• Dental Phobia Support

    Welcome! This is an online support group for anyone who is very afraid of dentistry or who suffers with dental phobia. Please note that this is NOT a dental problems forum! You can find a list of them here.

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What is causing this?

U

UKFearful

Junior member
Joined
Jan 11, 2022
Messages
6
Location
London, England, United Kingdom
I'm a man in his fifties and never had any fear of the dentist until the past few years.
I have had quite a lot of dental treatment over the years - orthodontistry, fillings, crowns, root canals and implants.
I had no problem with any of it until the last 5 - 10 years when I have become increasingly fearful in the chair.
I have no fear of dentists, pain, injections or any of the common things.
I am relaxed going into the chair.
The only issue I have always had is that my tongue goes all around my mouth, making things hard for the dentist.
But these days as soon as someone tries to put something into my mouth I begin to panic. I feel completely out of control and it almost feels as if someone is trying to force something into my mouth to choke me. It literally feels like a life or death thing, triggering a full on fight or flight reaction. Yesterday I managed to tolerate the X-ray plate on one side but when the dentist started pushing it in to the other side I freaked out and pushed his hand away very forcefully.
I now have to go for 2/3 extractions over the next 2 - 4 weeks.
Can you give me any advice to handle this situation?
How can I get over my phobia?
I have tried hypnosis in the past without success (and I am a trained hypnotist!).
Additional information - I have a small mouth that does not open very wide and I have big problems with my molars - over the years they have basically crumbled one by one. The extractions I need are both on molars, which is where I have the biggest problems.
I am also very loyal to my dentist (whom I have been seeing for 25 years) but he is a little bit "old school" and not always good about slowing down, explaining what he is doing or asking before acting - but he does try and he is patient and sympathetic about my difficulties. None of this has ever been a problem in the past. Although some of the treatment in the past has been unpleasant, I would not say that any one treatment has been traumatic. I certainly can't identify a trigger for this behaviour.
I also have a very strong gag reflex and can gag when brushing my teeth, particularly first thing in the morning.
Any suggestions?
Many thanks in advance for any help you can give someone who is completely desperate.
PS I have read elsewhere on your site about a shield, but just thinking about having something like that in my mouth is triggering. Even small things in my mouth feel huge (which I am sure is not uncommon) and anything bigger than a drill or a probe feels like it fills my whole mouth. Particularly if I feel like I cannot immediately spit it out or get it out of my mouth. Even a mirror yesterday felt like it filled my whole mouth.
 
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Gordon

Gordon

Administrator
Staff member
Verified dentist
Joined
Oct 25, 2005
Messages
7,892
There isn't much time to get over such an extreme reaction. So you're looking at IV sedation or maybe oral sedation to get the extractions done at least, then you can try working on this. CBT might be a help.
 
U

UKFearful

Junior member
Joined
Jan 11, 2022
Messages
6
Location
London, England, United Kingdom
@Gordon
Thank you very much for taking the time to reply.
I have tried sedation in the past with success - although an anaesthetist who sedated me once said I was the only patient he had ever come across whose gag reflex cut through the sedative.
Unfortunately my dentist does not have the facilities for sedation. And I'm afraid that I just can't afford it at the moment as I lost my job due to Covid and have not earned any money for the past year. Here in London the cost of sedation (and having an anaesthetist attend) is over $500 and I do not have the funds for that.
Perhaps you can answer a question for me as a dentist.
Although extraction is not fun by any means, my recollection is that the elevator (I think that is what you call the tool you use) is introduced from the side of the mouth meaning that not much equipment (apart from cotton and drain) go into the mouth. Is that correct? If so, I might be able to tolerate that, as it is having things that feel big being put right into my mouth that really freaks me out.
The elevator being mostly outside my mouth and being applied only to the outside of the tooth might be ok - if that is how it works.
 
Enarete

Enarete

Super Moderator
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Joined
Sep 18, 2017
Messages
3,221
Hi UKFearful,

sorry to read about your situation. Your description about how treatment currently feels for you - feeling entirely out of control and feeling like someone is trying to force you - sounds pretty traumatic. I could imagine how such an experience only reinforces your fears further.

You mentioned not seeing any trigger or any particular event that could explain how your fear evolved, but looking at your post a bit more in the detail, there are many small cues that over time may have had contributed to your phobia. It sounds to me like while you never had one particular traumatic experience, there have been small experiences of discomfort and loss of control. Things like slowing down or explaining what is about to happen sound to be very important for our ability to cope with the feeling of full mouth. If that is exactly what your dentist is not great at, I see how that may make you feel out of control during treatment. Your gag reflex sounds like another thing that just makes you more prone to feel uncomfortable.

As you could imagine, if this fear had build up over the course of 5-10 years and now you are at a point of having death anxiety and getting into fight-and-flight, there won't be a quick fix for that, as Gordon suggested. If IV sedation is currently entirely out of reach, maybe trying some oral sedation may help. Also, it may be a good idea to talk to your dentist and have them show you the instruments explaining the procedure in as much detail as you need to feel more able to cope. To get back the sense of control, it may be hugely beneficial to agree on a stop signal and having your dentist let you get out of the chair whenever you feel your anxiety is going higher. In this way you may be able to show your unconscious that you are in control and can leave the situation at any time, which may prevent the fight of flight response from happening. The pre-requisite of that is that you are able to monitor your state and actually use the signal once you see your discomfort is getting worse, but before you get triggered to the limit.

This may all sound like a huge task, particularly if you haven't worked with your dentist on this basis before, but may help you to get the extraction without sedation. I see how you would like to stick with your dentist and feel loyal, however if trying out another dentist would be an option, I can only encourage you to look into our recommendations. For London we have quite a few brilliant dentists who would be happy to give you the, amount of control and explanations you need to get through the procedure without further negative experiences.

All the best wishes
 
Gordon

Gordon

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Messages
7,892
Which teeth are due for extraction? As a sort of rule of thumb, lower teeth are mostly removed from the side, so not much goes over the tongue side of the tooth. Upper teeth especially molars, the forceps sort of approach from the tongue side a bit, although obviously with the mouth wide open the tongue is quite far away from the "action".
Oral sedation might be your only remaining option in the short term.
 
U

UKFearful

Junior member
Joined
Jan 11, 2022
Messages
6
Location
London, England, United Kingdom
@Enarete
Thank you very much for your message and support.
I think you are quite right that the reaction has built up over a number of slightly difficult incidents. There was also another incident that was nothing to do with the dentist and that is a bit disgusting. I suddenly found my airway completely blocked by what must have been a large plug of semi-solid mucus that must have been dislodged from my nasal passage or sinus.
It only lasted 10 seconds or so and the bolus quickly dissolved, but it was still a big shock and made me hyper-aware of how easily the airway can be blocked.
Strangely, if I can turn my head slightly to the left or to the right that often makes me feel a little bit better as I do not feel that the back of my throat is right in the firing line (if that makes any sense at all).
I have been trying to de-sensitise myself using self-hypnosis and EMDR. I am trained in hypnotherapy so I do know something about the process.
Self-hypnosis in the chair is pretty difficult as it can cut through mild anxiety but once a full-on amygdala hijack panic attack happens it is overwhelmed - the mind prioritises what it sees as a fight for life over everything else.
Many thanks once again.
 
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U

UKFearful

Junior member
Joined
Jan 11, 2022
Messages
6
Location
London, England, United Kingdom
@Gordon
Thanks for your very kind reply - that is really helpful information.
The first tooth to be extracted is a lower right molar (second from the back - but I don't have any wisdom teeth - they were chipped out of the bone when I was 13 because my mouth was too tight even at that stage to accommodate them).
That one should be mostly an external job from what you say, so I may be able to deal with that. I have no particular issue with the pain or with the idea of the extraction - just with having things in my mouth.
The second one due to be taken out (in early Feb) is an upper right molar (again second from the back, with no wisdom teeth). As that tooth has crumbled and there is little left of it above the gum line on the inside I suspect that the dentist will mostly have to attack that from the outside as well.
Perhaps it will help him if I turn my head a little bit towards him - which actually makes me feel a lot better for some reason.
Thanks once again for your kindness and support.
 
Enarete

Enarete

Super Moderator
Staff member
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Sep 18, 2017
Messages
3,221
@Enarete
I have been trying to de-sensitise myself using self-hypnosis and EMDR. I am trained in hypnotherapy so I do know something about the process.

Sounds like that experience you described may have been an important contributor to your current situation. I find it very interesting that EMDR haven‘t worked. Do you have any theory about why it failed?
 
U

UKFearful

Junior member
Joined
Jan 11, 2022
Messages
6
Location
London, England, United Kingdom
@Enarete
Apologies - I didn't explain myself clearly.
I haven't tried EMDR in the past, but I am just trying it now (self administered - but I am trained in de-sensitisation protocols in hypnotherapy and it is essentially the same process).
I hope that it will help.
You may ask why I didn't try it before. The honest answer is that I haven't seen a dentist for a couple of years (due to Covid rather than avoidance) and I thought that things would be better now. My gag reflex is not as bad as it used to be, I have a lost a bit of weight (so the palate is not as fatty) and the muscle tone in my throat is better - so maintaining an airway is easier now.
It has also been useful writing everything down here - so thank you for that and for your questions and your patience.
 
U

UKFearful

Junior member
Joined
Jan 11, 2022
Messages
6
Location
London, England, United Kingdom
@Gordon @Enarete
I just wanted to report back as I had the first extraction today (the lower right molar).
I had some anxiety but no major panic attack.
In some ways the hardest bit (from an anxiety/panic perspective) was while the local anaesthetic was going in and I could not close my mouth for what seemed like a long time.
After that it was not the most pleasant experience but I did not panic. As Gordon had said, most of the action took place outside the mouth with leverage applied from the side. So I did not have too much equipment in my mouth.
Strangely, I noticed that I was breathing through my mouth during the procedure - I don't think I have ever done that at the dentist before.
For the past couple of weeks I have been self-administering EMDR and using self-hypnosis, following desensitisation protocols (as I mentioned before I am a trained clinical hypnotherapist, so know the techniques). As I have been administering this I have literally been imagining the dentist holding me down in the chair and trying to suffocate me by putting things in my mouth, as this is how it felt to my amygdala that thought that I was in a fight for my life - hence the panic. I just kept noticing how I could maintain a clear airway throughout, no matter how hard the dentist tried!
This seems to have done a great deal of good - although I would not say that I am there just yet and will carry on with the desensitisation.
So, thank you very much for your understanding and your help. I have the second extraction in a couple of weeks.
Now I just have to avoid dry socket!
 
Gordon

Gordon

Administrator
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Verified dentist
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Oct 25, 2005
Messages
7,892
Well done you for getting through it. Unfortunately, the slower the local goes in, the less painful it's going to be for the lucky recipient :) Controlling your breathing is certainly a very good way to keep the panic under control.
Just don't start smoking to celebrate and you'll be fine with dry sockets :)
 
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