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Physically disabled and phobic--switching to a more modern dentist and worried about "diagnosis"



Junior member
Jan 28, 2015
Physically disabled and phobic--switching to a more modern dentist and worried about "diagnosis"


I've lurked on this forum for a long time now. As someone who did not even go to a dentist until I was 18 years old (I'm 21 3/4 now), this was one of the sites that helped calm me down a bit. Some history:

I have cerebral palsy and use a wheelchair, so it's hard for me to leave the house (Unless I need to leave for a medical appointment, I'm pretty much homebound.) Brushing my teeth is also hard because I have a severe gag reflex due to the condition, and I lack the coordination to do it. The feeling of an electric toothbrush against my teeth scares me, but I'm not strong enough to get calculus off my teeth and am constantly worrying, perhaps unjustifiably, about damaging the enamel. Because of this I did not brush for years at a time. The first time I went, I had such a big tartar deposit on my lower front teeth that I mistook it for enamel wear.

When I was 15-16 years old, I cracked the upper right molar right next to my wisdom tooth while chewing on some hard school food. This later came out in pieces and there was nothing left of the tooth at all except the roots. Being phobic, I told no one and let it sit for 3 or so years, until it started to hurt, which was what got me in for my first exam. I live in Colorado in the middle of nowhere, and the dentist was 87 years old--experienced but a little absent minded.

I wound up having a cleaning, and four cavities were found. Two of those were in my "vampire teeth" that are above my other teeth. I was actually adamant about keeping these teeth in, even though they are hard to brush, and the dentist said it would be better to leave them in because removing them at this point would leave too much space. All of the cavities were filled with composite and the dentist also performed oral surgery to remove the root mentioned above. I was very apprehensive about having a hole in my mouth, but minded it less after my wisdom tooth came in. After he was done cleaning, polishing, and filling my teeth, the dentist said that despite having red inflamed gums (but no shrinkage), I had very good teeth for someone who had never been to a dentist in 18 years and seldom brushed. HOWEVER, due to the severity of my gag reflex, I was unable to have x-rays because I kept gagging on the film.

Since that first series of visits, I've gone every 6 months for a cleaning. Two more cavities were found and filled with composite instead of amalgam at my request. The dentist has said my teeth look much better than when I first came in, and my gums, while still swollen in spots, are no longer red: they're dark pink instead. The only really sensitive spot is at the bottom of my front teeth, which remains red because I'm a mouthbreather. There are also gaps where calculus tends to accumulate. In spite of this, my dentist said I have no more gum disease.

Now we get to the current problem. Six months ago I was told a cavity could be starting again, but they left it alone. When I went in for a cleaning a few weeks ago, they had said it had gotten big enough to fill. A few days ago, I had an appointment to get it filled, but when the dentist saw the tooth, he realized there was already a filling there, elsewhere, on the same tooth. He poked the new cavity area with an explorer and it hurt (but I assumed it always did.) When I asked why they weren't filling the tooth, he said that the large filling that was already there (on the top instead of the inside) could break. I was sent home thinking it was a false alarm until I realized I really do have a cavity in that inside spot.

What is bothering me is this: the dentist straight up just told me to wait until the tooth starts hurting before they do anything, because he'd rather not subject me to a root canal if the filling or decay gets too close to a nerve. He said they'd pull it and give me a partial, but I can UNDER NO CIRCUMSTANCES tolerate a partial, because having to remove it and reinsert it is likely beyond my dexterity and would aggravate my gag reflex. I also can't stand the idea of having a removable tooth as opposed to something fixed.

Now, with that one appointment wasted, I'm losing my mind, and my parents have decided to switch me to a different dentist with a more modern office. My old dentist had one assistant (not a hygienist!) and thus did all the scaling and such himself. I've had to remind him to polish my teeth and the last cleaning really hurt my lower gums. It took 5 days for them to heal.

This new dentist is younger (probably anywhere from 40-60 years old) and has two hygienists. I haven't been to the office yet and won't be able to go for a week or two (one week to transfer Medicaid/Medicare paperwork, probably another week before the appointment.) I'm worried that, given the nature of my old dentist and any new equipment (pano X rays, diagnodent, etc) that they'll find a load of additional problems. More cavities, more gum problems, etc--despite the fact that I'm not in pain. It's driving me into a neurotic fit. I'm trying to keep cavities from getting worse but I'm just afraid to eat now.

My current oral care regime involves brushing once every 24h before bed, and sometimes also an hour after breakfast, with a soft manual toothbrush and toothpaste and rinsing with Listerine (recently switched to Listerine Total Care which seems to have helped and also contains fluoride itself.) I cannot floss.

tl;dr: I have some mild to moderate dental problems, but no pain beyond typical cavity sensitivity. No loose teeth. Crowding. Inflamed gums that have improved over 3 years, definitely doesn't look like perio. My old dentist did not do a filling I need, so I switched dentists and the trust gauge is 0 again. Worried about extensive bad diagnosis due to new tech/different dentist. How do I keep from going insane, and how do I make sure the dentist isn't going to over or undertreat because I have Medicaid/Medicare? For any dentists reading, how can I take better care of my mouth as a disabled person?

Thanks for reading.
Re: Physically disabled and phobic--switching to a more modern dentist and worried about "diagnosis"

Hi Ascherose and Welcome!
Glad you decided to share your story with us and think maybe people have been reluctant to answer waiting for a dentist to jump in and help sort out some of your concerns. That would not be me! I'm not a dentist and not sure I can be of any help except to say that I think you are going to be VERY pleasantly surprised by how much you like a newer dentist and more advanced office for several reasons.....so many I'm not sure where to start! Everything will be easier - sincerely. Even worst case scenario they do find some things to treat, the technology has advanced dental procedures from cleanings to fillings light years from where it was 20 years ago and while I like to think your dentist has remained somewhat current I kinda doubt it for two reasons right off the bat. If your mouth hurt for 5 days after he cleaned your teeth something is WAY wrong with his technique. They also no longer take the explorer and jam it in your cavities or suspicious parts of your teeth...and the one thing I have heard repeatedly since my reluctant return to the dentist in June is "WE DONT WANT TO WAIT TILL IT HURTS" the object is to actually drill and fill BEFORE you feel pain in that tooth....a new concept to me but odd that your dentist wanted to wait till it hurt?? Maybe I am confused. He also missed the fact there was a filling already in part of the tooth too?

I'm sorry, I don't mean to "slam" your dentist, my examples are to help you look to the future that lots of the questions you have may be answered by a new dentist and new technology available to you that you're currently unaware of can help diagnose treat and prevent things from happening and fix things that need repair. Change can be a good thing. Hard, difficult, character building but good. Seeing a new dr and getting comfortable with in the right hands with a new practice may be daunting but is a necessity for you and could be the best thing to happen to you, your teeth and maybe your phobia too.

Let us know what you think when you meet the new dr and staff and see the office!
Re: Physically disabled and phobic--switching to a more modern dentist and worried about "diagnosis"

Thank you for replying!

It's good to know that the upgrade to better tech is a mostly positive thing. My old office had an intraoral X-ray machine and support for both types of fillings, but I think everything else was manual (they had a buffer for polishing teeth with paste, but not for scaling/debridement so that all had to be manually done.) No gas either, although I've never had it and am not sure it would work well.

Although my gums rarely bleed when they are brushed, having scaling done with the metal tools has ALWAYS hurt to some degree and I find it worse than fillings. It's kind of like a tugging filling, especially when he tried to go below the gumline. I'm pretty sure that a dentist would consider what I receive on my lower front gums to be "deep cleaning" and they usually give shots for that (not at mine.) I forgot to mention that, although not soft, my gums bleed insanely when my teeth are cleaned. We're talking needing to rinse 3-5 times over the span of a cleaning, and all of the water is red.

I think this last time he may have gone particularly too hard on the lower front gum sector, which is what took 5 days to stop hurting. Although red and inflamed due to mouthbreathing, that section doesn't hurt to touch. I always could tolerate the pain from cleanings usually but this last one actually made me start exclaiming. (His response to that was that I should go to a place that puts patients to sleep--as I have a deep fear of going under for anything, no. Being awake and aware with no major alterations of consciousness, except for the removal of sensation, is actually part of what makes going to the dentist tolerable for me. And this being a very small, rural area, we don't have any practices like that.)

Despite having many years of experience people have said that this guy's technique isn't what it used to be--he is, again, 87 years old! When I was getting that root removed, it took an hour or two, and he had the forceps against the side of my lips the entire time--so the skin dried out and started flaking, and also hurt for a few days. Although he tried and mostly succeeded to make me not anxious (telling me I was doing well, etc. the constant narration of tooth numbers and other ambiguous comments in itself made me nervous.) He was doing this on the day of the refused filling, probably because he was checking my others, and it caused me to gag and freak out.

I think his patience for dealing with patients like me is low. My dad has warned me (counter intuitively) not to freak out or gag too much, because practices can refuse me service because of that. Although I'm not nearly as bad as some people when it comes to anxiety symptoms during an appointment (I agonize over them before but generally am too drained to care when the actual date rolls around), the gag reflex is not something I really have control over.

Although it can eventually be subdued, the proper way to deal with it, based on my experiences brushing my teeth, is to give a few seconds of recovery time and then try again.... usually by the third time or so it is okay. For some reason, though, my dentist did not seem to want to put in the time for this and assumed that this would go nowhere.

He looked at the existing filling on the tooth, on the chewing surface, described it as a large filling, and said that it could break. However, the new cavity was on the inside edge of the tooth and was bilateral. He poked it with an explorer and asked if it hurt (It did, but I assumed he meant everyday, constant pain, which there was none.) So, I think one of three things happened:

A) He could be concerned the filling process for this new filling will break the old one, on the same tooth.

B) He could be concerned that one or more of the cavities is too close to a nerve and therefore not worth treating, because he personally doesn't think I can handle a root canal, even though I would if it were necessary and I was frozen first.

C) He could just have not wanted to deal with me on that day or misunderstood me about the pain. However, if he was trying to make me feel better by saying that we could wait until it hurts, remove it, and then get me a partial.... well, that set off this whole neurotic episode. I'm not good at reading people, and my disability tends to make people sugarcoat things, even though I am intelligent enough to understand a lot of the medical terms and procedures behind modern dentistry. I can't stand the thought of having to get a partial or having another hole in my mouth. I need to have everything treated as soon as and as painlessly as possible, or else I agonize over it, which is not good for any facet of my health.

Procedures don't really scare me, problems do. Thinking about what he did to my gums, I'm wondering if I have pockets--but it doesn't look like recession or pockets, just gaps between the teeth. And even though they are sensitive, that sector of my gums never hurt as bad as the most recent cleaning--not even my FIRST EVER cleaning was as bad and that had 10-12 years worth of plaque and tartar buildup!
Re: Physically disabled and phobic--switching to a more modern dentist and worried about "diagnosis"

I don't mean to doublepost, but an update:

The paperwork was taken in today and I have an appointment, but the bad news is it's not until April 2nd.

​I am now very worried about the state of this cavity....