whatever, but I have never met someone who does what I do.

My counselor knows about it, but it took me a few weeks before I was able to tell him about it, so I really didn't see myself telling someone new (like a prospective dentist) about it after I'd just met him 5 minutes ago.

I suppose I could phrase my concern something like "I have difficulty believing that dental treatment can be painless, and I have developed coping mechanisms to deal with that distrust" or something like that. . .it doesn't give specific details, but it's a summary of this particular problem. . .

 

[vicki]

I am just feeling very self-conscious about this because I feel like I am the only dental phobe who has this type of problem. I have heard lots of stories about people gripping the arm rests or whatever, but I have never met someone who does what I do.

Everyone deals with and responds to fear differently, so the chances of hearing about someone who deals with fear in exactly the same way as you, are fairly slim, but that's not to say that it doesn't happen . People often find it difficult to talk about their fears; for a variety of reasons, let alone discuss their fears in specific detail, so that may be why you haven't heard similar stories before.

Some people feel better by talking through their fears in some detail, whereas others prefer to stick to the essentials. I've seen quite a few people with dental phobia since I qualified as a Hypnotherapist about 7 years ago and during that time, I think I've seen about two people who openly talked about digging their nails into themselves. Some of the other people might also have done the same thing, but maybe they didn't choose to talk about it. Some people shake like a leaf in the chair, others are paralysed with fear. Some people grip the arms of the chair, others grip their own arms; everyone's different.

I cross my arms and grip hold of each arm just above my elbows. It's partly a self defence thing because when I was younger, during dental appointments, my arms were held down onto the chair arms, so I can't rest my arms on the chair arms because it brings back too many memories. A dentist I used to see a few years ago would joke that I was in the 'coffin pose' since I looked like someone laid in a coffin when I was laid back in the chair. The other reason that I sometimes dig my fingers into my arms is as a distraction, to try and prevent the fear escalating or a flashback happening. If I can stay focused on the sensation of my nails digging into my skin, then my mind is focused on that and it can't produce a flashback and it seems to work most of the time.

I usually dig my nails in just enough to cause a bit of pain (to keep me distracted), but not enough to draw blood. However, on a couple of occasions, I have dug my nails in so hard that my arms bled because the fear was so intense that I had no idea how hard I was squeezing my arms until after the treatment was finished and I realised my arms were bleeding. The solution is very simple; I now make sure that my nails are cut short enough that I can't do myself any damage. I've already cut them short in preparation for my appointment on Wednesday and I will file them down again on Tuesday night just to be sure.

As Dr Daniel said, digging your fingernails into yourself is a symptom of the problem, rather than the actual problem itself. You may find that as you begin to trust your dentist, you feel less need to do this. I've never gone into any real detail about what happened to me when I was younger because I find it very difficult to talk about it in person and also because my dentist has enough to do sorting out my teeth. However, whenever I've met a new dentist for the first time, I usually just briefly mention (without going into too much detail) that I had a lot of bad experiences when I was younger and that I take beta blockers before appointments because I can get very stressed and sometimes have flashbacks. The reason I tell them is because they might otherwise wonder what was going on if I suddenly start shaking or hyperventilating in the middle of treatment.

On one or two occasions, I have given a bit more detail about the background to my fears, but only because the dentist (either my dentist or the endodontist I'm seeing at moment for several root canals) has looked a bit puzzled by my anxiety, especially if it's during a part of treatment that they didn't think would provoke any stress.

You don't have to mention anything if you're not comfortable talking about it. You probably won't get asked... I'm pretty sure I've exhibited some very stressed and strange behaviour in the past and I've never been directly asked about what's going on or what happened when I was younger. So, I would say that if you're self conscious about it, then maybe you could briefly mention it without going into too much detail (which is what I do - I usually make some joke about having to make sure I've cut my nails ) as this might help you to feel less self conscious, but I wouldn't worry too much about your dentist's reaction to it; besides, they're usually too absorbed in what they're doing .

 

[shamrockerin]

Thank you Vicki.

I always assumed that they were too busy working on my teeth to notice, and nobody ever mentioned my doing it when I was a kid/teen. It only became an issue recently because last year the dental assistant noticed it, and commented on it. So even if the dentist hadn't noticed himself, he obviously heard about it. Plus, then I felt humiliated in addition to already being scared and and anxious.

I have a little while before I need to worry about this; I haven't even scheduled an appt. yet. I guess I just wanted to have a "plan of action" before I even called to schedule it.

 

[Dr. Daniel]

I suppose I could phrase my concern something like "I have difficulty believing that dental treatment can be painless"

This sounds like the core of the fear. You have a core believe that dental treatment equals pain.
In that case, I would concentrate first is finding the right dentist for you (even before communicating), and I would go with first-hand recommendations from people you trust for a dentist who can treat without causing any pain. If a person you trust will refer you to such a dentist, you will develop a feeling of initial trust toward that dentist much faster.

A few pointers:
* Avoid chain of dental clinic. You will not receive there personal attentive care.
* A dentist that works fast can not provide a pain free treatment. Time is needed for slow administration of the anesthesia, wait long enough for it to take effect.
* I would recommend you to trust also your gut feeling about a certain dentist. Usually by the first appointment you will know what your gut feeling is.

 

[JazzyJ]

I think you should be up-front about it. The key is to finding a dentist you trust, and so I think by telling them of your coping mechanism, it'll be sort of like a test to see if they're a good enough dentist for YOU or not. Give them as few or as many details as you feel comfortable with, because at the end of the day, a fear of dentists is probably the second most common fear in the world after spiders, so I'm sure loads of them are more than willing to accomodate nervous patients of all aspects.

Also, you said one of the ways you can phrase it is by saying you have a hard time believing dental treatment can be painless. So does this mean you do what you do BEFORE the dentist does anything, or during? If before, would it be at all possible for you to try a different, less harmful/painful coping method before he does anything? I say that because that way your body can still alleviate some of its stress and fear before anything is being done without you hurting yourself in any way. That way, if the treatment is painless, you'll be able to notice that there's no pain, and perhaps that might even give you a bit of trust and confidence in your dentist from that point on? I'm sorry if that doesn't make sense or isn't how your mind would see it, but thought I'd say it anyway just in case it's something that could be considered.

 

[shamrockerin]

So does this mean you do what you do BEFORE the dentist does anything, or during? If before, would it be at all possible for you to try a different, less harmful/painful coping method before he does anything? I say that because that way your body can still alleviate some of its stress and fear before anything is being done without you hurting yourself in any way. That way, if the treatment is painless, you'll be able to notice that there's no pain, and perhaps that might even give you a bit of trust and confidence in your dentist from that point on? I'm sorry if that doesn't make sense or isn't how your mind would see it, but thought I'd say it anyway just in case it's something that could be considered.

I am not exactly sure what you mean here- while I am in the dental chair, that is when I tend to dig my fingernails in. I'm not really doing it before I'm there.