• Dental Phobia Support

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private v NHS, referrals, GA, costs - sorry long post

N

needlephobe

Member
Joined
Mar 2, 2014
Messages
29
Hi
Wish I'd found this forum sooner, it's great :)
OK so my main problem is massively severe needle phobia, though this has kind of become generalized to dental phobia too. Had several awful needle experiences as a kid (not dental). I've had dental treatment as an adult - once went to a dentist which offered sedation with gaseous induction, think they then gave IV once I was out though I believe I was conscious and cooperative but unable to remember anything about it afterwards - think the drug might've been xanax?? Anyway this worked great, but next time I went back to the same place a couple of years later for the same thing, once I was in the chair they said they were no longer able to give gaseous induction and I'd have to have a needle in the back of my hand. So I left. Next time I needed treatment my dentist offered me relative analgesia - so gas to the point of being almost unconscious then a local anaesthetic. Even though I was nearly unconcious I was still petrified and just remember screaming like a crazy lady - and still huge pain - to be fair, it was a wisdom tooth that had cracked in half and had to be extracted, probably doesn't get much hurtier.
Next thing was for a couple more extractions which weren't causing me pain at the time. I was sent to a Dental Institute but they could only offer IV sedation, I fainted in the chair during the consult. They then referred me on to a hospital where, months later, I had a gas-induced GA and the extractions. That was pretty good! Currently would be my preferred option in future if possible.
Thing now is that the NHS dentist who sorted out all these referrals etc is no longer working in my area and last time I went for a check-up the new dentist just tried to give me a filling by local but of course I couldn't handle it. Since then (about 5 years ago) I've not been back anywhere. Just before that I'd had a course of CBT (psychotherapy) for the needle phobia in general, which helped somewhat but I still could not manage the local. I didn't feel v comfortable with the new dentist either even for check-ups. Luckily I've had no problems since - I do look after my teeth pretty obsessively!! But would like to make a plan in case of future problems. I'm thinking of trying a private dentist. I'm also going to have some more CBT to try help with more with the needle phobia and would like to aim for one day being able to cope with IV sedation, BUT ... if I can't get there I still need a plan. So, from a private dentist, can they still refer for hospital treatment on the NHS? Or private treatment under gas-induced GA? (Guessing it would be for extraction at that point) and does anyone have an idea of costs if that were possible? I'm guessing a lot? Never had anything outside of the NHS before and would prefer not to but am terrified of getting to a place where I desperately need treatment and am unable to access it so would like to think about it in advance whilst my teeth are relatively well.
So sorry that's v rambling. :redface:
Hugs to all with similar problems :XXLhug: x
 
Last edited:
vicki

vicki

Well-known member
Joined
Oct 24, 2005
Messages
992
Location
UK
Hi and :welcome:

First of all, well done for finding us and posting a message; that's a big step for a lot of people, especially if you're terrified :).

I don't know whether you've seen it or not, but we have a page about needle phobia here:
https://www.dentalfearcentral.org/fears/needle-phobia/

There are a lot of people who are scared of needles and/or injections and if you have a read through some of the posts on this forum, particularly in the Success Stories section, you'll read stories from people who have been terrified of having an injection, but who, with time, patience and the right dentist, have eventually managed to overcome their fears.

I made the leap from NHS into private dentistry a couple of years ago myself and can tell you that it has been a much more relaxed and positive experience than I ever had on the NHS. That's not to say that all NHS practices are the same, there are some good and some not so good, but the main difference with private dentistry, apart from having access to a wider range of treatments, is that a private dentist generally has a lot more time to spend with their patients than an NHS one, which just makes for a calmer and more relaxed experience (which can only be a good thing when you're nervous or scared).

Since changing to a private practice, the only referral I've had has been for root canal treatment and that was to a private endodontist, so I'm not sure whether you would be able to get a referral for sedation or GA on the NHS from a private dentist as I think they tend to refer patients to other private dentists (or to a private oral surgeon if extractions are required). If you decide to contact a private practice, it's something that you can ask at your first appointment :).

General anaesthetics haven't been available in dental practices in the UK for a number of years now and the main reason for this is safety. There needs to be proper equipment and facilities to deal with any emergency situation, so for that reason, GA is only done in hospital now. What you can get in some dental practices, is various forms of sedation. IV sedation is usually the main option on offer (which isn't terribly helpful if you have a needle phobia!), but some practices also offer oral sedation (where you take a drug such as Temazepam or Diazepam) as well as Relative Analgesia. As far as I'm aware, GAs are only used in hospital for extractions now, with any other treatment being done using sedation if required.

The thing with phobias (and this is me speaking as both a hypnotherapist and a dental phobic myself :p:redface:!), is that the more you avoid the thing that you fear, the harder it becomes to eventually try and overcome the fear. It builds and builds until eventually it gets to a point, where it feels like you can't possibly cope with the thing you fear, so the only thing you can do is to avoid it.

Largely it depends on what it is that you fear. If it's something that you'll only ever need to come across once in a blue moon, then avoidance is an effective tactic. On the other hand, if it's something that is a normal part of life that you will come across at some time or another (like injections and needles), then avoidance just continues to feed the fear, fuel the problem and make things worse and harder to overcome in the long run.

When someone comes to see me because they want to overcome a fear or phobia, one of the first things that I mention, is that the only real way to overcome your fear, is to face it. People often recoil in horror, because they often can't possibly contemplate coming across whatever it is that they fear, but the reason I say it is that we overcome fears by replacing the old, negative and fearful emotions, with new, positive and calmer ones. Where the phobia is of an object or situation (such as needles and going to the dentist), this means replacing the old, negative experiences with new, positive experiences.

Fear is a response that we learn through experience, either our own direct experiences, or indirectly from others. This means that it's a response which can be unlearned (given the right help and resources). There are various ways to help you do that, whether it's CBT, hypnotherapy, psychotherapy or another way, but the end goal is the same.

From reading your post, although I realise the thought of facing and dealing with your fear isn't appealing in any way, having a gas induced GA won't do you any favours in the long run, because you'll still have the fear. A friend of mine that I did my hypnotherapy training with, quite often uses this analogy:

Day One: Imagine that you are stood at the edge of a field full of long grass. You need to get to the other side of the field, but there's no proper footpath. There's a way through the grass where it's been trampled down by a few other people who've crossed the field before you and that seems the easiest route to take, so you take it. You walk along the flattened grass and eventually you end up at the other side of the field, arriving in the same place as all the other people have before you.

Day Two: Now imagine that you are stood at the edge of the same field full of long grass. You need to get to the other side of the field. There's still no footpath, so do you follow the same route as everyone else has before you (walking over the flattened grass which is the easier route)? Or do you decide to make your own way through the grass? You decide to make your own path through the grass. You have to move the long grass out of the way and it's not as easy as taking the other path, but with a bit of work and determination, you create a new path and before you know it, you're at the other side of the field, in a different place that you've never been before.

Day Three: You're stood at the edge of the field again. You need to get to the other side and there still no nice footpath, however there are two makeshift footpaths where other people have walked across the field and flattened the grass, so it's easier to walk across. One route looks really well worn and is the route you took on day one and the other is the one you created yesterday. You decide to take the route that you created yourself. It's still a little harder than the other route, but you've travelled this path before, so it's OK. Before you know it, you're at the other side of the field, in a place that you've been before, it still feels a bit strange, but it's also a bit familiar.



When we have a fear, we become conditioned to respond in a certain way. The subconscious mind takes the path of least resistance; which means continuing with the old way of responding. Using the analogy above, when faced with a fear, we take the easiest path because we know where it leads to and what will happen. Avoidance is the easiest and most predictable option to protect ourselves from what we fear. But as long as we continue to walk down that path, we will always end up in the same place. If we want to overcome fear, we need to take a different path. It might be unfamiliar and harder to take that path than the way that we're used to, but the new path takes us to somewhere different. The more we take the new path, over time, the unfamiliar place becomes familiar.

I think in the long run, it would help you to overcome your fear, then you would be freed from having to worry about what might happen in the future. One of the best ways to overcome a fear such as needle phobia, is with systematic de-sensitisation, where you gradually build up to it in smaller, more manageable steps until eventually you become accustomed to having injections without the feelings of fear. We have a page on de-sensitisation here: https://www.dentalfearcentral.org/help/psychology/desensitisation/

Some dentists have experience of using this technique, or alternatively, you could see a psychologist or therapist who can work with you to help you overcome your fear (in conjunction with your dentist). If your GP referred you for CBT originally, it might be worth talking to them and seeing whether they could refer you again. Alternatively, depending on your finances, you could see a CBT therapist, psychotherapist or hypnotherapist privately yourself without being referred. Alongside this, you could contact a few dental practices that you like the sound/feel of and see whether they could help, then when you are ready, you could build up to having an injection.

I'll also send you a pm :).

Hope this helps; I'm sure others will chip in with their experiences too :).
 
N

needlephobe

Member
Joined
Mar 2, 2014
Messages
29
Hi Vicki. Thanks so much for the excellent reply, very much appreciated. :) The path analogy is great and helped me remember a similar way of thinking from CBT. I have been referred by my GP for CBT again at some point and really want to work on this. I guess I'm just looking for a back-up plan because of the fear of "failing", it's so hard having had some truly awful past needle experiences (don't want to go into those too much here) but I did make some progress last time and got to the point of having a routine vaccination at the end of it which was brilliant. :jump: I think because a few years have passed now and I've not had the opportunity to have any more needle exposure I could cope with (couldn't do the dental local even right after therapy) it's built up to feel like an impossible, massive challenge again. You're so right though, I NEED to deal with it long-term ... not just for dentistry. OK, so I AM going to make an appointment with a private dentist who sounds v good and has been recommended on here. I think if they have more time it might help, a 10 min appointment or whatever it is with an NHS dentist does add to the pressure. At least I have time on my side before actually needing treatment and maybe just going for a first appointment with a nice dentist at this point with no plan of immediate treatment will be helpful as I can maybe talk with them about a plan for getting there sloooowly!
Thanks again :thankyou:
 
N

needlephobe

Member
Joined
Mar 2, 2014
Messages
29
Rang up and registered with the private dentist today and they had a cancellation tomorrow morning so am going! :scared: :hidesbehindsofa: :o ..............
 
vicki

vicki

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Joined
Oct 24, 2005
Messages
992
Location
UK
Rang up and registered with the private dentist today and they had a cancellation tomorrow morning so am going! :scared: :hidesbehindsofa: :o ..............

Lots of luck... :clover::clover::clover:!!! Let us know how it goes! :D
 
N

needlephobe

Member
Joined
Mar 2, 2014
Messages
29
Did it!!! :yay::yay: So comfortable with the new practice,they are lovely. Makes such a difference when they take time and deal with you calmly, I only fainted a bit once. :redface: I need a few fillings and some gum treatment but nothing too drastic and so glad I've gone and hopefully can work on it slowly and get sorted before my teeth get to the stage of needing extracting under GA again. Not quite looking forward to it but not actually dreading going again next week. :p
Honestly, for anyone dithering, however scared you are, it feels flippin' brilliant to confront your fears.:jump:
 
brit

brit

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In My Dental Happy Place
Makes such a difference when they take time and deal with you calmly, I only fainted a bit once. :redface:

Congrats. Yes some people decide it is better to go to a cheap hairdresser and a private dentist rather than vice versa. :jump:
 
N

needlephobe

Member
Joined
Mar 2, 2014
Messages
29
^ I'll happily cut my own hair with a knife & fork if it means getting OK with getting my teeth sorted. :D
 
vicki

vicki

Well-known member
Joined
Oct 24, 2005
Messages
992
Location
UK
^ I'll happily cut my own hair with a knife & fork if it means getting OK with getting my teeth sorted. :D

I spent five years at art college with people who looked like they'd cut their hair with a knife and fork, so I'm not sure I could recommend it :p!

Depending on your budget (and your teeth), there are a few options to consider for financing dental treatment at a private practice and these include:

Private Dental Insurance:
There are a few companies who offer insurance to cover you for some or all of the cost of dental treatment. I think some of the supermarkets also offer dental insurance in addition to travel insurance as well. The amount you pay each month varies, as does the amount they pay out per treatment and the annual claim limits that apply. With most dental insurance plans, they either require you to be 'dentally fit' before you start the insurance plan, or alternatively, if you do have any outstanding problems, they will cover you for anything that arises after you took out the policy, but they won't provide cover for pre-existing problems or anything which you knew about before.

I currently have Boots Private Dental Insurance which costs me about £20 per month. They do set limits on what they will pay per treatment and also how many of each type of treatment you can have each year. Once my teeth are finally sorted out, I will be cancelling this and switching to Denplan though because the amount that Boots will pay out has been reduced quite a bit since they first started doing dental insurance. (e.g. I had a large composite filling in November last year which cost me £120, of which, the maximum I could claim back on the Boots policy was £57).

There are a number of companies who offer this type of insurance, so if this is something you're considering, then you need to look for the best deal for you.

Healthcare Cash Plans:
These provide cash amounts for various healthcare services including dental care, opticians, physiotherapy etc. Some of the plans pay 100% of your claim (up to your yearly policy limit) and some pay a fixed percentage (up to your yearly policy limit). If you don't have any major problems (or once you have your teeth sorted out), then these can be a better option than dental insurance because they don't usually put a limit on the number of claims or the number of various types of treatment you can have, the only limit is usually the yearly claim amount for each type of health care claim.

At the moment, I have one of the Sovereign Healthcare plans which costs me £17.68 per month. For that, they will pay 50% of the costs up to the yearly limit for each type of service, so at the moment on that plan level, it's £160 for dental, £180 for dental, £32 for prescription charges, £500 for physio etc. It's worth it for me because although it costs £212.16 a year (paid monthly), I claim over £400 back each year for various type of healthcare costs.

There are other companies as well including SimplyHealth and I think they all operate in pretty much the same way.

Denplan:
This is a specific dental payment plan that many private dentists accept. They offer three levels of services from a basic membership plan right through to a more expensive monthly plan which covers you for most treatments. There's more information on their website.

The costs usually depend on your dentist's assessment of your teeth and what your likely future needs will be. Once I eventually get my teeth sorted out, I plan to cancel the Boots Insurance and switch to Denplan instead.

If you decide to stay with the new practice you've just been to, they should be able to give you more information about Denplan and other ways to pay for treatment as well (many practices allow you to pay for more expensive courses of treatment in installments and/or offer interest free credit as well).
 
P

patient

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Mar 7, 2014
Messages
213
I am on denplan. It works for me. I was with an NHS dentist for years. My mother was on denplan 30 years ago and because she had good teeth that did not need much work done she cancelled denplan because she felt it was a waste of money when each time she went, the dentist said nothing needed doing. However, it was pointed out to me that even if you have no work done, it is still worth continuing with denplan because if you one day fall over and crack your tooth and need it repaired, it can be covered under denplan. A friend of mine goes to a private dentist and doesnt do denplan as she feels its a waste and simply pays upfront for whatever needs doing. Not everything is done via denplan though. Crowns you have to pay extra for and I am surprised its not covered but they say you have to pay for the cost of the materials and the work that the dentist does is covered under denplan.

Never in a million years would I ever have considered private dental treatment but I had a horrible NHS dentist who refused to treat what I thought was an infection, saying no there is no infection and I was in a great deal of pain in tears. I walked out of the surgery and walked straight into the private dental practice and was in so much pain I could not even speak to say what the matter was. The nice nurse told the dentist and by that time I had calmed down enough to explain. He sat me down and took a look and said yes you have an infection and treated it there and then and I walked home pain free :jump:

I then went back to the NHS dentist a few days later to complain and told them I was correct and that I did have an infection but the dentist refused to listen to me and kept saying oh well when I xrayed the tooth there was no infection and I BEGGED her to take another xray and she said no. Dentists like her should be struck off. What if I hadnt gone to the private dentist when I did? It may have got worse and spread to other teeth.
 
N

needlephobe

Member
Joined
Mar 2, 2014
Messages
29
I'm sure there are some super NHS dentists out there too though. :D They seem to have to make the best of pretty tight budget constraints and that translates into the amount of time they are able to spend per patient, doesn't neccessarily mean they're all not clinically competent. If you're fearful, the time factor will probably always be much more of a problem than if you weren't fearful.
Whether you choose to go for plans, insurances, etc, or to pay as you go along for private treatment probably depends more on your personal finances, attitude to financial 'risk', what value you put on forward planning and peace of mind, etc. :)
 
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