Getting Started-- Timing, Costs etc.

[mscam]

This may be one instance where the internet didn't send me into a further panic. I am a 34 year old woman who has not been to the dentist for 16 years. I have numerous issues with broken or decayed teeth most of which are in the back. Fortunately, I have never experienced any pain. Unfortunately, the lack of pain and my general terror/anxiety, embarrassment and concerns about costs have prevented me from getting the help I need.

I know I can't diagnose myself but I am prepared for full mouth reconstruction and possible jaw surgery/orthadontia to correct major open bite. I know that I can't keep living this way and that the sooner I get started the better. My questions as I begin this journey are:

1. For those of you in the U.S who are modest middle income people with crappy (1K a year max) insurance how did you manage the cost? Will I go bankrupt trying to make this happen? Are loans possible/advisable?

2. How did you manage with work? I am a teacher so I do have the benefit of a long summer but that also means that I need to be able to speak or risk losing my job.

3. I have never even confessed these concerns to my two closest friends in the world. These friends have helped me through the loss of both of my parents and generally are my major sources of support as a single person. I am sure they think I have terrible teeth, they've just been kind enough to never ask me about it. And now, after decades of friendship I am still unsure about how to bring this up to them.

Any insights are most welcome. I haven't made it into the chair yet but I think I can with your help!

 

[geos]

I live in Canada where dental fees are similar to what you have in the US, so I will try to answer.

Not having pain is good since it would allow you to stretch the time period on which work can be done.

1. For those of you in the U.S who are modest middle income people with crappy (1K a year max) insurance how did you manage the cost? Will I go bankrupt trying to make this happen? Are loans possible/advisable?

For this one, talk to your dentist. A good dentist would want to prepare a treatment plan you will be able to pay and you can manage. Some dentists even offer payment plans to help their clients and others offer prices more affordable for modest income people. As long as you manage this properly, you shouldn't need to go bankrupt.

2. How did you manage with work? I am a teacher so I do have the benefit of a long summer but that also means that I need to be able to speak or risk losing my job.

You would want to talk with your employer/HR for this one. Do remember that they would prefer see you gone for a few hours then see you miss days. You might want to talk to your colleagues to see how they manage to go to medical appointments. Also, talk with your dentist about limiting the freezing effect once your appointment is over.

3. I have never even confessed these concerns to my two closest friends in the world. These friends have helped me through the loss of both of my parents and generally are my major sources of support as a single person. I am sure they think I have terrible teeth, they've just been kind enough to never ask me about it. And now, after decades of friendship I am still unsure about how to bring this up to them.

Surprisingly, a lot of people don't even notice. A good way of bringing this up would be to have a talk with them on the subject without necessarily talking about it in full details. I never talked about my dental fear with my extended family(aunts, cousins and grand parents), but one day the subject came up. Everyone started mentioning their own stories regarding dental fears and gave me their support for an upcoming appointment and it was a light discussion.

 

[comfortdentist]

So I'm a dentist now but I certainly went through a time when money was most tight. I can tell you I am amazed at what people spend money on who say they have no money. What I mean is you get financial secure by what you do with your money much more than by making a lot of money. So I would recommend two things:
1. Check out (don't buy) the book "the Millionaire next door" easy reading
2. Look at every single expense everyone no exception and ask yourself is this mandatory. Do not justify it by saying "oh it's just ...." eliminate it! Think how your parents lived and what they had.

Of course you can always consider tutoring in addition to your job. I use to work many many hours as my debt payment exceeded 50% of my income.

This is a manageable temporary money problem. You might well be faced with much more serious problems later in your life.

 

[Steve In Cleveland]

A few years ago I was in the same situation, with teeth broken down, cracked in half, missing big pieces etc. After a long journey, my teeth are now beautiful (to me), pain free, and I'm such a happier person. It can be done. Here's what I learned:

1. Dentists can and mostly do try to save almost any tooth. For all the damage that I had, I only lost two teeth, both of which were worn down well below the gumline. Several other teeth were completely broken even with the gumline, or in jagged shape, and were able to be saved.

2. Probably 90% of the work I had done was completely painless. At the first hint of any feeling, I raised my hand or made a noise, the dentist got me more numb, and the work proceeded with no more pain. We worked slowly and I gained trust in my dentist, so what little pain there was was extremely short (10 seconds or so) and not nearly as big a deal as I feared.

3. You can choose to have a giant amount of work done all at once, but I had mine done in ~1 hour appointments before or after work, or on the weekends. Aside from an hour or so after some appointments where I was still numb and talked a little funny, no one ever knew I was getting work done. Root canals, crowns, extractions... all of these things turned out to allow me back on my feet and pain free immediately after the appointment. A strong dose of Advil sometimes helped, but most days not even that.

4. You'd be amazed at how many other people out there have bad teeth, are afraid of the dentist, need or have needed major work, or are hiding broken/painful teeth. You'll also be amazed at how unshocking your mouth is to the dentist. I thought for sure my dentist would draw back in disgust at my horrible mouth. I did need a lot of work on over half my teeth, but even at the first appointment she treated it just like a list of things to be done. I found that no one wants to hear about your teeth or cares/notices nearly as much as you do. A couple of my best friends (not to mention my wife) had no idea I was hiding such bad teeth. You can bring it up to your close friends now, or after you start getting work, or when you're done, or never.

The cost does suck. I've financed work by spreading it out over years, loading up a couple of credit cards, taking out loans, etc. The first step is to get looked at by a dentist, and he/she can draw up a treatment plan and tell you what if anything needs to be done right away. The costs are all pretty straightforward and up front. Almost everything can be deferred if you're not in immediate pain. Some dentists offer discount plans, payment plans, etc that might help.

More than anything, having been there myself, I can tell you that it's almost certainly not as horrible and life-interrupting as you expect. (Though it might, in the long run, be as expensive...) I was certain I'd have to have all my teeth pulled, go into hiding for weeks or months, or at least be out for days at a time with major surgeries. But we were able to do it gradually, one step at a time, in appointments that didn't leave me looking or talking any different, and didn't even leave me with anything other than an occasional mild headache. I should say that during the time I've had my dental work done, I've had jobs doing telephone tech support and corporate training. Almost without exception I was able to go direct from a dental appointment to work and still talk and teach just fine. A few times I even had a root canal done on my lunch hour.

There's no way to diagnose you over the internet, but the first step is working up the courage to go get the initial consultation. Most of the time the diagnosis isn't nearly as bad as you fear, and the work can be spread out to fit your schedule and budget. Good luck! I know exactly how terrifying it is, because I've been there. But I can tell you that one way or the other, it can all be fixed, and it feels so much better on the other side...

 

[mscam]

Thanks, Steve. Very encouraging. I have one big work project that is due by the end of the month. Barring disaster (which always feels immanent), I am going to get started at the beginning of February. This may sound like an excuse but it's actually progress. Before reading through this forum I was convinced I needed to wait until summer so that I could hide away.

 

[Steve In Cleveland]

Good for you!!! It doesn't sound like an excuse at all. Among other things, it takes a whole ton of physical and psychic courage to make that first visit. For some people, going to the dentist is no big deal, but for us phobics it's like going to war just stepping in the front door.

The other thing to know is that your first visit should just be an examination. Most dentists are familiar with phobics and will be extra careful to ask for permission and try to keep you calm. The first exam is usually a visual inspection (no sharp tools or poking around or pain of any kind) and if you are up for it, x-rays. However bad you think your teeth are, they won't be a shock to the dentist. And unless you're in pain, there's nothing that has to be done immediately. One of my fears was that the dentist would want to immediately do some kind of emergency work. But there was no lecture, no shock, and no pressure to do any other work. Your dentist will give you a list of recommended treatments, with prices, and you can talk about how you want to proceed and what you might start working on. Or you can just go home and digest it all. For all the anxiety leading up to it, the first visit is really just to get a picture of what needs done, and talk about options. No one will call you at home to pester you, or require you to make another appointment.

Good luck on making and keeping that first appointment. You can do it completely at your rate-- the first appointment is the hardest, psychologically, but it gets better after that as you learn to trust the dentist.

Feel free to post or PM if have questions or fears or just want to rant and ramble. We've all been there and know just what it feels like. And some of us have managed to break through and can tell you how great it feels to face the fear and start taking care of your self.

Take care!

 

[comfortdentist]

I'm glad that Steve in Cleveland has been able to work through his dental difficulties. I want to mention you thing that I consider ultimately the most important decision you can make and the one that will have the largest permanent impact.

Select most carefully the dentist whom you are going to trust your body parts to. This is important to everyone and critically important to anxious patients.

Example I occasional receive referrals from a native American clinic. Usually these patients are young, severe caries, not trusting at all of any outsider and especially dentists as their experience has been bad. So I saw this one teenager girl last year and this is how treatment went. First her background included severe drug abuse and dental phobia and a general inability for dentists to get her numb.
Appt. 1. One hour trying to connect with her and getting her to understand that I am different and will respect her even though no one has before. Difficult in general but add to that our age and culture differences.
Appt, 2 IV sedation for molar endo, extractions, general composites. Slow start took a lot of drugs and sweet talking but did well and was able to greatly lighten depth of general sedation and talk with her towards end of appt. Discussed treatment progress with her and mom at end of appt. Due to history of drug addiction I didn't want to sedate her more and didn't think I needed to.
Appt. 3. Four composite restorations performed on her front teeth with just profound local anesthesia. We discussed her extreme progress and she happily tells mom that it went fine. I explained to her that this is normal dental treatment and this is what she should expect from a dentist and what to do if she doesn't get treated this way. She thanked me and we discussed what I would do next time and what to expect.
This has resulted in a life change for her. Yes I'm happy too!

My son fractured his hand recently I flew him to my hand surgeon even though his injury could have been handled elsewhere. Why? I have complete confidence and trust in this surgeon. So being "in the system" I am very cautious as to which doctors and therapists I use. There are many types and I see ones that are dedicated to their profession and their patients. Unfortunately I think that eliminates about 90% immediately.
So I do spend more money on health care overall and as a result I don't spend money on cars.

 

[mscam]

Appointment made for one week from today with a DDS, MAGD who offers general and cosmetic dentistry with sedation. If you are the religious sort, pray for me friends.

 

[FearfulInMA]

Hi mscam!

First of all, good luck with your appointment!

I read your first post when you first posted and have been meaning to respond -- I just wanted to have enough time to respond properly.

Nearly 8 years ago, my situation was VERY similar to yours. I was 30yo in the US and was working as a teaching assistant/paraprofessional making very little money and dental insurance like yours. I hadn't been to a dentist in many, many years and, after a lot of pressure from coworkers finally made the decision to make an appointment with someone my coworkers recommended.

I needed a significant amount of dental work done including about 10 large fillings and my wisdom teeth removed. I had no savings and was barely making ends meet. A couple of things helped... first, the dentist was willing to work with me on making payments. I also was able to space things out so that I had time to catch up in between appointments. I also started tutoring to make a little extra money and all of that money went towards paying for the dental work. If you have decent credit, you can apply for CareCredit -- the thing with this is that you need to be sure to pay off the balance before the end of the 'interest free' period otherwise I believe you will be responsible for all of the interest that would have accrued during that time.

In terms of being able to continue to work while having all the dental work done, for the most part, it was totally fine. In fact, having a schedule where I was able to leave well before 5 pm allowed me to schedule appointments without having to miss work. Aside from having my wisdom teeth removed (which I did right before a long weekend so that I had time to heal and didn't need to miss work), I've never had any dental work done that has impacted my ability to speak (and I've had a lot of dental work done during the last 8 years). If you need to have a lot of extractions, it might make sense to plan them around longer vacations, but other than that, you should be totally ok.

Fear of the dentist can be so difficult to talk about, even with the people closest to us. I've always been really open about it, but I can totally understand why you wouldn't want to be. If you want to bring it up with your friends, you could do that in the context of telling them that you have this appointment coming up and that you are anxious/frightened/terrified/etc. As your friends, I can't imagine that they're react in any way other than to want to provide support.

Also, like ComfortDentist said, it's super important to find a dentist who you can trust and who does good work. If you don't get a good feeling about the one you will see next week, find someone else. I have recently moved about 3 hours away from where I used to live and I've continued to go to the dentist in the city where I used to live because I completely trust him and know that he does good work.

Take good care!

 

[FearfulInMA]

Just stopping by to wish you good luck today! I will be sending good thoughts your way.

 

[mscam]

Thanks, FearfulinMA and everyone who replied to this thread. It's been very helpful to re-read this morning.

It's about 8 hours until the appointment. I didn't sleep well but other than that I'm holding it together. My goal for today is to not waste time inventing worst-case scenarios. Soon enough I will have the ugly truth but also a treatment plan. This forum has really helped me realize that getting this first appointment over is a huge hurdle and most people only regret not doing it sooner.

Also-- since my first post I did tell my two best friends and it was almost a non-event so my concerns are down to two!

I'm planning to start a journal when I get back in case it helps anyone lurking out there trying to work up the courage for a first appointment.

 

[littlething]

Not sure if you've gone yet, but wanted to wish you good luck! Try not to think about worst-case scenarios - I know, easier said than done! Just think that it will all be over soon! You are right that the first appointment is the worst, but it gets easier. I thought finding out everything that was wrong with my teeth would be this horrible event, but in reality, finding out what's wrong and then having a plan of action to fix things made things easier.

Just breathe through the appointment, and take it one step at a time. Let us know how it goes!

 

[mscam]

Well, I made it. Everyone is exactly right that getting the first appointment done and knowing the plan feels great! Everyone is also right that choosing the right dentist is soooooo important. A compassionate skilled professional is what we all deserve. No shame at all! I'll put all the details in a journal when I have a bit more time but my first step will be 4 extractions with bone grafts (one wisdom tooth and some broken molars) and root scaling and planning. This will be done under conscious sedation with bonus valium the night before. After that heals up we'll have the talk about next steps which should include orthodontia for open bite and protective crowns to deal with restoration/enamel issues. It's going to be a long road so I'll be seeing you around here for a bit...

 

[Steve In Cleveland]

Hoooray for you!!!!! I'm SOOOO proud of you!

This is a huge first step, and I hope you're also proud of yourself for following through and facing your fears. From your "no shame at all" comment it sounds like you've found a dentist who is respectful and kind. In my opinion that's the most important part. A good dentist will help you build trust, and that will help you face the appointments you don't look forward to. I will say that over the course of my treatment plan I had a few appointments that were unpleasant and a little painful, but none was as terrifying as the first consultation, because I know my dentist is taking care of me.

I'm looking forward to seeing your journal and following your story. Whatever procedures you choose to do, and at whatever pace, it must feel nice to know that now you've got a dentist who can take care of you and that you're on the path to a healthy smile.

Plus now you can call your two friends and have them tell you how brave and wonderful you are too! After my first appointment I wanted to run around the office telling everyone, "I went to the dentist!" because I was so proud. But I knew it was like bragging that I'd finally tied my own shoes or something. Here on the forum and with your friends, you can share your pride and fears without being judged, because we've all been there. (Not to mention many lurkers to whom you are now a role model!)

Great job, and welcome to your journey...