Here we go again...

[Tome]

Hi... well, first, in a world full of dental phobics it'd be incredibly hard to identify you from your posts. Too many other people with the same problems as you.

Secondly, I wonder if things might go better if you wrote a letter saying what you need to say and then got someone else you trust to read it prior to giving it to the dentist... so you can put across what you need in a format the dentist can't interrupt, when you aren't intimidated or in fear.

I can understand why your dentist acted like he did. He was worried you'd act like you suggested you might, and could end up harming yourself accidentally.

There's an art to 'dentist management'

 

[kitkat]

I'm sorry things are kind of rocky with D5 so far! I so wanted things to be smooth sailing for you today but you survived! I don't fully understand the situation with the RCT vs filling but personally, I would take issue with them withholding my money for a service I may or may not need! That just doesn't make sense to me . Funny you mention that you would be worried about D5 reading your posts because I haven't mentioned the site to my dentist for the same reason! I'm too paranoid and would feel like I need to censor my posts just in case!

I can totally understand your distress to D5's reaction to your opening speech...it sounds like he may lack the patience/listening skills you are seeking but like you said it's early yet and there is time for improvement and time for you to figure each other out. If it is any consolation, I outright hated my dentist in the beginning but we grew on each other with a little bit of time. I was set on never going back to her but was forced back by my mother (I was still a minor at the time). So it could work out still...although I'm sad to report my dentist and I are in a bit of a rough patch too lately . We communicate alright but she just can't keep me comfortable during treatment and that's a big problem although I do feel like she really is trying. At this point I'm sticking with her for the sake of a good past track record but if my next appointment doesn't go well I may be looking elsewhere but enough about me. I like the idea of sending a letter/email since he seems a bit hurried and dominating in conversation. It sounds like your personalities are just clashing at the moment and maybe he doesn't quite know how to help you although maybe he thinks he does .

 

[Pianimo]

I can understand why your dentist acted like he did. He was worried you'd act like you suggested you might, and could end up harming yourself accidentally.

There's an art to 'dentist management'

Ha, there certainly is! Thanks for the advice. I usually do write down what I'm going to say in case I can't speak for anxiety, but I hadn't this time, although I had this thread handy on my phone jic.

I've been thinking a lot about all of this and actually the more I do, the more convinced I'm becoming that I haven't done anything wrong. I do definitely understand that I mustn't go around whacking my dentist (!) and that if I interfere I could cause harm to myself. However, while I'm lying there, eyes closed (I never open them, even when not sedated), mouth open, sedated and drowsy and to all intents and purposes at their mercy, if they do something that provokes a reaction in me, I have to maintain that is their fault, not mine (or at least, not either of our faults). A friend of mine told me a story recently of how when she was about 7 she went in to her mum's room at night, and instead of waking her mum up, she leaned over her, with her face almost touching her mum's face; then her mum did wake up, freaked out about this thing on top of her and smacked my friend in the face! lol So, who's fault was it? It was my friends' fault really - her mum didn't know what was going on until after it had happened. That's what it was like for me when I've done this.

The other aspect is control. If I ask them to stop (or wail in pain/distress since I can't speak with my mouthful!) and they don't, then I do, to be honest, feel within my rights to physically try to make them stop. It obviously should never, ever come to that. But just because they are the dentist/nurse etc and I am the patient does NOT put them in control. I have chosen to be there and to trust them to do what's right for me (which is why finding the right dentist and feeling safe with them is such a big deal), but that doesn't mean they get to do whatever they want and I just have to put up with it. If it did mean that, I'd never get in the chair!

Maybe the answer is just having a stop signal, although I don't know how well I'd remember it or be able to use it while sedated. The incident I was trying to describe to D5 yesterday happened with D4, when I 'came to' suddenly to find them doing impressions, felt like I couldn't breathe or swallow, panicked and just kind of flailed in the chair - I think I sat upright and tried to push them away from my mouth. Then I had no energy left so I kind of fell back in the chair and lay there crying, too weak to move. I know that he used a tiny tray and would have been very gentle and kind so I think I maybe had actually fallen asleep and then woke up to find this happening, and that's why I suddenly panicked. I have also a couple of times pushed a hygienist away though, and that was unsedated! It's just sudden panic when I'm gagging and can't cope and need them to stop - instinct takes over and I've done it before I realise, then I feel awful and apologise!! I've never done it violently, more just touching their arm and then they realised what was going on and stopped and gave me a break.

I think the only way to guarantee I'll never react is to knock me out. I can try my hardest, but when that panic takes over I'm not in control any more. People do crazy things when they're panicking!! I think what upset me so much yesterday was that he didn't even try to understand. I mean, he could have said "Well, you really must try not to do that because it's dangerous, but I'll make sure I keep talking to you, so hopefully it shouldn't happen." But he didn't, he just told me off....in a kind of pleasant voice (that's the only way I've ever heard him talk) but nonetheless I felt like a little kid being told off, and instead of feeling reassured I just felt even more scared. I don't think I did raise my arms at all during the appointment yesterday, that I remember, but I did a few times lie there crying and moaning and wimpering and wishing he would stop. And I don't remember him saying one nice or reassuring thing at all. I guess maybe I'm not remembering.....but honestly the only thing I remember them saying, over and over again, is "Open your mouth wider" - and that was when it was already open so wide that it hurt.

I don't get it tbh. He's built a career on treating anxious patients. Surely he can do better than that?? This just about sums it up really, I think:

It sounds like your personalities are just clashing at the moment and maybe he doesn't quite know how to help you although maybe he thinks he does .

I don't think I'm overly complicated to help, but he doesn't seem interested in trying. Maybe I'm being unfair - I keep thinking he must be popular to have got to where he is, so maybe it's me that's wrong... (Although, you could say the same about Justin Bieber! ) Anyway, I know I can get through any appointment with sedation, but honestly I hated every minute of it yesterday, and I've had other appointments in the past where I was all calm and relaxed and content, so I know that's possible, and I don't want to have to settle for less. *Sigh.*

I'm also really uncomfortable about the money situation, but I don't dare complain because I worry it will make him angry with me. R mentioned giving me a refund but then she spoke to him and he told her not to. I do understand the reasoning but at the same time, as things stand, a large sum of money (about 2/3 of my total treatment cost) is sitting in their bank instead of mine, as payment for something they haven't done.

Anyway...I'm doing ok today! I've had the odd ache in the teeth now and then, but that's it, and my jaw is gradually getting better too. I still find it uncomfortable/sore to eat on that side, so I've been avoiding it, but hopefully that will get better soon as well.

Hope you can get back to how things were with your dentist kitkat. Let's aim for parallel happy dentalness coming soon!!

 

[kitkat]

I don't mean to sway your opinion one way or the other but the more you share about your experiences the less I like this guy. I totally disagree with the money situation and I don't care for the way he has reacted towards you. It just seems like he's making your fear worse and I certainly hope he's not one of those dentists that just views sedation as quick fix or cure all to phobias and relies on you forgetting most of the procedure so he does not have to be bothered with dealing with the emotional aspects of your fears or even be super concerned for your comfort. I feel like someone truly wishing to help you get over your fears would just be more in tune and pressing communication vs just getting you sedated and getting the work done asap. I don't know. The whole thing leaves a bad taste in my mouth (no pun intended!).

 

[Tome]

I've been thinking a lot about all of this and actually the more I do, the more convinced I'm becoming that I haven't done anything wrong.

I agree, you aren't doing anything wrong, and it isn't your fault.

My suggestions were meant to try to get around the 'block' of the dentist'; trying to get him to behave the way you need him to behave for your treatment.

Choosing a dentist is more about personality than anything else... a dentist who's great for one person might be rubbish for another. I don't think it's about technical ability. Almost all dentists can do anything that needs to be done. But having someone you like and can trust is essential.

My current dentist in quiet, doesn't say much during treatment, and that's the way I like it I trust him, so he's the right person for me. But I think he'd be a terrible choice for you.

From what you've said so far I'm not sure that this guy is the right dentist for you. Obviously, that's your choice, but if you choose to continue seeing him it's essential that one way or another your views about how you need to be treated should be listened to... that's kind of why I suggested the letter. To put your views into a context where they can't be interrupted, or you can't end up being intimidated into shutting up.

If he's not willing to listen to what you say even when you write it down he is simply not a keeper.

 

[vicki]

Sorry that things didn't go as well as you'd hoped . Sometimes these things do happen and for all sorts of reasons; it could be that he was just having an 'off day' or perhaps that he isn't actually cut out to work with nervous patients really - unless they're sedated. Working with nervous patients does take a huge amount of patience and from what I gather, it can be very stressful for the dentist and also the nurse(s) as well. However, people who genuinely do enjoy working with nervous patients and helping them to overcome their fears, whether that's through sedation, psychological techniques or just being a nice person who treats their patients as human beings, usually accept the extra stress caused because they know that it's actually a two-way thing, where the dentist's behaviour affects the patient's behaviour and vice versa.

I've been thinking a lot about all of this and actually the more I do, the more convinced I'm becoming that I haven't done anything wrong.

From what you've said, I don't think you did anything wrong at all. If a practice is promoted as having a special interest in working with nervous patients, then although for some people sedation is a major part of that, I would expect them to also be accustomed to talking to patients and providing the necessary time and reassurance needed in each case. It sounds a bit like it was a production line where you were expected to just go in, sit down, get sedated, have your treatment and then go home.

I do definitely understand that I mustn't go around whacking my dentist (!) and that if I interfere I could cause harm to myself.

Most people understand that they're not supposed to resort to physical violence, but the thing is, it should never escalate to that point in the first place if there is two-way communication between you and your dentist.

Human reactions in times of panic or extreme stress does vary from person to person; some people sit there and shake, some jump up and do a runner and some lash out, but it's a response which is designed to protect us in times of real danger, not in a situation which is either not dangerous in the first place or which we could control and de-escalate by other means (e.g. by asking the dentist to back off instead of whacking them).

Part of overcoming and dealing with fears involves communicating with your dentist so that things never actually get to the point of panic, so that through effective communication (and patience) you learn to cope with things over time and with repeated positive experiences. With practice, the panic does eventually subside. However, if you have sedation, that psychological learning doesn't happen which means that each time you are faced with a potentially panicky situation, your brain has no previous, more controlled experiences to refer to and so the panic reaction is set off - even if it's something that you might have experienced several times before.

Having said all of that, your new dentist already knew that you were nervous from your previous appointment and discussions with him. Although (technically) he was right to point out that you mustn't hit out, the fact that someone feels the need to do that in the first place, means that something has gone wrong somewhere along the line - either because they haven't talked you through what is going to happen and explained what you might feel etc, before they do it, or that although it may have taken you by surprise, hitting out is a bit of a drastic panic reaction, which probably wouldn't happen if a) you had proper trust in your dentist in the first place and b) things were taken at a calmer pace where you had sufficient time to process what was happening along with previous positive experiences to draw upon.

Either way, he could have handled it a lot differently - he could have said something along the lines of: "Well you know it's important that you don't do that because you could hurt yourself or me, but I will be talking to you throughout so that you know what's happening and what to expect. If you want a break at any time, just let me know and I'll stop straightaway" etc etc.

I think the problem is that "Working with Nervous Patients" means different things to different people. If you look at various dental practice websites, quite a few have a nervous patients page which explains how they help patients with various fears and anxieties. Some places talk about how nice their dentists are and how their relaxed and calm manner helps patients to overcome their fears and that they also offer sedation for those who need/want it, if time, patience, tlc, de-sensitisation etc isn't enough. Other practices talk about sedation only and how it makes you relaxed and sleepy and how you won't usually remember anything about the treatment, so it's great for nervous patients. They don't say anything about what else they do to help patients and so the art of helping someone actually becomes more of a science. The trouble is, in the real world, everyone is different, so whilst doing root canals and fillings may be very scientific and precise, communicating with different patients and helping them as individuals is very much an art.

The other aspect is control. If I ask them to stop (or wail in pain/distress since I can't speak with my mouthful!) and they don't, then I do, to be honest, feel within my rights to physically try to make them stop. It obviously should never, ever come to that. But just because they are the dentist/nurse etc and I am the patient does NOT put them in control. I have chosen to be there and to trust them to do what's right for me (which is why finding the right dentist and feeling safe with them is such a big deal), but that doesn't mean they get to do whatever they want and I just have to put up with it. If it did mean that, I'd never get in the chair!

If you ask someone to stop and they don't, as one dentist pointed out to me several years ago, technically they're continuing against your consent, which is more or less assault.

About 12 years ago, I had to go to hospital for an endoscopy (where they feed a camera down your throat and into your stomach) as I had developed severe acid reflux. Most patients opt for IV sedation, although you can go without sedation and just have anaesthetic spray at the back of your throat if you prefer. For some reason, I let them persuade me to have sedation and so I went into the room where the trolley was, laid down and the doctor put the IV in and injected the midazolam. After about what seemed like a minute, the doctor started putting a piece of plastic in my mouth to hold it open. At that point, I didn't feel sedated at all, but I was starting to panic because I thought they were starting before the drugs had kicked in. I spat the plastic thing out and so it was put straight back in. I spat it out several more times (I was laid on my side, so it kept dropping on the floor which meant they had to keep getting a new one ) and the whole time, I was hyperventilating, panicking and telling them (very clearly) over and over again "NO!". Despite this, the nurse who was stood behind me, just held my arms so that I couldn't move and they carried on.

I didn't feel sedated at all, yet the IV was definitely in the right place and the drugs had been injected. Some time later, I was laid on the chairs in my mum's office as she worked at the same hospital and I could hardly stay awake. My face was covered in purpura (tiny blood spots where the blood vessels beneath the skin leak - similar to the meningitis rash) because my blood pressure had shot up and I had bruises all over my arms. She was (quite rightly) extremely concerned and so phoned the consultant who'd done the endoscopy to find out what had gone on and he told her that I'd been struggling with them throughout. When I later told her that they'd carried on, despite me saying no repeatedly and that they'd held me down, she was furious. Needless to say, heads rolled since she was one of the senior managers.

After that incident, I realised that far from making things a nice relaxed experience, sedation takes away any sense of control and so you are totally in the hands of the people treating you. This is fine if you trust them 100%, but if you don't, then you either need to find someone who you do trust 100% or find a way to cope without it.

Last year (and earlier this year), during all the root canal treatment I've had, coping with the rubber dam (which is a huge no no for me) and the length of appointments plus any possible pain, was a terrifying prospect, however a decent dose of diazepam was a good 'half way house' because it ticked all the boxes; I was in a very chilled out mood and wasn't really bothered about what was going on (and taking it the night before helped with this as well ); I could still communicate and hold a normal conversation; I could remember everything that was happening (well apart from the bits where I was really comfortable and fell asleep and then tried to act as though I'd been awake all along! ) and the positive knock-on effect of this is that I'm much better during normal checkups and more simple treatment now; and more importantly, I still had control of my arms and legs and so could walk (or stagger since my legs felt as though they belonged to someone else!) out if I needed to.

Maybe the answer is just having a stop signal, although I don't know how well I'd remember it or be able to use it while sedated.

Stop signals are only any use if you can use them and you know that the dentist will actually stop .

I think the only way to guarantee I'll never react is to knock me out. I can try my hardest, but when that panic takes over I'm not in control any more. People do crazy things when they're panicking!!

The key is not to let it get as far as panic in the first place - and with the right dentist, this is possible.

From everything you've posted so far over the past few months, it doesn't seem as though sedation is actually helping you really in the long run, especially considering your fears about not being in control. It might enable you to get treatment over and done with, but if you imagine that it's a bit like learning to ride a bike. The first time, you sit on the saddle, it feels a bit odd, you take your feet off the floor, start to pedal and then you fall off. It hurts a bit (or a lot!), you cry, your mum rubs your grazed knees better, sticks a plaster on it and tells you to try again. The second time, you get back on the bike, you pedal, you wobble along for a few seconds and you fall off again, but you've moved a bit further this time. You try again and again and again and you get a few bruises and grazes in the process. Eventually, you learn to ride your bike and before long, you're out all day in the summer holidays, riding your bike with your friends.

Using the same example, but applying it to dental phobia; if every time you need treatment, you have sedation, so that you don't have any proper rational fully conscious memories of what happened, it's like repeating the first time you try to ride a bike, but over and over again, because you don't learn from the experience and move forward. Lots of people find sedation really helpful, especially for occasional long appointments or complex treatment, but if you get into a cycle of believing that you *need* it, then it can be very hard to break that cycle. Henry Ford once said:“Whether you think you can, or you think you can't--you're right.” and it's true. If you think you can't do something, then your brain becomes biased and sets everything up to find reasons why you can't. If you believe you can, the same thing happens; your brain works towards things that enable you to make it happen.

I think what upset me so much yesterday was that he didn't even try to understand. I mean, he could have said "Well, you really must try not to do that because it's dangerous, but I'll make sure I keep talking to you, so hopefully it shouldn't happen." But he didn't, he just told me off....in a kind of pleasant voice (that's the only way I've ever heard him talk) but nonetheless I felt like a little kid being told off, and instead of feeling reassured I just felt even more scared. I don't think I did raise my arms at all during the appointment yesterday, that I remember, but I did a few times lie there crying and moaning and wimpering and wishing he would stop.

People deal with others who are panicking or upset differently - some people instinctively know what to say to make everything OK, some people might get it a bit wrong but at least they try and some people feel uncomfortable when another person is upset, so instead of actively trying to help, they either ignore it (hoping that you'll calm down by yourself) or dismiss it (hoping that you'll shut up so they can get on with their work). From what you've said so far, it seems as though whilst he may be technically very competent, he's not naturally gifted at working with nervous patients, however with sedation that's not a problem once the drugs have kicked in.

To a certain extent, what Tome said is correct - it is possible to train your dentist - if they're amenable to learning. It may be that he does want to help, but doesn't quite know how to go about it, in which case, receiving a well written letter which clearly sets out what you're worried about and what you'd need to know or to happen for you to feel OK, might just be what he needs. If you write a letter and post it to him before your next appointment, then by the time he next sees you, he will have read it. If he behaves differently and thanks you for letting him know and things generally feel better, then you might be OK. If not, then it might be time to find a new dentist that is right for you.

Just because someone is the practice owner or boss, doesn't mean they're the right person for everyone. You will know when you've got the right dentist . For me, it happens when I don't fear going to see them (for checkups or treatment); I don't feel unsafe at any time; I don't worry about whether they will stop when asked because I know that they always will; they never judge or be nasty or lose patience if I'm panicking; they're not rough (most important); that although I may be scared of certain parts of treatment, I know I will cope with it and it will be OK somehow; that they will always make sure things are numb and won't carry on if it's not; and that they are a nice normal person who has a sense of humour and treats me like a normal person even though I may at times get scared.

I've seen about 13 or 14 dentists so far in my whole life and only one has ticked every single box; it's just a shame that he's the person I'm seeing for specialist treatment and not my regular dentist . I think it was Dr Daniel who said that it's not meant to be like a catholic marriage - if you find that he's not the right person for you, then keep searching until you find one that is .

I'm also really uncomfortable about the money situation, but I don't dare complain because I worry it will make him angry with me. R mentioned giving me a refund but then she spoke to him and he told her not to. I do understand the reasoning but at the same time, as things stand, a large sum of money (about 2/3 of my total treatment cost) is sitting in their bank instead of mine, as payment for something they haven't done.

That sounds as though he's intending to go through with the rct at some point anyway so they're hanging onto your money. Hmmm.... He should have really explained that this was the case (if it was) and if not, then you should have been refunded. Having said that, I've never paid up front for any dental treatment - NHS or private . You pay after the treatment has been completed, or you pay in installments as you go along if it's a large sum of money. I think if it were me, I'd be asking them to clarify the situation - are you going to be having a root canal or not? If not or it's uncertain, then there's no reason why they can't refund you. If it later turns out that you do need it, then you just pay them the money again. If you are definitely going to have rct, then why haven't the appointments been booked in, since at this point in time, they've taken money for a service that hasn't been provided.

You're perfectly entitled to ask - you're the customer.

 

[Tome]

After that incident, I realised that far from making things a nice relaxed experience, sedation takes away any sense of control and so you are totally in the hands of the people treating you. This is fine if you trust them 100%, but if you don't, then you either need to find someone who you do trust 100% or find a way to cope without it. .

My current dentist was very surprised when I refused sedation. But my phobia is mainly caused by fear of losing control - and sedation for me is a very bad option because it plays right into those fears.

 

[Pianimo]

Thanks guys - it's really helpful being able to talk this through and read your advice.

Vicki - I have to pay upfront when I'm being sedated because you're not allowed to pay afterwards, when you're not fully aware etc. He said he is not sure whether or not I will need RCT in that tooth. I'm a bit hazy on the details because we had the conversation after treatment finished when I was still all woozy. He had expected the tooth definitely to need RCT and in the worst case scenario even to need extracting (I gave written consent to that as part of the treatment plan cos I can't give consent during the appointment, while sedated). That was based on the gland in my neck and the panoramic x-ray. I don't think there was much visible decay because it was between the two teeth, and I've had no symptoms in either of them. During treatment, as I said, I felt pain in the tooth, which he said meant the tooth was vital, which he wasn't expecting. So he took another x-ray (the one they do in the chair, that I can't normally do!) and I think that must have given him a clearer picture? He said he cleaned it all out (but presumably not the roots?) and put a filling in and then we could see how it settled in the next couple of weeks. (Although, he's going on holiday so it's going to be a month instead.) If it settles down fine then it shouldn't need RCT and presumably I'll get a refund, after that appointment. If it does need it then I've already paid for it. He said both fillings are very deep but he's hopeful they will be ok. I don't know if the filling that's in is temporary or permanent - it doesn't feel like the other fillings I've got but they were at a different practice so I don't know if they use a different material. It doesn't feel like a temp either!

I've just remembered, he did say at the beginning of the appointment - while I was crying! - that we could do less and just see how I got on, maybe only do one tooth etc. I don't remember answering him....I would rather get as much out of the way in one go but at that point I wasn't really up to talking, although I appreciated that he was trying to reassure me (though it was still going to be *him* deciding how much to do rather than me!). I don't think that was part of his decision at the end, but I don't know - I was obviously distressed and in a lot of discomfort by the end of the appointment so maybe he knew I couldn't take any more.

I do think he can't have got to where he is if he's not good at his job - and that by definition means being good with anxious patients, since that's his specialty. However, as Tome says, we're not all the same and so it may be that we just don't suit each other. I don't know. He's obviously well-liked in the practice generally - after the first time I met him, R greeted me back in the waiting room afterwards with, "He's lovely, isn't he?!" And if he were no good with anxious patients he just couldn't have got to where he has. I just find him very intimidating, which takes me back to how I felt with my childhood dentist. I feel like a kid again, with no control. I don't think it's necessarily his fault even, though really he hasn't helped!

It took me a while to get used to D4, but the biggest thing about him that made me feel safe was what Vicki said - I knew he wouldn't respond negatively no matter what I did. I found it tricky to start with that he was so quiet and laid-back, because initially that meant I filled in the blanks with assumptions that he was annoyed etc, because he wasn't saying otherwise. But I began to realise that no matter what I said or did, he would just say "Ok". So he was predictable in a good way, and I felt safe and not afraid to talk to him or ask him questions. With D5, I feel afraid to do that. And I think there's a worry that he might do what he thinks is best, because he's so sure he's right, rather than what I want. I've nothing concrete to back that up with though, so maybe I'm wrong.

As for the matter of sedation, I understand what you're saying Vicki, but I really do need it. It's the one thing that's got to me before on DFC is people insisting that it's necessary to 'move on' from sedation etc or reach a point where you don't need it. Some posters (not you!) have had a real bee in their bonnet about it for some reason, and practically bullied others over it. What happened to you in the hospital sounds horrific! I have had both positive and negative experiences of doctors/hospitals etc myself, and I think it's terrifying how hit and miss it can be whether you get a doctor/nurse who actually gives a hoot about you, or one who quite clearly doesn't. Definitely, if you don't trust whoever's performing the procedure - medical or dental - then sedation becomes a bad thing instead of a good thing.

For me, my phobia is basically mouth-related rather than dentist-related. That's why brushing my teeth at home is so difficult. I can't stand having things in my mouth and I gag really easily, which then makes me panic because I'm emetophobic! If you told me I had to sit through and hour's dental appointment fully awake I honestly think I just wouldn't turn up. Even with the loveliest dentist in the world whom I am not afraid of at all, and zero pain, I still couldn't bear the treatment. I respect and envy others who are able to cope with it, but I just have zero desire to do it. For me, the answer is a lovely dentist + sedation. I make myself cope with check-ups and cleanings unsedated, but that's my limit. When I thought (twice now!!) that I had found a dentist and a hygienist (D3 and H1 then D4 and H2) whom I felt safe and comfortable with, it was such a relief. I knew that with people like that, and sedation for treatment, going to the dentist could be something I didn't like and that made me anxious, but that I could cope with and not be too big a deal. That was huge for me and I felt so relieved and proud that I'd got there. Then, it was all ripped out from under me when I had to find a new dentist and hygienist.....and then the same thing happened again!

I've had, I think, 5 sedation appointments now. They were all quite different in my experience:
1. With D3, About 1.5 hours I think, for RCT and fillings. It was overall really positive - I was a shaking, crying wreck beforehand, but I felt happy and relaxed in the chair, and came out of the room peaceful and smiling (according to my dad!).
2. With D3. About 2 hours? More fillings and a cleaning. I had some pain and discomfort during the appointment, felt more unhappy and came out down and exhausted. One factor was that in appointment 1 there's been a nurse just there to hold my hand and take care of me, and she was lovely, but in this appointment she was ill and the one who replaced her just ignored me.
3. With D4. Maybe an hour? For RCT. This was the one with the impressions incident. It wasn't great, and I came out upset (clearly having been crying) and worn out.
4. With D4. Putting the onlay on. This was quite short, and I came out relaxed and breezy.
5. With D5. About 1 hour I think. You know the details!

So with D3 and D4, both of whom I felt safe with by the end, I had one positive and one negative experience of treatment. So on that basis alone, I think I need to give it more time with D5. It's really not straightforward anyway, I think, knowing when you've found the right one. D3 was my 'type' of dentist in that she was very reassuring and I was comfortable communicating with her. However, she said I should have my tooth extracted whereas D4 saved it. D4 was definitely not what I thought I was looking for, being so quiet etc, but his calmness had a calming effect on me, he gradually earned my trust by listening to me and being kind and not reacting negatively to my fears, and he was so incredibly gentle in his touch, better than any other dentist/hygienist I've ever had. I think that has an effect psychologically too, because the implication is that he is taking extreme care over you, which means he cares about you and won't mistreat you etc. D5 is more communicative and very pleasant but also comes across as rather assertive, which I think might inspire confidence in some people, but for me it just makes me nervous!

I think if I still had H1 or H2, I wouldn't feel so bad about my dentist not being ideal, but although I'm much happier with H4 than with H3, she's still not my ideal whereas the first two were. So I feel like I've been made to settle for second best all round. I really don't think I'd have the confidence to ask to see someone else though, given who D5 is, so I feel like I'm stuck with him. Maybe with time I will get used to him - that happened with D4 so I still have hope.

I do think that I have been able to go through that learning process of learning not to be afraid with both D3 and D4, even though we used sedation. It's just that with each new dentist it's like starting again from scratch, and that would be the same whether I used sedation or not. I have continued to make myself have hygiene appointments entirely unsedated, and I don't find that it gets any easier to cope with in a physical sense, but what does change is that I learn to trust my hygienist (especially the first 2!) so that I am more relaxed and feel safe, knowing they would stop in an instant if I needed them to, and they don't think I'm stupid for being afraid. But in terms of the physical discomfort and the gagging and the struggle to cope with having all this stuff going on in my mouth, I still hate it and find it just as difficult to deal with as I always have. So, for me, sedation is a wonderful solution to a very real problem, and as much as I would steer clear of a 'sedate 'em so that they stop being so annoying' dentists, I also would not go near a dentist who wanted to 'wean' me off needing it. Sedation makes something unbearable bearable for me, and what I need is the right dentist to go alongside that.

Sorry Vicki, I know I've been very defensive and I hope I've not offended you at all. I'm really grateful for your advice and I can understand the logic behind what you're saying but I honestly believe that for me, going without is not the answer. Also, I've never had the experience some people talk about where one minute they're having the IV put in and the next they're in recovery. I know I've had times where I've faded in and out during appointments, but I've always been aware for large chunks of it and can remember it afterwards - very clearly initially, then over the next day or so it starts to get blurry and some bits disappear. This time he gave a lower dose so I was very aware the whole time. That probably is one reason I found it so unpleasant tbh!! For me, the 'happy' memories I have from treatment that help me be more confident the next time are the ones where I was lying there relaxed and sleepy and actually not caring that they are doing things in my mouth (which is just unthinkable for me!). The bad memories are the ones where I was more aware and uncomfortable or in pain or just hating having all this stuff happening in my mouth and desperately wanting them to stop. Being unsedated would inevitably mean having far more of the latter kind of memories and probably none of the former! Even in my best hygiene appointments where I went in not too nervous and came out happy, I still hated every second of the cleaning itself.

Oh dear, I'll get off my soapbox now!! Fwiw Vicki, I think your latest dentist sounds lovely. I just need to find me one of those.....

 

[Pianimo]

Ha, Vicki, I've decided you're a bad influence on me - I just manage to train myself to start writing shorter posts, then along you come and I'm back to posting essays again!

 

[Tome]

that's got to me before on DFC is people insisting that it's necessary to 'move on' from sedation etc or reach a point where you don't need it. how hit and miss it can be whether you get a doctor/nurse who actually gives a hoot abSome posters (not you!) have had a real bee in their bonnet about it for some reason, and practically bullied others over it.

I strongly feel that what the patient wants and needs is what should happen (unless a request is positively damaging i.e. would harm them or the dentist).

So, if someone wants sedation it should be available.

And if someone doesn't want sedation, that also should be available.

It's really black and white to me that when you're dealing with someone who's a phobic and has been avoiding dentists for years... just getting them into the dentist chair is a major achievement for them and, once in the dentist chair, their needs and wants should be catered to. That's far more important than some theoretical optimal treatment plan.

 

[vicki]

Vicki - I have to pay upfront when I'm being sedated because you're not allowed to pay afterwards, when you're not fully aware etc. He said he is not sure whether or not I will need RCT in that tooth.

I see what you mean now, although they could still ask you for payment afterwards (on another occasion when you're 'sober') either by you paying in person or by them sending an invoice which you then pay. It just seems a bit strange that they would ask for such a large amount of money up front, when they don't know for sure that you need rct . The other thing to consider is that whilst your money is in their bank account, they're earning the interest on it which they then keep - even if you don't need rct and they eventually give you a refund.

All the root canals that I've had recently (and during each appointment, I've been spaced out on Diazepam ), have all been invoiced several days or sometimes weeks after each one was completed, so I either sent a cheque through the post to pay the bill, or handed a cheque over when I went to the next appointment if it was only a couple of weeks away. On the other hand, my normal dentist charges for the treatment straight after the appointment (like most do - where you pay at reception on your way out), so on the one or two occasions where I've had diazepam for treatment there, I've still paid before I left, but I did have someone with me to take me home (and make sure I knew what I was going !), but also, I had already agreed to the cost and treatment at the previous appointment where I was sober and un-drugged, so even though I put my card in the chip and pin machine to pay, I was only paying what had been previously agreed and also my friend checked the amount for me before I put the PIN in, just to make sure (not that they would try and fleece me whilst I was away with the fairies, but you can never be too careful! ).

During treatment, as I said, I felt pain in the tooth, which he said meant the tooth was vital, which he wasn't expecting. So he took another x-ray (the one they do in the chair, that I can't normally do!) and I think that must have given him a clearer picture? He said he cleaned it all out (but presumably not the roots?) and put a filling in and then we could see how it settled in the next couple of weeks.

It sounds a bit like the situation I had with my lower left molars when I used to go to an NHS practice a few years ago. I'd been having pain in my first lower molar for about 3 months until it got to the point where I was told (after I'd had some sort of sealant stuff put on it yet again) that if it didn't settle down within a week, to phone up and book a root canal appointment. Anyway, the pain got worse, so I did as I was told and phoned to book an hour's appointment for a root canal. By the time I went to the appointment (which was about 3 weeks later), the pain had spread to the second molar as well, so the dentist said that he didn't have time to do two rcts and that he wasn't sure which one was causing the pain anyway. So instead, he would do two fillings with some sort of steroid/sedative stuff in to see whether that solved things and that he would put a temporary glass ionomer filling on top, so that if they worked, the top part of the filling could then be replaced with a permanent filling.

It was all fine for about two days and then the pain came back in the first molar again but it was much worse this time, so I booked an urgent same day appointment and the dentist tried to open up the tooth into where the pulp is, to put a dressing in there, but it hurt too much (it wasn't numb despite several injections), so he did as much as he could and said that I needed a root canal.

To cut a long story short, the pain never really settled until I had the root canal re-treated and also rct on the tooth behind, but I think it does depend on what's actually wrong with your tooth and also how close to the nerve the fillings go and how much your teeth can withstand.

Quite often, people have root canal treatment because they've either got an infection or abscess, or the tooth has died so it needs filling to prevent an abscess, but sometimes it can be due to irreversible pulpitis (which hurts... a lot) where the pulp becomes inflamed to the point where it can't recover anymore (unlike with reversible pulpitis where if you fix the cause, it should solve the problem), which as I understand it, often leads to an abscess if the tooth is left untreated.

In my case, all my molars (apart from my wisdom teeth) ended up with irreversible pulpitis (possibly due to a combination of acid reflux, me possibly grinding my teeth and also numerous rounds of drilling and filling by various dentists over the years), but fortunately because I was seeing an endodontist for the re-treatment of the existing root canal anyway, I opted for root canal treatment before it got to the stage where I ended up with an infection or abscess. It relieved the pain within a couple of days and things have been a lot better since.

I know that they use x-rays to detect traces of infection, but I think they can also see how large the pulp in the tooth is, which can be a possible indicator of inflammation. Just a guess, but it might be that if he thinks your tooth is inflamed rather than infected, then there's a chance that a filling might settle things down and possibly avoid the need for a root canal.

He said both fillings are very deep but he's hopeful they will be ok. I don't know if the filling that's in is temporary or permanent - it doesn't feel like the other fillings I've got but they were at a different practice so I don't know if they use a different material. It doesn't feel like a temp either!

It might be a temporary filling - especially if he's intending to either do a root canal at a later stage or replace the filling with a permanent one. Again, I'm guessing, but I think it might be because permanent filling materials are more 'robust' and so take more work to remove, so to save your tooth from unnecessary drilling etc, they put a temporary one in until they're sure what's going on with the tooth.

He's obviously well-liked in the practice generally - after the first time I met him, R greeted me back in the waiting room afterwards with, "He's lovely, isn't he?!" And if he were no good with anxious patients he just couldn't have got to where he has. I just find him very intimidating, which takes me back to how I felt with my childhood dentist. I feel like a kid again, with no control. I don't think it's necessarily his fault even, though really he hasn't helped!

"Lovely" means different things to different people though and we perceive other people very differently. I remember the last dentist I saw at the NHS practice a few years ago. The nice one I had been seeing had left and so because they knew I was nervous, the people on reception (who were nice) decided that rather than put me with my dentist's replacement, because they didn't know what he would be like, they recommended that I saw one of the dentists who was already there and in the words of the nice head receptionist: "Oh he's lovely and really gentle, you'll be fine with him".

I went to see him a couple of weeks later and, expecting him to be OK because they'd said he was, I instead discovered that whilst he was indeed very gentle and I hardly felt a thing, he also didn't talk... at all. He said hello when I went in and then nothing... absolute silence throughout the entire examination and treatment. Whenever I spoke to him at the beginning of appointments, whatever I said, his response was always "Oh. Not to worry". Certainly not my idea of "lovely" at all, especially since I need them to talk and tell me what they're doing otherwise I start to panic. Like you, I felt like a child again, with no control over what was happening, so much so, that's what made me leave and go elsewhere.

As for the matter of sedation, I understand what you're saying Vicki, but I really do need it. It's the one thing that's got to me before on DFC is people insisting that it's necessary to 'move on' from sedation etc or reach a point where you don't need it. Some posters (not you!) have had a real bee in their bonnet about it for some reason, and practically bullied others over it.

Realistically, there does come an end-point to having sedation eventually though - can you imagine being 95 years old and hobbling in there with your zimmer frame? Most people do reach a point where they don't need it eventually and for all sorts of reasons; maybe because they've reached a point where they decide that they want to start overcoming their fears, or they've got a different dentist who they feel more comfortable with, or some other reason. But the thing is, it takes varying lengths of time to get to that point because everyone is different - for some people it's only a few months, some people a few years or maybe even decades, because people progress at the rate which is right for them.

I think what struck me about some of your recent posts, is that you seem to have experienced stress and anxiety, whether you've had sedation or not sometimes, which is very different to the people who post stories about going in, having the IV sedation, not remembering much after that and then going home feeling wonderful. If you're going to experience the anxiety and stress whatever you do, then I just wondered whether it might be a better long term solution to pro-actively start managing and taking control back, so that in the longer term, you could start to feel better.

Sometimes, people have multiple fears that are all tangled up with each other, but underneath it all, they have one underlying fear that drives it all (e.g. your phobia being mouth related and being emetophobic which then fuels your dental fears and possibly problems with your own dental hygiene at home), which if addressed, it can lead to improvement in other areas too.

I think the only time I really get a bee in my bonnet, is when people insist that there is only one way to deal with things e.g. sedation is the only way for anyone with a fear, or alternatively you mustn't have sedation because you'll come to depend on it. Some people can't cope with treatment any other way than with IV sedation, some people are completely terrified by the thought and couldn't possibly go anywhere near it and some people are in between, dipping in and out of various things that can help as and when needed.

Personally, I never thought that I'd end up taking diazepam for treatment. Taking beta blockers for appointments was OK because although they slow the heart rate and curb the adrenaline surge, they don't affect you psychologically, so I knew I was always in control. But most people have a brick wall or barrier that they come up against at some point and for me, that barrier was long appointments and the prospect of having to cope with the rubber dam (totally impossible). So needs must and I decided to try diazepam. It worked a treat and now I know how it works for me, I know it's there if I need to use it again, but I don't intend to if I can cope without. Having said that, 8 rcts means 8 crowns at some point and that means impressions - which I really don't cope well with at all. So somebody will be writing a prescription for some more happy pills for me at some point .

What happened to you in the hospital sounds horrific! I have had both positive and negative experiences of doctors/hospitals etc myself, and I think it's terrifying how hit and miss it can be whether you get a doctor/nurse who actually gives a hoot about you, or one who quite clearly doesn't. Definitely, if you don't trust whoever's performing the procedure - medical or dental - then sedation becomes a bad thing instead of a good thing.

It was horrific - one in a long line of horrific experiences over the years. The thing that started it off, was that I'd actually had midazolam (the IV sedation drug) a couple of years earlier when I was having surgery on my wrist. I was getting really stressed before they gave me the GA in the anaesthetic room at the hospital, so they gave me a hefty dose of midazolam and I don't remember anything else until I woke up in recovery. My mum was there with me and said that it was about 5 or 10 minutes after the midazolam that they injected the GA drugs, but I don't remember this at all. So, when I went for the endoscopy, I was expecting the same thing to happen again - that once the drugs had been injected, I'd blink and it'd all be over again. But it wasn't - I didn't feel the weird room spinning feeling and I was awake and panicking the whole time. Not what I expected at all!

It can be very hit and miss and I think if you need sedation and you also have fears about not being in control, then it becomes even more important to make sure that you're seeing someone who you do feel safe with and who does give a hoot.

I remember when my dentist originally referred me to an endodontist to have my first root canal re-treated last year. The guy he referred me to, turned out to be an absolute monster who couldn't care less, had no patience, was rough, rude, impatient and basically ticked all the wrong boxes. No way was I going back to him for a second visit and thank god my first visit was only for a consultation and a couple of x-rays, nothing else. What made it worse, was that my dentist had reassured me about how wonderful this guy was supposed to be; very calm, very patient etc etc. Anyway, some time after I'd gone to see another endodontist (who I see now ), I came across some posts on a dental professionals forum from the first guy I'd gone to see, where he was talking about receiving referrals from other dentists for rct and he was referring to patients in the most derrogatory manner. I think he actually referred to certain groups of patients as pukers and gaggers and that the only way to deal with them was to sedate them. Whilst I know that a fair amount of banter and joking goes on between professionals (which patients are not supposed to hear), it still was not the sort of language that you would expect to see from someone who is supposed to be good with nervous patients! I think I had a very lucky escape indeed.

I think, if it were me in your situation, you need the sedation but you're not sure about the dentist and whether you feel OK with him or not, I would try writing him a letter setting out a bit about why you're scared, what your specific fears are and what he can do to help. If you send it through the post in plenty of time before your appointment, he has to have read it before he next sees you. It would take a pretty hard and nasty person not to respond positively to such a letter, because you're actually writing it with the intention of trying to improve things - for you and also to make his job easier. Once you've sent the letter and you then go to your next appointment, with any luck, you should start to see some improvement in how he is with you and it might even open up some useful conversation which might help. If not and nothing changes, then it might be time to re-consider.

I went through a similar thing about 9 years ago:

The Letter

One thing that struck me - why not send the letter off to the other recommendation you got as well? That way, you'll have a chance to "compare responses" (if they have the time to respond)... Good idea 8-) - except that by some strange coincidence, the recommendation is for a practice which is...

www.dentalfearcentral.org

Sorry Vicki, I know I've been very defensive and I hope I've not offended you at all. I'm really grateful for your advice and I can understand the logic behind what you're saying but I honestly believe that for me, going without is not the answer.

You're not being defensive and no you haven't caused offence - you're perfectly entitled to voice your thoughts and opinions the same as anyone else, after all, that's what DFC is here for; to discuss things, share ideas etc .

Fwiw Vicki, I think your latest dentist sounds lovely. I just need to find me one of those.....

Oh he is totally lovely . I don't think he does IV sedation though, so it wouldn't be any good for you . Having said that, I don't think he'd prescribed diazepam or similar before I turned up with a mouthful of problem teeth, but when my GP refused to prescribe any more because they didn't believe I could possibly need that much dental treatment, he spoke to a pharmacist to make sure that he was allowed to prescribe it and he has prescribed for my treatment ever since, so you never know (but then again, you'd miss the amusing stories that he sometimes tells if you were sedated! ). My usual dentist has recently started offering IV sedation though, but like you, I'm having dentist doubts of my own at the moment anyway .

 

[Pianimo]

Thanks both of you again. I'm glad I haven't offended you Vicki. There were one or two posters in the past (you may know who I mean!) who could be really pushy about this issue and it made me nervous about voicing my opinion, even though I know that's not what DFC is really like! Either extreme - 'sedation is for everyone' or 'everyone who has sedation should be trying to wean themselves off it' - is unhelpful and doesn't allow for how different we all are.

I have GAD so I am anxious about things generally, with doctors/dentists etc being a trigger, and also have a few phobias. The mouth thing kind of predates all that though - that's been there as long as I remember and is not so much a fear as it's like someone who faints when they see blood - I have a physical reaction to seeing mouths. I can see that I have since built up fear and anxiety around it because of that reaction, but originally I wasn't afraid I just gagged/threw up when I saw a trigger (and this was long before I became emetophobic). So there is anxiety attached to it but even with no anxiety whatsoever I still would just find having dental work done (or cleaning my teeth, etc) one of the most unpleasant experiences I can think of. So, for example, I would rather have a painful procedure on my hand than a pain-free, unsedated dental procedure; and if you offered me a million pounds if I sat and watched someone else having dental treatment, I still don't think I could do it!! I'm not afraid of watching, I just couldn't bring myself to do it, and the money isn't worth it!! I know this makes me weird!! But I honestly don't think it's likely ever to change.

For that reason alone, I really don't mind if I need sedation for my whole life. The anxiety adds another layer and another reason to use it; I would love in one day I got better and stopped being so anxious about everything, but even then the primary issue still remains. I don't feel a need or a desire to stop using or relying on sedation. It obviously bothers some people (again, not you Vicki!!) that I would say that, but it doesn't bother me at all. I personally can't see any difference between IV sedation, oral sedation (like diazepam), even listening to music or closing your eyes....sure, any of us could make ourselves manage to go without the things that help us cope, but why should we? If you find something that works, use it!!! To me it seems daft not to. Just my opinion!

I do appreciate what you're saying in that I've had bad experiences even with sedation. However, I have had two experiences - to my memory, the only two in my life - where I was actually relaxed and content in the chair, and they were both due to sedation. What I want is for every appointment to be like that! Or, at least, most of them. My unsedated appointments probably never will be, but my sedated ones can be, and that's what I'm aiming for. So for me that means sedation, but also an understanding dentist who is kind to me and with whom I feel safe. Jury's still out on whether D5 can be that dentist.

It's interesting what you said about the dentist who just said "Not to worry" and then worked in silence - he sounds a lot like my D4!! However, when I asked him to talk more he did and I grew to feel really safe and comfortable with him by the end (just in time for him to leave! ). In terms of writing a letter, I can see why it's a good idea but I really wouldn't know what to say. I already had a talking appointment with him when I first met him, and I told him a lot about my history and my fears etc then. So I can't really just say the same things again. What would you think I should say? I daren't say anything that sounds critical of him or of anything that has happened, and I've already told him my background, so doesn't really leave me much to say!!!

Wrt payment, I usually pay at reception after the appointment, but when I've been sedated I pay beforehand instead. That was the same at P2 (my last practice) too, and I think it's pretty standard. When he drew up the treatment plan he was convinced RCT was necessary and only changed his mind during treatment. He also planned to see me in just a couple of weeks, but it's turned out to be double that because of my own schedule and then he is going away. So he probably thought for a couple of weeks it wasn't worth it, though I still think I should be the one to make that kind of decision about my money!! I have had no symptoms in either tooth prior to treatment and afterwards it ached for a few hours, and has been a bit sensitive to chew on (almost back to normal now), but that's it. So hopefully that's a good sign. Thanks for explaining all the details - that's really helpful!

As for the filling itself, it looks like the same material in both teeth, so I assume it must be permanent, as can't see why he'd put a temp in the other tooth? Though he did say both were very deep and we'd need to see how they settle. They don't seem the same colour/consistency as the other composite fillings I have but they are cheaper ones! They definitely feel more solid than the temps I've had before.

One positive thing I've just thought of, he put the IV in more quickly and painlessly than pretty much any dentist/nurse/doctor I've ever had! Normally I have a really sore hand/arm afterwards and all kinds of bruises - this time there's just a teeny dot and you'd never know it was there. It's all part of who he is though - when I told him that people normally find it hard and apparently my veins are too close to my skin (been told that a few times) he just said "Nonsense!" - which is a typical response from him!! He did say he does 20 a day (!) .....I don't think it can be quite that many but I suppose that does point to how many (anxious) patients he is seeing.

I think maybe that's the issue because I guess amongst all those, I'm just one more, and maybe it's easier to treat us all the same (nicely, but the same) than to figure out what is best for each one of us. The thing is, it may all be a doddle to him, but every appointment and everything I mention to him is a big deal to me and brushing it aside because it's not an issue to him doesn't help me. I guess some people will take confidence from the fact he is so sure of his own ability to help and do a good job, but it puts me off because I feel kind of insignificant to him, rather than an individual person he's really keen to help. When he says/gives off a vibe of, "You have nothing to worry about cos I'm really good and experienced at this", I don't feel reassured, I feel scared, because it makes me feel like he won't take kindly to me raising an issue or suggesting (shock horror!) that something he's doing actually isn't what's best for me or what I'd prefer. I don't know whether that's fair or accurate in reality, but it's what his words and manner communicate to me. Someone very sure of themselves is not very approachable, are they? Or, at least, not to someone like me they're not.

Maybe, though, I'll get used to him, and then he'll seem less scary, and I'll start to feel safe with him. That's what I'm hoping....

 

[vicki]

Thanks both of you again. I'm glad I haven't offended you Vicki. There were one or two posters in the past (you may know who I mean!) who could be really pushy about this issue and it made me nervous about voicing my opinion, even though I know that's not what DFC is really like! Either extreme - 'sedation is for everyone' or 'everyone who has sedation should be trying to wean themselves off it' - is unhelpful and doesn't allow for how different we all are.

I think I know who you mean . In an ideal world, your anxiety would improve and you would eventually wean yourself off sedation, but in reality, everyone is different and what works for one person, may not work for another. Things also change, what seems impossible now, might be very different in 10 years' time. If having sedation enables you to have the treatment, then so be it - it's better than not having the treatment at all . I can remember at my first appointment with the person who's been doing all my rcts; when I mentioned that I was really anxious, have had a lot of bad experiences and pain in the past and so I was thinking of trying diazepam because I can get really stressed out, I was expecting him to react negatively. But instead, I think he said something along the lines of "If it means that we can get you through the door and you feel comfortable, then that's what's important". Taking diazepam for me, isn't ideal, but since that first appointment, my outlook on things has changed a bit as well and if I need to take it, I do. It's as simple as that.

I have GAD so I am anxious about things generally, with doctors/dentists etc being a trigger, and also have a few phobias. The mouth thing kind of predates all that though - that's been there as long as I remember and is not so much a fear as it's like someone who faints when they see blood - I have a physical reaction to seeing mouths. I can see that I have since built up fear and anxiety around it because of that reaction, but originally I wasn't afraid I just gagged/threw up when I saw a trigger (and this was long before I became emetophobic). So there is anxiety attached to it but even with no anxiety whatsoever I still would just find having dental work done (or cleaning my teeth, etc) one of the most unpleasant experiences I can think of.

In my 'other job' in hypnotherapy, I do work with people who have GAD from time to time and I know how it can have a major impact on life at various times. Everyone is different, but quite often, it has a kind of 'snowball effect' in that it starts off quite small and limited in the way if affects a person and from there, it just gets bigger and bigger, until it touches nearly every aspect of a person's life. Fears and phobias quite often behave in a similar way too; in that they start off quite specific, but if left unchecked, they can get bigger and bigger and start to encompass more and more things.

Your physical reaction to seeing mouths, sounds very much like a conditioned response of sorts, which the more it happens, the more it reinforces itself. You might know what set it off originally, or you might not - sometimes these things are caused and can happen for a wide variety of reasons, however if it is a conditioned response, then it can (with the right therapist), be unlearned or unconditioned. You may be familiar with Pavlov's experiments with dogs, where he rang a bell every time the dogs were fed. Each time the dogs received, they salivated. After a while, he rang the bell (the stimulus) but didn't produce the food, yet the dogs still salivated (the response). In your case, you see a mouth or something mouth-related (the stimulus) and you gag/throw up (the response).

There's an article on conditioning on Wikipedia here:
https://en.wikipedia.org/wiki/Conditioned_response

I can't say for definite that you would be 'cured', but this sort of thing usually responds very well to hypnotherapy, since a lot of what we do, is to 'condition' people to respond in a different way, or in other words, to replace one way of responding to a trigger or stimulus, with another. There are also different techniques that can be used if necessary, to get to the root cause of why it all started in the first place.

In terms of writing a letter, I can see why it's a good idea but I really wouldn't know what to say. I already had a talking appointment with him when I first met him, and I told him a lot about my history and my fears etc then. So I can't really just say the same things again. What would you think I should say? I daren't say anything that sounds critical of him or of anything that has happened, and I've already told him my background, so doesn't really leave me much to say!!!

You say what you would like to say in an ideal world, if fear/nerves didn't stop you saying it in person. You say what you want things to be like and what you think would help you to have a good appointment and to feel OK. It doesn't matter if you've said it before, it won't harm them or you by putting it in writing - if anything, it's more likely to be remembered. Most patients don't write letters to their dentists, but some do and most of the stories on here where people have done the same thing, have had a positive outcome.

You don't need to be critical of anything that has happened previously, instead you talk about things going forward and present it in such a way that you're writing the letter to help him to help you. It may be that he sees quite a high number of nervous patients and if so, it's probably quite difficult to remember what helps for each individual patient. That's possibly why he has developed an air of confidence which he hopes will work for most people.

When you write a letter, it goes on your records, so it will be there for him (and your hygienist) to refer to before each appointment if they need to, so that they can remind themselves of what works for you. Most dental practices use a similar electronic records system, where it is split into two parts - one part contains your contact details and appointments plus any general notes and the other part contains your dental records and any documents such as referral letters, test results and x-rays etc. Usually, the receptionists can only see your appointments and payment history as well as your contact details. But the dentist, hygienist and nurses can see everything. If you write a letter before your next appointment, they can put something on the system in the general notes section so that they know how to help you and/or to read the letter (which will also be on the system).

Shortly after I left the NHS practice I used to go to, I requested a full copy of my notes from them. About a year before I stopped going there, I wrote a letter to my dentist which explained about my fears, what exactly caused me fear and what he could do to help. The only difference was that instead of posting it, I gave the letter to him in his hand after he'd done a couple of LA injections, just before I went back to the waiting room to sit whilst they took effect (and whilst he saw another patient). About 20 minutes later when I went back in to see my dentist for him to start treatment, he didn't say anything about the letter, but he had obviously read it, did everything I had asked and subsequent appointments were a lot better. When they sent me a copy of my notes after I requested them, not only had they scanned my letter in so that it was on the system, but the dentist I gave it to, had put that I was phobic in the general notes section, that I needed more time and to read my letter (for other dentists to read if they needed to).

You could start off by saying something about appreciating him trying to help you and that he may remember at your last appointment (the one this week) where you were very anxious and cried a bit etc etc and lead into it that way, by saying that you thought it might help if you explained some of your specific fears and also what might help, so that future appointments can go as smooth as possible... or something along those lines. I think I started by drawing up two lists; what I was scared of and what might help.

You could always post a draft on here - I'm sure people will be able to give you useful feedback and suggestions .

 

[Pianimo]

Well, I'm not sure how this happened, but I'm back at the dentist tomorrow. I'm sorry for not replying to your last post Vicki - I've spent this summer either away or under lots of pressure from work (or both!) so all dentistry-related thoughts have been pushed to the back of my mind (well, as much as they ever can be!). I've been so busy (fraught would be another word for it!) that these appointments really have crept up on me. And yes, I said appointments....after all that faff trying to separate out my appointments, I decided this time just to put my review on the same day I was already going to see H4....well, it seemed like a good idea at the time.....

I'm seeing H4 first, which I'm both relieved and worried about! I generally fall apart at the end of appointments from the sheer effort of getting through them, so unless I'm still running on adrenaline from knowing there's another appointment to come, I'll probably be going in to see D5 exhausted, in tears and with all reserves empty. Lovely. On the other hand, it does at least mean that my teeth will look nice when he sees them! (I'm still struggling with keeping things up at home so they do need a clean. ) I'm worried enough about H4 seeing what they're like; at least I only have to go through that with one of them!

As for the review itself, I've no idea what D5 is going to say about the tooth....or teeth? I think he was waiting for both of them to settle before making any decisions. I've had some sensitivity to heat there since the appointment, but no toothache or other symptoms. I'm hoping that's a good sign but I really don't know. I don't know if he'll need another x-ray or anything. Not knowing what to expect from the appointment plus being scared of him anyway isn't great really, but with all that's going on with work I'm not as worried about it as I should be, if you know what I mean! I also don't know what's going to happen about the money situation (I paid for treatment I didn't have and they kept the money) - the plan was obviously for it to be resolved tomorrow, so I hope it is and that I don't have to be in any way assertive, because there is simply no way that will happen!

I haven't had chance to think about writing the letter, but I think I may do it ahead of the next time I need treatment....which may be soon or, hopefully, not for a while!! I do reckon they must have most of what I would say in my records already, because in my first appointment with H3 (and I think D4 as well), when I was telling her about my phobia and my history etc, the nurse was typing up notes of everything I said. Of course I don't know whether D5 has read some or all or none of it, but it should be there. I'm very worried he wouldn't respond well to me writing. But if I can't feel able to speak to him in person then I suppose writing it down is the only other option. (Well, or finding a dentist I am not afraid to talk to....but I don't really dare leave him either, so.....)

Anyway, I'm feeling glum and quite numb about tomorrow, and kind of a bit in denial. Normally I'd be panicking by now, but I think because I've not really had time to think about it, somehow I don't quite believe it's really going to happen! The glumness comes from knowing I'm going to see two people neither of whom I really want to see. Trying to be positive thought - I'm hoping that the appointments will go well and I will start to feel comfortable, at least with one of them. Maybe, just maybe, I'll come out , or even, or even better, !

Well, a girl can dream....

 

[Pianimo]

Well that was over before it began. I'm now unable to make it today so I've had to call and rearrange. I do feel frustrated as well as the usual "Wahoo, I don't have to go!!!" feeling! Particularly as they've rearranged me for 5 weeks' time, which is quite a long time given D5 originally wanted to see me within 2 weeks of my treatment (which was at the beginning of August). I would quite like to know what's going on with both my teeth and my money! I did say I'd rather I could come sooner, but the receptionist didn't offer another time so I just accepted it. I may email R later and see if there is anything earlier available.

I did at least pluck up the courage to ask about the money situation....apparently it's listed as credit on my account and they are just waiting for my appointment with D5 to confirm for definite whether to give the refund. I have never been concerned that they were about to take off with my money , it just seemed a little off to me that this money is sitting gaining interest in their account rather than mine - it's like essentially I have given them a short-term loan! Even if I do end up needing the RCT, during the period between my last appointment and the date I have the treatment the (not insignificant sum of) money should still be mine, not theirs. I don't think they're being unscrupulous or anything - it was only intended to be for a couple of weeks, not the couple of months it's turned out to be - it just doesn't quite sit comfortably with me. What would you think if it were you? (That's to anyone reading!)

 

[vicki]

Glad to hear you're OK , although the thought of having to wait for another five weeks isn't that great is it? It seems like a long time to wait just for an appointment that has been rearranged, especially for a private practice? I think the longest I've ever had to wait when I've phoned to cancel, was about two weeks at most. It's definitely worth emailing the receptionist to see if there's anything they can do, because the less time you have to wait, the less time you'll spend worrying about it . On the other hand, it may be that you're having to wait five weeks because you're wanting to see both the dentist and hygienist one after the other and maybe they haven't got many appointment slots available that can allow that to happen - another alternative would be to do two separate appointments, so that you can get seen quicker. Also, it might reduce some of the worry because you'd only need to worry about seeing one person instead of two. You might have more luck if you were to see the hygienist one week and the dentist the week after.

Even if I do end up needing the RCT, during the period between my last appointment and the date I have the treatment the (not insignificant sum of) money should still be mine, not theirs. I don't think they're being unscrupulous or anything - it was only intended to be for a couple of weeks, not the couple of months it's turned out to be - it just doesn't quite sit comfortably with me. What would you think if it were you? (That's to anyone reading!)

I think if it were me, I'd be asking them for my money back. It's actually quite cheeky of them tbh. If it was a smaller amount of money that they were hanging onto for a couple of months, I probably wouldn't be so bothered and they could knock it off my next bill. However RCT isn't cheap, so for that amount of money, I wouldn't expect them to be hanging onto it on the basis of just in case. I think I would ask them for the money back and then if it turns out that you do need RCT after all, you can always pay them again.

I think the whole thing about paying up front is a bit dodgy anyway even if you have had sedation. Whenever I've had expensive courses of treatment, then the norm is to either pay at each appointment in instalments (after you've seen the dentist) or to pay at the end, either at the final treatment appointment or to pay an invoice which is sent to you. On the odd occasion where I've been dosed up on Diazepam (at appointments with my own dentist where I pay at reception afterwards), then although technically I'm not quite with it, because I've had sedation, I have someone with me to take me home and that person is the responsible adult who makes sure that I know what I'm doing when it's time to pay. Also, there isn't an issue with consent or anything else because I've already consented to treatment and the cost at a previous appointment when I've been stone cold sober.

If I had IV sedation and for some reason I couldn't pay for my treatment at reception afterwards, then because I know the cost, I would either have paid the person who's with me the money beforehand and they would pay for me, or I'd give them my credit card and they would do the transaction instead (because I would have told them the amount to pay and pin number beforehand when I was sober). There is no way that I would ever pay in full before treatment was finished, I might pay in instalments, but never in full.

If you've paid in full up front and for some reason, you have cause to complain, then really you haven't got anything to bargain with because they've got your money in full.

 

[Pianimo]

Deja vu alert....it's the night before my rearranged appointments, and I'm poorly. Life has been very stressful lately, my dental hygiene has been all over the place and I'm still afraid of my dentist, so inevitably there's a (significant!) part of me that would love it if I'm too ill to go tomorrow. BUT, I know I need to go, and if I end up having to cancel again and wait another however many weeks, I'll be so frustrated. Hope I feel better in the morning!

Thanks for your reply Vicki, and sorry I didn't respond - the aforementioned stress got in the way! Fwiw, having thought it over, I don't overly mind paying before treatment, although I don't see why my chaperone shouldn't be allowed to pay for me afterwards if I did mind. I do think that they shouldn't have kept my money after I didn't have the RCT. However, I don't do assertion or confrontation, and have had so much going on that I've not had time to think about really, so I've not done anything about it. I guess we'll see what happens tomorrow....assuming I make it.....

 

[Pianimo]

Well, I made it. Tbh, with so much going on and then a rather eventful time just moments before going in, I didn't really have time to think about where I was , so I wasn't as worked up as I would normally be. My head was just somewhere else - even now I feel like I haven't actually been there. It's all just a blur in my head. Very bizarre!

Anyway, I have decided I'm happy with H4, so that is a good thing. I don't feel as comfortable with her as with H1 or 2, but she's obviously kind and caring and she listens to me, and she was very understanding about my lack of dental care lately and I didn't feel judged at all. She had her assistant helping (which is what I said previously I didn't want) and she was kind of there before I'd noticed, and by then I had things in my mouth and was just focused on getting it over with so I didn't say anything. It helped I think that I'd had a conversation with her (the nurse) before we started and she seemed nice, so it wasn't just some stranger. And I'm sure my general state of distractedness helped too - I just shut my eyes and pretended she wasn't there! lol I'm not sure she actually helped that much practically....I still felt my mouth was too full of water, and I ended up with water down my neck and even my back! But anyway, I coped, H4 was nice, and then I was out before I'd really registered that I was there in the first place.

Then it was time to see D5. I still feel nervous and afraid around him, but he was friendly and again, I was having this sort of not-really-here experience so I just sort of chatted and joked with him, despite feeling anxious underneath. It was like I was numb - I knew that underneath I was frightened but somehow it didn't quite show up....I can't describe it really. Anyway, he said that the fact I was having occasional twinges of heat sensitivity, plus the fact that when he put pressure under my neck it hurt (like he tested before) meant that there is some infection there. He can't know for sure which tooth it's in but he assumes it's the one that he was going to to RCT on before, but then didn't. So, now I'm getting my RCT!

He said there's no rush, as long as it was within the next 2 or 3 months. Due to what's going on in my life at the minute, it may well end up being a couple of months before I can take the time off work to go, and so that will be two more months in which they have my money! But I'm just past caring tbh - too much else to be worried about! I obviously don't want another appointment and all the worries I had before about pain afterwards and possibly needing antibiotics etc are back, but I just don't have time to think about it right now. I'm going to email R and book and appointment in - and also my next one with H4 because I didn't book that in either, although I think they do it automatically if you don't book one in, but that can sometimes be with any random hygienist and obviously that's no good for me.

D4 is still what he is, and he's not what I'd pick, but I am getting used to him and I want to try to make it work with him rather than have to go through the process of finding another dentist and starting again. I may write to him ahead of the next appointment, I'm not sure. I was able to articulate myself pretty well today but I knew I was only having a review so the anxiety was naturally on a very different level, plus I was in that strange state of mind anyway.

I have noticed that they've made a mistake on my treatment plan again - so I'm listed as due to pay for the RCT, which I'm not, but sedation is not listed and that is the one thing I do need to pay for! So I will ask R to sort that out too and make me another treatment plan.

Tbh I'm just glad I made it there, got it out of the way, and can now get back to worrying about everything else that's going on! Hope life's going more smoothly for everyone else out there.

 

[Pianimo]

Had a letter today saying my monthly fee is going up. Ended up sitting here questioning why I'm paying them at all. I'm really disillusioned with it all at the minute, but I'm trying to bear in mind that things are still horribly stressful in the rest of my life so I don't know whether that's colouring my viewpoint. It's just hard to convince myself it's worth spending any more money on something I hate so much!

Sigh.

 

[carole]

Hi stick in there pianimo and don't worry too much about the rct they aren't that bad. Although I am dreading having to have my very back tooth treated any time now as it is giving me some little niggles. I think I am due a check up app, I just need to ring up and make an appointment.

I hope everything that is causing you stress and trouble goes away soon. Nice to see you on here and well done for making it to your app