How to deal with situation created by freaking out after weird appointment, please help!

[NervousUSA]

So sorry this is a long story I really need advice and would welcome advice from dentists but also anyone else who might want to chime in. Background: I am an extremely anxious person with medical trauma, I also believe I have many traits of autism and have a diagnosed autistic sibling, though I have never been diagnosed with anthing. I had a dental implant installed last year and a crown put on it this year. There was a lot of drama with the dental implant crown installation where the crown got stuck and couldn't be pulled out, and shifted my teeth, changing my bite for a while, and changing how things feel, I have also noticed my jawbone has shrank around the implant. I recently went to a prosthodontist for a second opinion on the implant, just to see what he thought about the crown mainly, without telling my dentist or telling the prosthodontist my dentists name, and he said the crown was OK but I had some bone loss around the implant (didn't say if that was ok or not and I didn't think to ask). Since I don't want to tell my dentist that I am suspicious about the implant and saw a prosthodontist, and my checkup was soon, I thought I would address the bone loss there, I knew I was due for xrays. What happened: Last week, I had the appointment for a cleaning and a checkup. When I got to the appointment, I was taken to the room by the hygienist, told the dentist wasn't in the office, and I would be given x-rays and a cleaning and the dentist would look at my x-rays when he got back, and I wouldn't be seeing a dentist. I said I needed a dentist for a checkup. The hygienist said "I can do that, I can do everything he can do except diagnose". I argued back and said I needed a dentist because of my dental implant, and I also told her they should have told me beforehand that the dentist wasn't in the office. The hygienist told me my bone loss looks ok to her, but I can make another appointment to see the dentist, and have a note put on my record not to bring me in when the dentist isn't there again. Turns out, he was out all week due to a family emergency. I booked another appointment to come back and see the dentist. I felt really stressed, angry, and anxious, because they hadn't told me the dentist wouldn't be there, and I don't believe the hygienist can do everything the dentist can do except for diagnose, and started to have extreme anxiety with my heart pounding like crazy, and got hardly any sleep. The next day I called the practice and asked if my return appointment would cause me to be billed for two exams. The office person told me they hygienist didn't give me an exam, so I repeated to her my conversation with the hygienist whereI said I needed a dentist for a checkup and the hygienist said "I can do that, I can do everything he can do except diagnose". The office person said the hygienist cannot do an exam they give an evaluation or something like that, and told me the hygienist is really experienced, but not as educated as the dentist. I asked if it was their policy not to notify patients if the dentist isn't going to be there and they said "yes, unless it will be an issue" but "it only happens two days per year". Yet I had been told the dentist was gone all week at my appointment. I asked if the only way for me to find out if a dentist would be there at my appointment was to call right beforehand and was told "yes". At this point, I started to get completely stressed and angry so I asked for my next cleaning in six months to be cancelled. They asked me if I wanted to reschedule it and I said no. They asked if I was going to another dentist and I said I didn't know what I wanted to do. I said I was uncomfortable with how the appointment had gone and didn't feel good about it. At all times I was polite, and didn't yell, though I am sure I didn't sound happy, and I thanked the office person (they said "OK"). I don't know what to do, I don't want to look for a new dentist, I have really mixed feelings about this one, but my previous one was a full on scammer who wanted to do unecessary work, which this one hasn't. I still have to go to the appointment this week to get the checkup I didn't get, and am afraid there will be drama or people mad at me for cancelling my cleaning and saying that I was uncomfortable about the appointment and unhappy about what happened. I am afraid there will be some argument or conversation or drama this week, and keep trying to play out what can happen. I am afraid this dentist will dismiss me as a patient. I am also feeling though like they are substandard to not be there or give the patients checkups, to have hygienists saying they can do everything the dentist can do, and it isn't fair not to give people notice that their appointment has been changed in this way. I know I am out of control with anxiety and obsession over dental stuff, but also think the way they treated me wasn't right, and I fear what is coming. I can't sleep and am feeling sick all day every day with a pounding heart. Need any advice on this situation and advice on what to do. Please help!

 

[letsconnect]

I would be miffed, too, if I had booked a check-up and it didn't happen. It sounds weird that the dentist would do an exam by just looking at x-rays, seeing how they're only one part of a dental exam (in fact, many check-up appointments don't involve x-rays)... unless hygienists in the US are trained to a far higher standard than elsewhere, this doesn't make much sense.

It sounds as if you're a bit worried about the bone loss around the implant - why don't you email the prosthodontist you saw (or get him to call you back) and ask him what the significance of the bone loss is, and whether it's ok or not? Just say you forgot to ask while you were there... they should be happy to reply!

 

[NervousUSA]

Thanks so much for the response! Hygienists here can have a two year community college certificate, I think some have a bachelors degree. Nothing like the education level of a dentist. However all their professional publications and organizations advocate for them to have a larger and larger scope of practice, without advocating for more education or training. Dentists often like having hygienists do more so they can do less and hope to spend all their time doing expensive procedures, not doing other things with patients. It is called "maximising" hygienists when discussed by dentists as a business practice. I talked to my friends and family, no one had ever had this happen to them and they all thought it was very abnormal. I ended up talking to two dentists, two dental assistants, and a hygienist, on another online forum about this. One dentist said it was so unprofessional I should quit the practice, the other dentist said it would be OK/legal for some hygiene procedures to be done like this (he didn't say a hygienist should do a checkup or anything about not notifiying patients), two dental assistants said this was legal, rarely done, and could be OK if patients were notified so they could decline it. One hygienist answered that this is legal and said she is so experienced she can find almost any problem a dentist can, she didn't answer if it is normal not to notify. I will contact the prosthodontist about this, good idea, he said I could. I have to go to the second portion of the checkup tomorrow, the same hygienist will be there, but this time, with the dentist. Very anxious about it, since I had told the office to cancel my further appointments after this, and the other things that happened in that phone call, so worried there will be a confrontation, and all the other worrying possibilities of what can happen next. Any advice on how to handle the appointment tomorrow?

 

[letsconnect]

No advice really, except that I sort of agree with the dentist who said that maybe you should quit the practice and look elsewhere... did your appointment already happen? If so, how did it go?

 

[NervousUSA]

Thanks for asking. It went OK. There were no confrontations and I got a checkup from the dentist like I wanted. I know I was acting awkwardly and talking unclearly because of being super anxious now for two weeks, and couldn't do well asking questions but that's the way it goes. The dentist said my implant is OK, and I believe him, whatever other stuff he does, he is not one to get aggressive about treatment and overtreat like my previous dentist was.

 

[letsconnect]

That sounds like a fairly positive outcome then, glad to hear that things weren't too tense and that the implant looks ok