Trauma/unnecessary work in past - anxious if filling needed?

[ReassuremeJ]

I had several repeated bad experiences with my original dentist who I went to for 30 years. Now my current dentist has suggested a small filling, I’m really anxious of intervening too soon. I’ve been told by dentists I probably had unnecessary dental treatment in the past.

With my original dentist, checkups, (where he played mind games) let alone treatments (wouldn't say which teeth) were scary and repeated. (Pretended I was having several root canals, then redid a filling to teach me a lesson). My fear is from trauma not phobia. Since leaving him, dentists have said they’d question me needing the work I’ve had done.

Background on the cavity:

7 years ago, my dentist was retiring. Another dentist wanted to fill a small cavity. A second opinion said not to. A 3rd opinion - my retiring dentist - said she was surprised a filling had been suggested, decay had arrested and I did not need it.

It is that same cavity which my current dentist would like to fill, so I’m anxious as to whether it is clinically necessary. It will be my first treatment since my original dentist & it's triggering.

I’ve had the cavity almost 10 years. It doesn’t show on x-rays & should be a small additional filling in a molar (on the cusp). My dentist said it’s only just into the dental material & could wait for months (due now).

My dentist said she’d had an emergency before me where someone had no signs of decay but a large abscess, so I wondered if it may have influenced her. I’m worried that if I was judged on fillings, not realising they may have been unnecessary, that could affect a decision to intervene. I also wondered if she’d forgotten she’d seen it before.

My main fear is intervening in a tooth sooner than is clinically necessary and starting a cycle where more work will be needed in future

I could try a 2nd opinion for reassurance but any appointment makes me anxious. I’m not sure what I'd do if a 2nd opinion said I didn’t need it - I don’t want to burn bridges. I could ask my dentist to double check but doubt it would make a difference and it’s hard to be seen questioning someone’s judgment. It may be a cavity that arrested in the past needs doing after a certain point?

I’d be very grateful for advice.

(Also, I really prefer amalgam for longevity & fewer lifetime interventions - can you have 2 amalgam fillings in one molar without risk of cracking?).

 

[Gordon]

I'd remind her that the defect has been there for a long time and you'd prefer her to just monitor it for now. If she's adamant that it needs filled after that then I'd probably go with it.

Yes, you can have 2 amalgam fillings in one molar, it's pretty common. These days though I'd probably go with a well done composite for the new filling, they last as well as amalgam and since they're bonded into place the risk of secondary decay is reduced significantly.

 

[ReassuremeJ]

Thank you very much - I do welcome any replies.

It may seem insignificant & small, but my fears can feel overwhelming. For years, I’ve felt as if my teeth are rented and belong to a dentist. In a dental context, I find it hard to speak up (I used to feel punished for doing so). I think my brain’s protective mechanism kicks in with dental anxiety to try to stop me repeating the past.

I’m nervous at the thought of asking my dentist to monitor it (it’s sensible advice) - I’d agree to anything once in a dental chair just to get things over with and escape. I like my dentist so I’m especially worried about being seen questioning her judgement. I think it’s good for me to learn to trust in a dentist again, so I’m concerned about burning bridges (though obviously I’m scared of unnecessary work and letting myself down again by not questioning things - you can see the internal battleground…).

Is it normal for patients to ask to monitor something a dentist has recommended, or to question something? Would dentists be offended by this? I’m not sure how common this is. If I did decide on a second opinion (although that might scare me) should I admit it to my dentist? I’m wondering whether it might be more common in (UK) dentistry than I think.

 

[Gordon]

It may seem insignificant & small, but my fears can feel overwhelming. For years, I’ve felt as if my teeth are rented and belong to a dentist. In a dental context, I find it hard to speak up (I used to feel punished for doing so). I think my brain’s protective mechanism kicks in with dental anxiety to try to stop me repeating the past.

I know, it's hard to advocate for yourself in this situation, sit down, open wide and shut up syndrome can kick in too easily

I’m nervous at the thought of asking my dentist to monitor it (it’s sensible advice) - I’d agree to anything once in a dental chair just to get things over with and escape. I like my dentist so I’m especially worried about being seen questioning her judgement. I think it’s good for me to learn to trust in a dentist again, so I’m concerned about burning bridges (though obviously I’m scared of unnecessary work and letting myself down again by not questioning things - you can see the internal battleground…).

You could try either e-mailing your dentist before hand or else bring a friend with you for moral support or to advocate for you.

Is it normal for patients to ask to monitor something a dentist has recommended, or to question something? Would dentists be offended by this? I’m not sure how common this is. If I did decide on a second opinion (although that might scare me) should I admit it to my dentist? I’m wondering whether it might be more common in (UK) dentistry than I think.

It should be a team effort between me and the patient to decide on what's being done, a second opinion might just add even further confusion, it sounds like this cavity is really on the edge of needing filled or not, so a second opinion won't necessarily clarify things. Sorry, it's the "fun" of working with biological processes, there's not many absolute answers

 

[ReassuremeJ]

Thank you very much. I really appreciate the response (and thanks for the understanding). I'm going to send an email to my dentist.

It's also reassuring to hear that you can have things which are on the edge of being needed or not. (It's useful to remind myself, after difficult past experiences, that it's a case of dentists trying to use best judgement and can be slightly subjective). I guess this is the nature of dentistry being preventative...

 

[ReassuremeJ]

I’m sorry to reopen this but I have an imminent appointment and there’s something specific adding to my anxiety.

In response to my email, my dentist suggested an itero scan of my teeth as a way of watching the small cavity. I know they were trying to help reassure me but it had the opposite effect and made me panic.

It’s hard going for an appointment/ potential filling without adding a new thing into the equation. I’ve said I’d prefer not to do a scan but I’m feeling anxious in case I’m told it’s the only way to watch the tooth and avoid intervening. (My dentist said it’s hard to remember a tooth). I’m especially scared of having too much information - information which might mean earlier intervention than necessary because it highlights other potential problem areas sooner than they might otherwise be seen, and which could cause me anxiety in advance of something ever becoming an issue. So the suggestion of a scan has played into some of the very fears I was trying to ease. I also don’t want to panic that declining a scan means I have a filling I could otherwise avoid.

Am I making a mistake if I decline a scan to monitor what is a small cavity/potential filling? (I thought scans were for more extensive work?) Can my dentist simply look again and adequately give a professional view? I thought it best to ask on here because I’ll go down a rabbit hole with google and I’m likely to get myself in a state when I need to stay calm.

 

[Gordon]

Can my dentist simply look again and adequately give a professional view?

Yes. It's hard to remember precisely what a tooth looked like (and photos don't really help!) but if it gets worse it'll be easier to detect, if you see what I mean.

 

[ReassuremeJ]

Thanks Gordon, so for clarification, my dentist should just be able to look at the tooth in question without a scan being necessary?

As you suggest, as things progress/ if they worsen it becomes more obvious to a dentist that intervention is needed…

Am I right in thinking an itero scan might flag areas of concern sooner than otherwise noticed and before needing treatment (and wouldn’t normally be needed for small cavities?)

 

[Gordon]

I'm not familiar with Itero scanners, reading their website they seem to claim they are more sensitive to detecting decay than x-rays. I'm not sure if that translates into anything meaningful clinically or if it's just marketing speak..
If the lesion is fully visible then I'd expect the dentist to be able to see with the naked eye/probing if it needs filled or not.

 

[ReassuremeJ]

Thanks Gordon, I’m very grateful for you looking at that. I’ve just got back from my appointment (the scan was not suggested again but might come up in future).

My dentist is happy to keep a watch - said (as you said) that it’s one of these borderline things. Apparently, it’s a pit on a cusp (so a less usual place) with staining & arrested, which they’d ignore if it wasn’t for some shadow so they’ll review it again in 6 months with another X-ray.

I really appreciate the support I’ve had on this from this forum. Every time I have kindness from both my dentist and on here it helps challenge negative memories, so thank you.

 

[Gordon]

Thanks for the update, always nice to hear things go well. It would be fantastic if there was an absolutely reliable way to diagnose decay, so many things have been tried in the past but nothing really works apart from the Mk 1 eyeball and some experience