Told I'm too anxious for root canal

[Sardine]

Hello, I am in my twenties, transgender male, and have significant mental health problems (including panic disorder, general anxiety disorder, and social anxiety disorder, as well as autism), and a fear of the dentists.

A month or so ago, I saw the emergency dentist who started the process of a root canal. I was terrified, but she was very kind and respectful. She said I'd have to see my regular dentist for the rest of the treatment. I felt relieved after seeing her, as she'd been so understanding and kind. She let me listen to music to drown out the sound of the drill, and said to raise my hand if I needed a break or felt pain. Despite my fear, I didn't have a panic attack during the treatment.

My new dentist is someone I haven't seen before, but I booked an appointment to see her. I was scared, but hoped she'd be as kind as the dentist I'd seen before.

During the first appointment (a check up), I was shaky and tense, and the dentist asked me some slightly rude questions. I am transgender, and she asked some questions which went beyond things she'd need to medically know and towards general curiosity. She didn't even say hello before she started to ask these questions. I don't mind answering questions, but definitely not when I'm tense and shaky and frightened because I'm at the dentist. It made me feel worse, as I felt very scrutinised. In the past, other dentists have just asked the medical necessities and not asked anything further.

Anyway, I saw her again today for part two of my root canal. I asked if I could listen to music and she said yes. She said to raise my hand if I hurt or needed a break. As soon as she got in there with the drill, she kept asking why I was tense. She kept having to take it out so I could answer, then I'd sit up and say "sorry, I'm just anxious". She asked this over and over, and I started to get more anxious because I felt like my tension was inconveniencing her.

Anyway, I felt a bit of pain at one point and raised my hand. I think she may have just nicked my gum, but she started to prepare another syringe of local anaesthetic. She then stopped and said "are you having a bad reaction to the adrenaline?" and started to get really serious and asked more about why I was tense and anxious. Of course, I was already anxious and shaky, but I was starting to feel panickier and panickier.

She called the procedure off, and said it is too dangerous to do, as I was too anxious. She said she thinks I should have the tooth taken out instead, because then I'll be under general anaesthetic and can't be tense. At this point I was crying and hyperventilating, and she kept touching me. I don't like to be touched, but was struggling to speak because I was panicking. She said I can't see the special clinic for anxious patients for some reason. I asked if I could ask my GP for diazepam so we can try again, which I've had before, and she said if I could try, but she doubts it'll work and that I need it taken out.

I was sent away after being referred to the hospital to have the tooth removed, but the nurse said I can cancel that and try again with diazepam if I want. Again, the dentist said she doubted it'd help. I also noticed that she changed my records to say "she", despite me being FtM and having explained this in some detail when she'd asked before. As in, "she is becoming a man. She is autistic. She has to have root canal done on her tooth". That probably seems really small and stupid to be upset over, but the other dentists didn't do that, and it's pretty rude.

I don't want my tooth removed, and I want to try again with diazepam. I didn't feel like I was going to have a panic attack until she kept asking why I was tense constantly (literally every minute or so). It seemed obvious that I was going to be a bit tense because of the procedure. I don't know what to do. I don't know if I can ask to see a different dentist. Could I ask to see a dentist who has experience with particularly anxious or mentally ill patients? Is that a thing in the UK?

Sorry this is so long

 

[krlovesherkids777]

Sardine,

Welcome to DFC and we are really glad to have you here and sharing your story. Really sorry what happened with the second dentist. That would be really upsetting and stressful I imagine. It sounds like you did really well with the emergency dentist. I sensed a peace even though you were nervous like she treated you kindly and respectfully even though , dental work can be hard.

The second one just seems to keep digging a hold deeper and deeper for your anxiety. Just seems not to be a good fit. You should be able to pick who you see, I'm not in the UK, so I don't totally know the system, and if you are on NHS it may be quite a bit more limited . I know I've heard Gordon suggest community clinics for special needs before/ extra anxiety and whatever other reasons. It seems he mentions them having a bit more patience sometimes .

Could you go back to the emergency dentist and let her finish? I know my regular dentist is an emergency dentist and he is extra kind and patient and also does regular dentistry. I myself wouldn't pull a tooth if you can save it, just because you are anxious and the dentist doesn't know how to help keep you calm and relaxed during a procedure.. I bet you can find someone to help you.. You really already sound like you did great with the emergency dentist so you have what it takes! You just need someone kind ,patient and respectful to you!

 

[Sardine]

Sardine,

Welcome to DFC and we are really glad to have you here and sharing your story. Really sorry what happened with the second dentist. That would be really upsetting and stressful I imagine. It sounds like you did really well with the emergency dentist. I sensed a peace even though you were nervous like she treated you kindly and respectfully even though , dental work can be hard.

The second one just seems to keep digging a hold deeper and deeper for your anxiety. Just seems not to be a good fit. You should be able to pick who you see, I'm not in the UK, so I don't totally know the system, and if you are on NHS it may be quite a bit more limited . I know I've heard Gordon suggest community clinics for special needs before/ extra anxiety and whatever other reasons. It seems he mentions them having a bit more patience sometimes .

Could you go back to the emergency dentist and let her finish? I know my regular dentist is an emergency dentist and he is extra kind and patient and also does regular dentistry. I myself wouldn't pull a tooth if you can save it, just because you are anxious and the dentist doesn't know how to help keep you calm and relaxed during a procedure.. I bet you can find someone to help you.. You really already sound like you did great with the emergency dentist so you have what it takes! You just need someone kind ,patient and respectful to you!

Thank you for the advice and kind words. Apparently I can't change dentist mid-treatment as they're paid individually rather than the practice being paid. I wish I could go back to the emergency dentist, or see someone with more patience, but it looks like that isn't a possibility.

I'm going to ask my GP about diazepam, and I will try to explain to the dentist that I'm only tense because I'm nervous, that I don't need to be asked a lot, and that I'll say if I need a break.

I think what happened is that she took me being tense and shaky for panic and pain, which is why she kept on asking me and then suddenly stopped. Maybe she doesn't have a background treating nervous patients, because it seems obvious to me that someone who has anxiety disorders and doesn't like the dentist will be tense at the best of times.

At the moment, it seems like it's that or having the tooth removed. It sucks, but it looks like I will really have to try to get through it. I'm terrified, but I'm really hoping my GP will get me some diazepam to help me through it.

Thank you again!

 

[geos]

Looks like the new dentist didn't help you much with your anxiety. Seems it would be preferable for you to see someone you feel comfortable with.

Edit: I edited my comments after seeing your reply.

 

[Enarete]

Hi Sardine,

there is so much going on in your post I don't even know where to start.

First of all, having significant health problems such as those you mentioned doesn't automatically make you "untreatable" or needing a special kind of dentist, as you saw during your emergency appointment. Being kind and respectful is no special ability but rather an absolute base of any work with clients/patients/people. So is trying to understand people and avoiding offending them through unsensitive questions.

Another thing to mention is that overasking and overinterrupting the procedure would make pretty anyone very uncomfortable. I also can see a sense of not believing you as you mentioned to have said that you were "just nervous" and she kept on asking and interrupting despite that.

I am surprised she told you treating you would be dangerous and I didn't understand what she thought was dangerous. Anxiety is an inner state that only you can feel and it doesn't interfere with a procedure in terms of safety as far as you manage to stay still and let the dentist work and it sounds like that wasn't the problem (at least at the beginning of the procedure). I might have missed details, but it sounds like your dentist jumped into the conclusion that you need general anesthesia quite quickly. Usually, general anesthesia doesn't get used for dental procedures unless a last resort and it doesn't sound like your dentist had exhausted all possibilities.

The things that made you upset aren't small and stupid at all, on the contrary. Again, treating people with respect and kindness is the basis of any profession and she clearly made you feel bad.

Now I totally get your decision to try diazepam. The only problem I see with it is this: what exactly would you like to treat with the diazepam? It sounds like you hadn't had an anxiety problem during the emergency appointment and the first stage of your last appointment. What I see as a problem is more a sense of unwillingness to treat you that I see on your dentist's side. You mentioned she twice said she didn't think diazepam would help. Also she seems to be unwilling to try out anything else to help you save the tooth. Diazepam won't help change her mind and the difficulty is, that you need HER to believe that the treatment is possible in order to treat you.

Last but not least, when it comes to dental treatment, psychology comes first and then comes medication. So the first thing to take care of is having a dentist who is a nice person with the right chemistry and if that doesn't work, then it might be a good idea to try some medication. Going the other way around might not work well and could have a negative impact on your ability to attend in the future.

This was very long and just my view of things based on what you said. I respect your wish to try it out with her and the fact you can't change dentists right now and I really hope it will work out. If it won't, I can only encourage you not to give up and find a dentist who will treat you. It would be a shame if you would lose your salvable tooth because of someone who doesn't care about how you feel. From what I see in your post, you do not need any expert for nervous patients or mental illnesses, but more a person who will be supportive and treat you kindly, such as that emergency dentist.

All the best wishes, fingers crossed and do keep us posted

 

[Sardine]

Hi Sardine,

there is so much going on in your post I don't even know where to start.

First of all, having significant health problems such as those you mentioned doesn't automatically make you "untreatable" or needing a special kind of dentist, as you saw during your emergency appointment. Being kind and respectful is no special ability but rather an absolute base of any work with clients/patients/people. So is trying to understand people and avoiding offending them through unsensitive questions.

Another thing to mention is that overasking and overinterrupting the procedure would make pretty anyone very uncomfortable. I also can see a sense of not believing you as you mentioned to have said that you were "just nervous" and she kept on asking and interrupting despite that.

I am surprised she told you treating you would be dangerous and I didn't understand what she thought was dangerous. Anxiety is an inner state that only you can feel and it doesn't interfere with a procedure in terms of safety as far as you manage to stay still and let the dentist work and it sounds like that wasn't the problem (at least at the beginning of the procedure). I might have missed details, but it sounds like your dentist jumped into the conclusion that you need general anesthesia quite quickly. Usually, general anesthesia doesn't get used for dental procedures unless a last resort and it doesn't sound like your dentist had exhausted all possibilities.

The things that made you upset aren't small and stupid at all, on the contrary. Again, treating people with respect and kindness is the basis of any profession and she clearly made you feel bad.

Now I totally get your decision to try diazepam. The only problem I see with it is this: what exactly would you like to treat with the diazepam? It sounds like you hadn't had an anxiety problem during the emergency appointment and the first stage of your last appointment. What I see as a problem is more a sense of unwillingness to treat you that I see on your dentist's side. You mentioned she twice said she didn't think diazepam would help. Also she seems to be unwilling to try out anything else to help you save the tooth. Diazepam won't help change her mind and the difficulty is, that you need HER to believe that the treatment is possible in order to treat you.

Last but not least, when it comes to dental treatment, psychology comes first and then comes medication. So the first thing to take care of is having a dentist who is a nice person with the right chemistry and if that doesn't work, then it might be a good idea to try some medication. Going the other way around might not work well and could have a negative impact on your ability to attend in the future.

This was very long and just my view of things based on what you said. I respect your wish to try it out with her and the fact you can't change dentists right now and I really hope it will work out. If it won't, I can only encourage you not to give up and find a dentist who will treat you. It would be a shame if you would lose your salvable tooth because of someone who doesn't care about how you feel. From what I see in your post, you do not need any expert for nervous patients or mental illnesses, but more a person who will be supportive and treat you kindly, such as that emergency dentist.

All the best wishes, fingers crossed and do keep us posted

Thank you so much for the in-depth and thoughtful comment! A lot of what you said felt very accurate.

I believe she was worried about me suddenly panicking and moving with the small files inside of my tooth. She was worried I'd inhale something, but as you astutely pointed out, I wasn't twitchy or hyperventilating until she kept touching me and told me that I need the tooth removed. I was still, but tense and probably frowning. I thought that was fairly normal for any patient during dental treatment, as it isn't pleasant.

I remembered after posting this that when I first saw her she asked for a list of my medications. One of them is an antipsychotic (for a mental health problem I didn't mention above) and there was a bit of an awkward pause after I explained what it's for, and she started to ask how it works. It's something to do with dopamine, but I'm not sure, so I said so and just mentioned that I know it can interfere with certain antibiotics. I'm not sure if that made her think, from the start, that I would act irrationally and try to leap from the chair mid-treatment.

You're right about diazepam, in all honesty, but if I can't change dentist it will help relax my body and then maybe she'd be more willing to treat me. I've had it before for unrelated problems, so it's not a new medicine for me. GPs can be unwilling to prescribe it, but maybe evidence of a referral for extraction will help prove that it's serious enough for a one-off prescription.

I think if she refuses again, I'll ask if I can see another dentist in the practice. I think someone who is calmer would be helpful. Like I said, I'm not sure that's possible, but it can't hurt to ask. She mentioned the specialist anxiety clinic but said I can't go there as its only for people with anxiety disorders (... which I have), so perhaps I could get proof from my GP that I do have panic disorder, etc., and then she could refer me.

Again, thank you so much for your comment. It really helped me look at everything in a different light, and it was very kind.

Looks like the new dentist didn't help you much with your anxiety. Seems it would be preferable for you to see someone you feel comfortable with.

Edit: I edited my comments after seeing your reply.

Thank you, geos! I might try asking about changing anyway, just to see if it's possible.

 

[Enarete]

It suprises me that a dentist asked you how a medication works. She should know it or look it up herself as she is the doctor.. anyway that's not what this is about. Sending you well wishes and really hope it will work out and you will be able to get your root canal. Do keep us posted.

 

[Sardine]

It suprises me that a dentist asked you how a medication works. She should know it or look it up herself as she is the doctor.. anyway that's not what this is about. Sending you well wishes and really hope it will work out and you will be able to get your root canal. Do keep us posted.

She really ought to have!

I saw my GP the other day to ask for diazepam. She gave me a prescription for a small supply, and wrote a letter to the dentist. Apparently there's a clinic for anxious patients and I should absolutely have been referred there rather than for an extraction. She was very shocked at the dentist's behaviour. I'm going to try again with the dentist in Wednesday, but if I can't manage it, hopefully the doctor's letter will prompt her to refer me to the clinic for anxious patients. She made a point of listing my diagnoses of panic disorder and anxiety disorder so that the dentist will know I'm not self-diagnosing or exaggerating.

Wish me luck for Wednesday! Although at this point, I'd far rather see the clinic for anxious patients.

 

[Enarete]

Can‘t your dentist refer you to that clinic straight away? After all, trying again with diazepam was your idea. It sounded like your dentist didn’t really want to try.

I am delighted to read that you got some validation and reassurance from your GP, you must have been very relieved...

 

[kitkat]

Gosh, I really commend you Sardine for trying again. I’m not sure that I would be able to. At least you have a back up plan but I’d hate for you to have another unnecessarily negative dental appointment to further reinforce your fears. I’d say if the other practice is a choice, don’t waste your time on the previous dentist and move forward with new clinic unless there is some reason that treatment can not be delayed.

 

[comfortdentist]

You don't present yourself as an unreasonable patient to treat. I think you need to change dentists

 

[Sardine]

Can‘t your dentist refer you to that clinic straight away? After all, trying again with diazepam was your idea. It sounded like your dentist didn’t really want to try.

I am delighted to read that you got some validation and reassurance from your GP, you must have been very relieved...

Gosh, I really commend you Sardine for trying again. I’m not sure that I would be able to. At least you have a back up plan but I’d hate for you to have another unnecessarily negative dental appointment to further reinforce your fears. I’d say if the other practice is a choice, don’t waste your time on the previous dentist and move forward with new clinic unless there is some reason that treatment can not be delayed.

You don't present yourself as an unreasonable patient to treat. I think you need to change dentists

Thank you all for the kind words and validation of my concerns! I went back today after taking 4mg diazepam, and was referred to the special clinic after I gave my GP's letter to the dentist. I was told they will use nitrous oxide to relax me to do the root canal. I'm very happy that I've been referred to someone who will likely be used to anxious patients, though I've never had nitrous oxide before. I know it's what they used to use in dental practices. My mum says she remembers being given it when she was younger.

Thank you all again for your help and kind words, it really helped to have that validation and reassurance

 

[Mike]

Nitrous is a great drug, most patients feel lovely and relaxed and maybe a bit floaty. It’s very controllable and just gets increased a step at a time until you’re comfy.

It sounds to me like it’ll be ideal for you