Has anyone encountered a fear of the gap created by an extraction?

[happydaze]

This may be aimed more towards the clinicians, but if there is someone on this forum who suffers with this particular fear then I'd like to hear from you also.

I have a recent new patient who has a phobia of the gap that would be left by an extraction. To be clear, the extraction itself does not worry him; only the gap that is left. His teeth an in reasonable nick, so he is now facing his first extraction in his forties and hence the phobia has only just become a problem. This is doubly difficult for our team because he also is phobic of dentures. We are looking at the prospect of making him a provisional bridge, but even that won't be easy as the tooth to come out is LR7 which leaves us with a distal cantilever bridge unless we also prep the sound LR8 . Add to that there is a deal of other work to do- ideally beforehand- and you have quite a challenge.

I'm mainly trying to get an idea of the prevalence of this phobia, but if anyone has any management strategies I'd appreciate that too!
m

 

[Kim]

Hi

I'm sorry as I am not a clinician, so can't help in that respect and when all said or done, I haven't that specific fear (wouldn't do me any good anyway, as I have the hugest gap wearing dentures) But I am sure that somewhere on DFC I have read a post or two whereby people are worried for various reasons, one of them being if my memory serves me right that other teeth would move? It would obviously be more helpful if I could remember who actually posted them, but I'm sorry I can't, but maybe someone will chip in and help recover my memory loss

Well done to you for actually thinking about the predicament of this particular patient's phobia and how you can help him. And if it is of any help, I just got complete dentures a couple of months ago, and although they do take a bit of getting used to, they are nothing to fear tell him, and I am not a seasoned pro, just someone who like anyone else having to wear partials or complete dentures, can do it

I hope you get the answers you are looking for.

Take care.

Kim

 

[brit]

Not aware of anyone posting along such lines but it is normal (not phobic) to not want a gap surely, especially if it is in a visible place or if function is affected?
Ditto dentures - anyone who saw their grandparents popping them in the glass - really would rather avoid dentures. I would think this were logical and rational to know that dentures are an inferior substitute for natural teeth and better avoided if possible.
Tell him from me an implant can feel 100% like a real tooth so saving for one of those would likely be a better solution than a bridge.

 

[happydaze]

Thank you both for posting so soon. This seems like a good time to add in a little more detail.

Obviously I know that nobody likes to have a gap, especially if it's a front tooth! Jeez, you must think I'm out of touch or stupid to tell me that. A gap is one of the most common problems, but it's usually easy to resolve with a temporary denture until you are ready for a final prosthesis, or with reassurance alone if it's a back tooth (as in this case).

This gentleman is properly phobic of dentures and gaps; not in a colloquial sense but in a medical sense, as his fear leads among other things to avoidance. The LR7 has been painful on and off for years and he has had one such episode since he came to my care. I have exhausted all options for treatment except extraction but he refuses even though he is in severe pain every day. With a gap- even at the back of the mouth- he says he could not cope or leave the house. Ditto the idea of a denture. He gets sweats and nausea when we talk about it. Believe me, the first thing I tried was to talk about his issues with dentures and he ain't amenable to there being "nothing to fear" as Kim suggests!

He will accept if a fixed prosthesis is ready to go in straight after extraction, but that is taking time to get to. We are planning to move to an implant eventually Brit, but he isn't suitable for immediate placement after extraction, let alone immediate loading. So we have to aim to give him a provisional (temporary) bridge during healing instead of a gap or denture. The problem with that is that in his situation it is really pushing the mechanics to do it.

Before posting I did run a search of the site to see if anyone else had posted a similar problem, but didn't find anything. What Kim mentioned was helpful, so I'll try another search.

If anyone has any other useful advice or experience of this phobia then please keep posting!
m

 

[shamrockerin]

Hi Happydaze,

I am 30, and after being away from dentistry for 12 years, I finally returned after a crown broke off (with the tooth still inside it).

My current dentist decided that the tooth cannot be saved because it was so decayed (it had previously been RCT's which is why there was no pain to indicate a problem to me).

I am facing an extraction and I am terrified of it, but I am also very scared of the gap. I had a terrible experience getting that crown, and getting a bridge is basically like getting 2 crowns so the prospect of a bridge is horrifying to me. Also, I cannot even figure out how I would be able to pay for prosthodontic treatment because my insurance only covers a small portion of it.

Getting an implant is even more horrifying because it involves someone I don't know (my dentist doesn't do them) drilling a titanium screw into my skull. Furthermore, this option is even more expensive than a bridge.

So the last option is leaving a gap. In my case, it's a molar to be extracted, and it wouldn't be noticeable, even when I smile so I am not worried about how I'll look. I do not know if this is your patient's concern. but I know that when a gap is left, the corresponding tooth super-erupts and other teeth may shift, making the situation even worse and further treatment will become necessary. Fear of extensive treatment is a major contributing factor in dental phobia, so just the thought of all this work going into a single tooth, let alone all the other teeth, can make it seem overwhelming.

 

[Gordon]

Not come across this particular fear before, it's unusual to say the least.

As a temp idea, how about a Maryland bridge for the 7? You'd get a cantilever it forward off the 8 with a rest on the occlusal of the 6? Should do OK for a few months until you can get an implant organised?

 

[swampiesue]

Hi I would say that I am more than terrified of having to have false teeth, I am terrified of having a gap. I have two upper bridges and have lost a few teeth on the bottom left hand side. But I would say the fear of losing any more teeth and having a denture goes beyond Normal. To the point It has been making me really depressed.

 

[brit]

This gentleman is properly phobic of dentures and gaps; not in a colloquial sense but in a medical sense, as his fear leads among other things to avoidance.

Well I can think of plenty of posters who put off (avoidance) having a full denture and that must be for multiple reasons. To a dentist a denture is the solution that restores health but the the individual it is a big deal (even if they are happy their care will be painfree and empathetic) for all kinds of self-esteem reasons. One such poster was B I think yonks ago. She felt she was too young to go down that route and the shocked look of a receptionist confirmed that for her and made her avoid for years longer.

Presumably there is some thing in his past (traumatic childhood extractions maybe/being teased) which has led to this fear of a gap even if not visible to others - can he explain why he feels this way?
Hats off to you for caring, it sounds like you are doing all you can by plugging the gap temporarily for him until a more long-term solution is reached. Maybe he needs counselling alongside. Interesting that Gordon has never come across it either.
I know my Dad had a horror of false teeth (because his parents had them) - he does now have a partial denture but won't wear it as he prefers the gaps. I believe this is common because dentures are not that easy to adapt to.

My original concern was that an ideal solution (implant) was not seemingly on offer in your first post. I mean if I had to have a denture despite my best efforts to avoid one, I would want it implant-supported. That would be easier to accept and deal with for anyone I think, faced with needing extreme treatment.

This will sound dumb again but are you sure he is not afraid of the treatment process to carry out the extraction - he may not be giving the real reasons for not wanting to extract the painful tooth.

Another thought - is it a sensory thing? A poster called Codewarrior amazed us years ago by not being able to bear the feel of amalgam in his teeth.

 

[gettingthere]

I can't say that my situation is exactly the same as the gentleman you describe but I can certainly relate to the fear of a gap created by an extraction and this is one of the reasons why is took me the best part of two years to actually undergo the extractions that were recommended to me.

I don't know if I can explain it properly but for me, the thought of having this piece of flat gum in my mouth where a tooth should be made me physically sick. Worse was the thought of some kind of indentation. Just the word "socket" in any context would cause an automatic nauseous reaction and I genuinely thought I would not be able to live with the feeling of a gap in my mouth. As a child I found losing my baby teeth quite traumatic and would hate that look and feeling of gum with nothing growing there. For me, however this went hand in hand with an intense fear of the extraction process in particular and even when solutions such as having the extractions under GA were proposed, this did not address the issue of living with a gap and so I kept delaying treatment until I could find a way of coping with this. In my situation, the gaps were towards the back of my mouth but I refused to believe that they would not be visible in any case it didn't matter. I would be able to feel it.

I was eventually referred for CBT to assist with many aspects of my dental phobia but one of the issues on which we focused a lot of time was the prospect of living with a gap. I remember my therapist, trying to help my see past the impending treatment and asking me to focus on an upcoming holiday (after the procedure) and how I would be happy at that point and I think I shocked her by bursting into tears and saying no, I wouldn't be happy. Anytime I thought of the holiday, excursions booked etc, I could only think that I would be doing these things with gaps in my mouth and therefore would be miserable no matter where I was and what I was doing.

We spent a lot of time exploring my feelings about teeth, extractions and past experiences that had led me to feel this way and I became aware that my fear of the gap was partly rooted in a lack of confidence; constant rating myself against others who looked better than me or were more successful in life and I felt that a visible gap would be a physical sign of ugliness or an indication that I could not look after myself properly therefore was stupid, inadequate and a failure. Also it would be a reminder of the (in my mind) brutal and violent procedure that had taken place in my mouth, in my head and like a battle scar, it would force me to re-live the procedure or previous bad experiences and would never allow me to forget. A lot of the former issues stemmed from my mother's attitude towards teeth - she would always point out people with bad teeth or gaps and tell me that they were disgusting people. When I was at school I remember she wanted me to change classes because our teacher had bad teeth and she felt it was a terrible example to give and when I lost my baby teeth, she didn't like me going out or told me to keep my mouth shut because it looked horrible so I grew up believing that gaps were a bad thing and that losing teeth was to be feared. During the CBT sessions, I learned how to challenge these beliefs and therefore change the way I felt about this happening to me. I also took on a practical challenge which involved buying some theatrical make-up to black out my tooth and go about my daily business to see if anyone treated me any differently (they didn't!) I even wore this to a very formal family wedding in front of my mother - who didn't even notice! That was a huge revelation even though it didn't help with though thought of how a gap might feel in my mouth. That one just had to be a leap of faith once I felt my confidence has increased at least as much as it ever would. Coming around after the procedure I was in a state of panic when I realised it had happened and I now had these gaps and yes, feeling that fleshy gum for the first time was difficult but somehow I managed to cope with it and especially once I realised that they were not visible and nobody need know what I had been through, I started feeling differently - like my gaps were a badge of honour and rather than traumatic scars, they were a secret and personal proof to myself of what I can overcome - against the odds and against my own expectations - when I really put my mind to it.

It is worth saying that I am not afraid of dentures and had considered this as an option if I really could not cope with the gap - although I had been told it would be unnecessary due to the position. Even then however and despite the fact it would mask one fear, it was still a difficult decision to make and as others have testified here, I did consider myself too young and there was a huge stigma about going down that route so although not a fear in the way the thoughts manifested themselves, it was stilla difficult thing to consider.

I hope this has helped understand your patient a little better. I wish you and him all the very best of luck.