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B-blocker or diazepam?

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Peppa

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I am due to have bonding on a molar tooth. It is 2/3 filled and in the remaining third I have 2 non cavitated potholes. Despite my anxiety, I requested to have them filled due to being worried about them getting worse. Dentist says they are due to my teeth being non aligned.

My dentist says if I can cope with a cleaning then this won’t be a problem. However my fear is due to being crowded out and being unable to swallow. The last time I had treatment awake was a deep filling where the injection and drilling were fine but I panicked during the filling stage where I had two people standing over me. I have had IV sedation twice and required the full dose.

Could someone please give me some idea on the steps that this type of treatment will have? I have also had a tiny chip on a temporary filling fixed and it being no problem, is this the same or different?

Even though my brain understands it’s quite a minor treatment I am afraid my body will just go into panic mode from previous experiences. What drug would be best in this instance? I have propranolol, but would have to ask my dentist for an anxiolytic- would it be prescribed in this circumstance?

thanks for any advice.
 
Gordon

Gordon

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Can't really comment on the procedure without knowing more. It doesn't sound like it's going to be very invasive.
If your dentist is happy to give you the sedation and you feel like you want it, then why not? Hard to say what kind of drug would be needed without knowing you or what's getting done. My "go to" drug would be Temazepam, works well and has a much shorter duration of action than Valium.
 
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Peppa

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GP has refused to help with a dental related problem. I’m gutted and my confidence is so low now that I don’t think I can face talking to my dentist about it. I went to my GP as I don’t find it easy talking to my dentist.
I think Im going to just go ahead and hope the beta blockers stop any panic starting.
 
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Peppa

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I’ve now asked my dentist who has also refused any medication. She says it’s not necessary but surely that could be argued for anyone and any procedure? Feeling really lost and not understood.
 
Gordon

Gordon

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Sounds like you need another dentist then.
 
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Peppa

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That’s true, but I want to have this done first.
I’ve been looking up the steps of the bonding procedure and wondering what is routine in the UK (private practice, if it makes a difference)? I’ve seen that some steps can be combined.
I just need some idea of the steps involved.
Thank you.
 
Enarete

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She says it’s not necessary but surely that could be argued for anyone and any procedure?
This interesting. I am not sure how on earth can another person be able to tell anything about a subjective phenomenon that's happening inside of your body and mind. What is it that makes you want to get the treatment with her at any cost? Also wondering whether it would be an idea to ask the dentist about the steps involved. You have the right to know what a procedure involves before agreeing on it.
 
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Peppa

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Thanks for your reply. I am hopefully moving soon so don’t want to go through the process of starting at a new dentist again. I also live in an area where there are really no dental phobic specialist practices (Believe me I’ve looked!). As it’s an optional treatment id be worried another dentist wouldn’t offer it as an option.

trying to be optimistic, she has said that if I can cope with a cleaning then this will be fine. I’m hoping that she’s also basing this on check ups I have with her, and also the fact that it’s quite a minor procedure.

I was trying to look up the procedure to help with my anxiety, and I see there are treatments availabke that combine some of the steps so was hoping some one could confirm. I’d be calmer if I knew it was even simpler than what I’m preparing for.
 
Gordon

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It kind of depends on what material is being used as to what steps are required. Very, very generally it would be
1) Isolate the tooth, either cotton wool rolls or rubber dam, to prevent saliva contamination
2) Prepare for bonding, roughen the surface (a bit like sanpapering something before you paint it) lots of different ways to do this
3) Bonding agents applied (varies massively depending on what's used)
4) Apply filling material
5) Set filling with light or wait for catalyst reaction
6) Remove isolation
7) Check/adjust bite and polish filling
 
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Peppa

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Thank you so much.
I hope the rubber dam isn’t planned, as I couldn’t tolerate that.
My last panic attack at the dentist was during the layering part of a large filling. If it’s potholes on the cusps that are not decayed is it likely to be a single layer?
is it also possible to be not too reclined if it a lower molar?
 
Enarete

Enarete

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My last panic attack at the dentist was during the layering part of a large filling.
You mentioned this situation in the first post and I was just thinking what a scary situation, having a panic attack in the middle of a procedure.. may I ask you how the visit went on from that point? Did you toughen it out or did you have to interrupt the procedure? Also how did your dentist react to that?
 
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Peppa

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I’d been fine with the whole procedure up until the point where I had two people standing over me. My original memory of my mouth being held shut by the orthodontist as a child caused me to panic at that point. I must have got through the rest of the procedure as it was completed. I was unable to have any further treatment from that dentist as that attack caused me to panic at much minor things after that point. I then had to progress to IV sedation at another practice.
So this will be my first treatment without sedation since then (4 years ago).
Thanks so much for your replies, I’m not having a good day today. Still can’t work out whether to try to get through this appointment or to wait until I get a more understanding dentist.
 
Enarete

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Sorry to read about what had happened back then. What a traumatic experience.. I can't even imagine how powerless and violated you must have felt. It's very brave of you to try to overcome this and to push yourself, even giving it a chance without iv sedation, it is important for this to be a good experience for you.

There is one thing that I thought maybe significant. You kept asking about how the procedure is done and googled, focusing on the part of layering the filling, however looking at the actual trigger, it looks like it's about two people standing over you. You also seem to be ok with cleanings (maybe because they are done by just one person?) and also with injections and drilling... it seems to me that if you would manage to avoid two people standing over you, you would be fine. Is this something you believe your dentist would be willing to help you with or would that be in the "too much" category already?

It makes me a bit sad for you that you have to deal with this alone. Because you are only a part of the treatment and there are factors that are in your dentist's hand as they are doing the procedure. Life is so much easier if the provider is willing to listen and help.. and in this case you're not even requesting anything complicated.
 
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Peppa

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Thanks so much for your understanding. Ive been trying my best to overcome it but unfortunately I just don’t seem to be able to get any help. You are right- it’s about being crowded out so I will ask on the day. What would they do for things they need two people for in this case?

I was also going to request not to be tipped back too much. Just a bit worried about annoying them just before starting treatment and also about starting off on a negative note with it. I intend to take a beta blocker beforehand too (seeing as I’ve been denied temazepam!).
 
Gordon

Gordon

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Not tipping back too much should be possible if the dentist is agreeable.

Managing without an assistant will be extremely difficult, it's important to keep saliva from contaminating the area or else the bond fails (basically the saliva bonds instead!) so it really needs 2 people.

Whether it needs layering or not depends on the material being used and the depth of the hole. The light only penetrates a couple of mm so if it's deeper than that it needs done in stages.
It's something you could bring up in advance so that a material is chosen that doesn't need to be layered.
 
Enarete

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I was thinking maybe the nurse could just try not to bend over too much? If a filling in the past was not a problem and the only difficult point was the layering.. I suspect there was a nurse present and suctioning all the time, but during the layering something was different and created the feeling of having two people over?
 
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Peppa

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Thanks, I think I’m getting to the exact source of the problem- two people standing at either side was fine, but the panic started as soon as both were directly over me, I suppose for the layering/light curing? This is probably a direct memory of the past trauma.

I am hoping that only one layer will be needed, they are shallow and non cavitated. Also hoping that being private they are more likely to have the mixes that combine the bonding steps?

My treatment plan has it down as an anterior composite restoration when it’s on a molar, but maybe this is because it’s on only one third of the tooth.
thank you again.
 
Gordon

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It doesn't matter if it's private or NHS really, the choice of bonding agent is very subjective, some dentists just settle on what works "in their hands" and use it for everything :)
 
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Peppa

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Thank you. I am feeling better about it today, it does help having people who understand.
For some reason id feel much better about it if the acid wash step wasn’t involved. So I’m hoping that step is combined with the bonding agent application part.
 
Gordon

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I was a big fan of the self etch stuff but a lot of dentists just don't get on with it.

If you read all the research then the separate etch/bond process has a marginally better bond strength, so if you need to get the etch stage you could perhaps console yourself with the thought that you're having the best possible treatment? Just a thought.
 
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