Shocked and terrified

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Laura86

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#1
Hello,
My dental phobia is about as extreme as you can get, so a special needs dentist (I have autism) gave me a plan where I would get an OPG X-ray that they could access online without me seeing, and then we would book a general anaesthetic/day surgery after they analysed the images. Due to stress, phobia and anxiety, I have requested not to be told specifically what treatment will happen under the general anaesthetic until the day. This in itself is a compromise- I desperately wanted to not be told until after general anaesthetic procedures, but legally I have to give prior consent. They are going to pre-medicate me for the 60 minutes or so between giving consent and going under anaesthetic.

Today, I was contacted with a quote for the dentist alone- $3835 (Australia). This is separate to the cost of the hospital and anaesthetist. They have said that part of that cost is additional loading for the work being done in hospital, but even taking that into account, I’m in complete shock that I need treatment amounting to that much when I’m not in any pain at all and can’t see visible evidence of major issues. The same dentist had told me that I would well and truly know and feel pain if I needed a root canal or extraction, so does this mean I need $3000 worth of fillings? How is that even possible?

I’m very perplexed as to how I could need procedures costing nearly $4000 when I’m in no pain. I’m not worried about fillings or root canals as they aren’t likely to give me a painful recovery, just scared of the prospect of extractions. How likely is it that I could need teeth out without having had any pain beforehand? I’m really hoping I’m just being overcharged for multiple fillings/scaling or something.

To be honest, I’m far more scared of the procedure and possible pain afterwards than having to pay the money, so I’m really hoping I’m just being massively overcharged. Going to a different dentist isn’t an option as I need a special needs dentist who can plan and perform procedures according to my needs.

Thanks for any advice
Laura
 
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Laura86

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#3
I doubt I can be treated without general anaesthetic, as the high cost of just the dentist’s work suggests extensive treatment is needed. Given that I have never had any dental treatment before (my parents never took me to the dentist even once), plus my extreme phobia, GA is the only option if work needed is on that scale.

To tell the truth, I’m far more scared about the procedures than the money. The cost is only scaring me because it’s an indication of the level of the treatment needed. I’m not in any pain, so I don’t understand how I could need that much treatment. That’s why I’m hoping I’m just being overcharged. I also know that if I’m told what treatment is needed prior to the GA date, I will not cope between now and then.
 
Dr. Daniel

Dr. Daniel

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#4
I doubt I can be treated without general anaesthetic, as the high cost of just the dentist’s work suggests extensive treatment is needed. Given that I have never had any dental treatment before (my parents never took me to the dentist even once), plus my extreme phobia, GA is the only option if work needed is on that scale.

To tell the truth, I’m far more scared about the procedures than the money. The cost is only scaring me because it’s an indication of the level of the treatment needed. I’m not in any pain, so I don’t understand how I could need that much treatment. That’s why I’m hoping I’m just being overcharged. I also know that if I’m told what treatment is needed prior to the GA date, I will not cope between now and then.
I am not so certain. It could be that the treatment plan include more treatments than with a patient that goes to the dentist regularly. Imagine there is a small cavity in one of the teeth: if the patient is cleaning the area correctly, has a cleaning, flouride and an x ray once in a while, it’s perfectly ok to leave the cavity untreated. However, if the small cavity has a higher risk of developing a real problem, the dentist will choose to treat it rather than following on it. This principle applies also to other dental treatments.
 
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Laura86

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#5
Thanks, I’ve looked up costs and even if I needed cleaning and fluoride on 12-15 teeth it wouldn’t come to nearly $4000- that’s how I know there must be more involved. My main fear is extractions because of the likelihood of experiencing pain afterwards. To know that the need for an extraction is unlikely if teeth are not in pain would be somewhat reassuring.
 
Dr. Daniel

Dr. Daniel

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#6
Thanks, I’ve looked up costs and even if I needed cleaning and fluoride on 12-15 teeth it wouldn’t come to nearly $4000- that’s how I know there must be more involved. My main fear is extractions because of the likelihood of experiencing pain afterwards. To know that the need for an extraction is unlikely if teeth are not in pain would be somewhat reassuring.
The fact that a tooth is not painful does not say that it shouldn’t be extracted. It does say though that there is no rush.
If you want, you could ask for your x rays and share these in this forum so that the dentists can share their impression whether anything needs to be extracted.
Regarding the postoperative pain: there are some effective ways to reduce that. You should your dentist on how because every patient is different, but generally speaking: taking an NSAID like ibuprofen half an hour before the dental work, course of antibiotics before hand, keeping the site cool, can really lessen the postoperative discomfort. Of course, there is always some discomfort but it can be very manageable.
 
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Laura86

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#7
Thanks, I’m aware that no pain doesn’t necessarily mean no extraction needed, I was just wondering if it’s very likely that I would need a tooth pulled out if there is no sign of trouble.
I’m not accessing xrays at all because I know that if I find anything out in advance, then I won’t cope between now and the procedure date, and possibly chicken out, which will obviously make any dental issues worse. The plan with the dentist is that I will be told on the day, sign the consent form, then be drugged into oblivion in preparation for general anaesthetic.
 
Gordon

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#8
The trouble with GA is that it's very risky to do a second one too quickly after a previous one.
So when treatment planning for a GA case you have to be very careful that any treatment you do will be successful immediately. In other words if there's any doubt that a filling could result in any after pain from the tooth, then the tooth needs to come out.
Similarly root canal treatment is very rarely done in the GA setting, there is simply too big a risk of needing to go back in quickly if the tooth flares up after the GA. Crowns and inlays are also almost never done under GA for the same reasons.
Following on from all that, it's entirely possible that a tooth is not causing you any bother just now but will be treatment planned for extraction at the GA.
Hope that makes some sense and good luck!
 
brit

brit

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#9
Is there anyone you trust who could find out in advance for you what is being proposed? It seems high risk to only find out on the day as you propose. Also as having GA can compromise the care you receive and result in your losing teeth unnecessarily as Gordon mentions, could you at least try with local anesthetic before resorting to GA? With a kind caring dentist you might well be able to cope just fine and you could have several much shorter appointments and go at a pace you choose. The action you are taking seems rather drastic.
 
Enarete

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#10
Dear Laura,

reading about your situation my first thought was that agreeing on a procedure but not knowing what is planned and just finding out shortly before the treatment puts you into a very vulnerable position. With the most treatments there are options and decisions to take and to discuss these together with your dentist as well as planning a treatment can be a process as such. Also, if I got you right, they have been planning treatment based on x-rays without looking in your mouth?

Even if the treatment was done well under GA, I was wondering how would life go after that? It is always good to have a trusted place you can pop in if you have any questions or of anything bothers you or maybe need anything to get looked up after the treatememt. And of course, regular check-ups and cleanings to make sure your teeth stay healthy..

I understand that your phobia is really extreme, however I would like the image of a caring health / mental / dental care professionals helping you and planning step by step a bit nicer than what you said is planned (writing this without really knowing what your options are and how your system works).

Sending you good wishes and hugs no matter what you do, let us know how you got on
 
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Laura86

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#11
Thanks everyone. Because of having never had any dental treatment before, this one is being done under GA because there is 32 years’ worth (whatever that may be). The plan is that after this, I will be having regular examinations and if any need like fillings comes up, it will be done with gas, numbing gel and local anaesthetic.

I have asked the dentist about the implications of working off xrays alone, and she has said that they may overestimate from xrays, then scale back treatment on the day if they see something isn’t required. Being a special needs dentist, she is reluctant to put me through more than is necessary, but also didn’t want to give me a quote for one amount then have to charge me much more.

At the moment, I’m suspecting my bottom two wisdom teeth need removal, and this cannot be done in the chair because of how they’ve developed.

The other reason for GA is that it can all be done at once. If I go for one session under local and find it more than I can handle, I’m unlikely to go back for the rest of the treatment. In the future, things will be different as I’ll be going more regularly so there is unlikely to be as much treatment needed. Right now, just going for the consultation appointment in an examination room without getting in the chair traumatised me for a week- this is what we’re dealing with here.
 
brit

brit

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#12
Just seen your other thread. Historically many people in the UK have had impacted wisdom teeth removed under GA in an NHS hospital. I did so myself many decades ago. I think this makes what you have proposed less drastic. Given that you know this aspect in advance - maybe ask for a clearer idea of the rest of the treatment plan too so you can make a fully informed decision rather than a rushed one under stress on the day. Best wishes.
 
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Laura86

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#13
Thanks Brit, I’m actually just speculating about the wisdom teeth one because I can see they didn’t come in properly. I don’t know any of the treatment planned.
 
Gordon

Gordon

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#14
As a special needs dentist, I very often would be presented with a patient who was already under GA and I had had no previous opportunity to look inside her mouth. In fact even having an x-ray was a major bonus.
Your special needs dentist will be familiar with working under these conditions so not having an exam first is not a big deal.

I think your proposed treatment plan is a good one Laura, get everything sorted out and then start maintaining things from a good solid foundation.
Very best wishes from me, please come back on here and update us on how it all goes and feel free to ask if you have any questions at all or just want a bit of a chat :)
 
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Laura86

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#15
Thanks so much! It took 2 months with a psychologist to even get as far as the xray. Like I said, the amount of money scared me and I hope I’m just being overcharged because of the GA/hospital/getting it all done at once by a specialist dentist situation.
I’m not too worried about the course of the procedures themselves since I won’t be conscious (and am getting pre med), I’m just hoping I can cope with pain afterwards, and praying for no extractions other than wisdom teeth given that I don’t have the money for replacement teeth and don’t know how many extractions I can recover from the pain of afterwards. I’ve also heard root canals can be painful afterwards even if they are successful. Hopefully the hospital will give me endone as I have a bad pain threshold.

I hope so much that I will wake up from the GA and the whole treatment ordeal will be over. I need that so much.
 
Gordon

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#16
They will give you some long lasting pain relief as part of the GA. The worst of the pain should be over within the first 24 hrs, most of which will be covered by the stuff you'll be getting when you're asleep, so don't worry too much about after pain.
 
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Laura86

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#17
Thanks so much! Hopefully wisdom teeth will be the only extractions (if any at all). Hoping I’m just being overcharged for cleaning/scaling/fluoride treatment/maybe a few fillings. I can understand a special needs dentist Charing more, especially in hospital under GA.
 
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Laura86

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#19
Thanks, I seem to be getting over the intital shock and am reasoning that:
1) I won’t feel anything during treatment as I’ll be under GA
2) Pain after procedures can be managed with medication.

I’m just hoping so much that I don’t need extractions because I can’t afford prosthetics- but I guess I’d have to be pretty unlucky to need a bunch of teeth pulled if I’m not feeling pain.