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written a letter to dental surgeon and dentist...check pls

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overcame_1t

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Feb 26, 2009
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Would love some feedback from a dentist if possible.
I hope you dont mind me starting a new thread, but please say it it is inappropriate.
I didnt initially want to start a new thread, but I thought it best to.
I hae written some letters for my dentist, and surgeon, to give them in advance of my appointments, and would love a dentist to check them to see if they are ok, and not stepping on professional toes.

Sorry that the post is a long one.

1) Letter to surgeon


Dear Mr -------
I would greatly appreciate if you could read this letter prior to our consultation on the 11th September, at **** community dental hospital, as it may save your valuable time.
There have been some changes in my prescribed medication, since making this appointment, which may affect treatment.
I thought you needed to be aware in advance.

I have some concerns regarding my forthcoming extractions.

I do not intend, by this letter, to step on professional toes.
As you probably know, I have two broken molars and a wisdom tooth requiring extraction, and I had an X ray, which I do not yet know the result of, and presume this will be discussed in my consultation with you.

My dentists know that I am on diazapam, but there have been some changes. Since my last visit to the community dentist I have gone on a benzodizapine reduction program and am slowly tapering off it with the help of my GP, my mental health care co-ordinator, and a tranquiliser support organisation. As expected, since the reduction program commenced, I have been experiencing some withdrawal symptoms including panic attacks, greatly reduced appetite, etc.
I am also now on trazodone

With regards to the extractions, I have three issues, regarding the treatment, the options i have as to how the teeth get extracted.

1) Benzodiazapine sedation
2) General anaesthetic
3) Local anaesthetic

1) Benzodiazapine sedation

Since commencing my reduction program, I am unable to take any additional benzodizapines outside of my reduction program, due to them adversely affecting my reduction programme, and adversely affecting my recovery.

2) General anaesthetic

Firstly, due to being isolated with no friends or family, I have unsuccessfully found anybody to escort me to the hospital, should I opt for this procedure.
Secondly, for reasons stated above, I would not be able to have any form of benzodiazapine premedication prior to the procedure.
Thirdly, As I am suffering benzodiazapine withdrawal symptoms, I have been finding that I need to eat every two hours, otherwise my withdrawal symptoms greatly worsen, particularly the bad panic attacks, due to low blood sugar levels.
I understand, that, as part of the procedure, I would need to be nil-by-mouth for a long time, before the procedure, and that I probably would not be able to eat for some time afterwards. As you can understand, this has given rise to great worry, and for this reason, I would prefer not to take the option of general anaesthetic, as the worry of this is already affecting my day to day life.

3) Local anaesthetic

I feel that this would be the option that I would prefer to take, regarding the extractions, but again, am very sorry to say, that due to my benzodiazapine withdrawal symptoms, I understand that, to have an adrenaline based local anaesthetic would overstimulate my nervous system, and cause panic attacks, during and after the procedure.
I therefore, respectfully request that I be given a non-adrenaline/
Epinephrine based local anaesthetic. I understand that the non adrenaline based local anaesthetics are not as powerful and that I may need more than one injection. I do not have a problem with this, provided it is fine with you. I am not afraid of needles.
I hope you do not feel as if I am undermining you professionally, but I feel that this is the only option for my extractions.

I would greatly appreciate some advice on this.

I am writing this letter for self help reasons to alleviate some of my terror, and hope that you dont mind.

I greatly appreciate your time and attention in reading this letter, and look forward to some reassurance and advice.




Letter to Dentist

I would be extremely grateful if you could read this letter prior to our appointments on the 22nd, and 29th September, when I am due to have some fillings.
There have been some changes in my prescribed medication, which you may need to know about, and I feel this will affect my treatment.
I felt the need to notify you in advance of the treatment, to save your valuable time.

As you know I have been on diazapam prescribed by my doctor. I am also now on trazodone.
Since our last visit, I have been put on a diazapam reduction program, as they are starting to have adverse affects.
Since going on the program, I have, as expected, been experiencing withdrawal symptoms, one of which is panic and overstimulation of the nervous system.

On my last visit, if I am correct, I was given articaine, which was not a problem at the time, as I was not, at that stage, in withdrawal, as I had not yet started my reduction programme.

Now that I am withdrawing from diazapam, I am respectfully requesting, that in my next treatment, I be given a non adrenaline/Epinephrine based local anaesthetic, as I have found out that an adrenaline/Epinephrine based local anaesthetic would greatly adversely affect my withdrawal symptoms, during and after the procedures, and I fear it will set me back in my recovery.

I understand that the non adrenaline/Epinephrine based local anaesthetics are not as powerful, and that I may need a top up during the procedure. This is not a problem for me, as I am not afraid of injections.

I am so afraid of having an adrenaline/Epinephrine based local anaesthetic, that I would rather have the fillings with no anaesthetic, than risk worsening my symptoms, if the non adrenaline/Epinephrine were not to be available.

I have written this letter in preparation, as I am extrememly worried and desperate for some advice, reassurance.

I greatly appreciate your time and attention in reading this letter.




Please could someone advise if these letters are worded ok, as I intend to send them on monday, but would rather a dentist/surgeon checked them over to make sure that I am not causing any offence/undermining any authority.
Feel free to add any suggestions, or if you feel that I have put unneccesary things in them, feel free to let me know, I would rather they sounded right before being sent.

Thank you for also taking the time to read them.

Appreciated

OI
 
brit

brit

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I've moved this back to Dentistry Questions as otherwise a dentist is unlikely to pick it up. I am not a dentist but I think the letters are absolutely fine and I really think they will appreciate your having taken the time to do this. The CDS dentist is going to be totally 'used to fears' and it is easier that you know what yours are exactly. You have given them a way forward and they do need to know about the medication change so you are acting sensibly, I'd do the same myself.

Mike, Gordon....can you chip in please?
 
A

annie778

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Im not a dentist either but personally in the surgeon's letter I would remove the sentence "I do not intend, by this letter, to step on professional toes."

I'd also remove para's 1. and 2. giving explanations why you cannot use those methods and amend 3 to read "as I am unable to take benzodiazepines and have nobody to escort me home post-sedation, options 1 and 2 are not suitable for me. I feel that option 3 would .... etc..."

It's up to you whether you want to keep these in, but I feel that the letter is too long and wordy as it stands and Ive a feeling surgeons don't have a great deal of time and patience to read long letters. Also the stepping on professional toes phrase may grate.

The letter to the dentist looks fine.
 
brit

brit

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Surgeons have medical secretaries with plenty of time to read such letters and highlight salient points. It is written from the heart and will offend no one.....I would only leave out 'stepping on toes' because there is no need to cast yourself in such an inferior role but if you feel more comfortable doing so then that is also fine.

On the GA thing, I would have thought if you don't have an escort....you could just be kept in for longer.
 
A

annie778

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Surgeons have medical secretaries with plenty of time to read such letters and highlight salient points. It is written from the heart and will offend no one.....I would only leave out 'stepping on toes' because there is no need to cast yourself in such an inferior role but if you feel more comfortable doing so then that is also fine.

Sorry brit don't want to disagree with you, but in my experience if you want to get your point across with medical professionals then it is better to be as concise as possible as their attention span is not often geared towards reading long correspondence. Usually a letter is date stamped by the secretary and put in the in-tray of the recipient. If there is a need to highlight then it's a sign that there is superflous text.

My reason for suggesting leaving out the stepping on toes comment was that not only does it as you say cast the writer in an inferior role, but it also assumes a point of view we do not know the reader will have. It can therefore come across in a negative way.
 
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overcame_1t

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Feb 26, 2009
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Pls could someone check the revised surgeons letter....

.....as per the advice on this thead, I have amended it.
Pls let me know if it's good to go?
thanks

"Dear Mr -------
I would greatly appreciate if you could read this letter prior to our consultation on the 11th September, at ****** Community dental hospital,
Therehave been some changes in my prescribed medication, which will affect my forthcoming treatment, and this letter is to make you aware of those prior to this appointment..

My dentists know that I am on diazapam, but I have now gone on a slow reduction programme and am in withdrawals, and am having symptoms including panic attacks, rapid heartbeat etc
I am also now now on trazodone

I will be unable to get my teeth extracted under benzodiazapine sedation, and cannot take more benzodiazapines apart from the daily dose of 7mg, as this will adversely affect my taper.

I am unable to have a general anaesthetic, as I need to eat at least every two hours, otherwise overwhelming withdrawal symptoms set in, particularly panic.
I understand, that, as part of the procedure, I would need to be nil-by-mouth for a long time, before the procedure. For this reason, I would prefer not to take the option of general anaesthetic, as the worry of this is already affecting my day to day life.

Local anaesthetic is the option that I would prefer to take.
I would be unable to have an adrenaline based local anaesthetic as it would overstimulate my nervous system, and cause panic attacks.
I therefore, respectfully request that I be given a non-adrenaline/Epinephrine based local anaesthetic.
I understand that the non adrenaline based local anaesthetics are not as powerful and that I may need top-up injections prior to the procedure.
I am not afraid of injections.

I would greatly appreciate some advice on this, prior to our consultation on 11th September please..

I greatly appreciate your time and attention in reading this letter, and look forward to some reassurance and advice."
 
brit

brit

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I think you are better leaving the GA option in there rather than rule it out as it is probably the least stressful option for you...there is probably a way round the 'nil by mouth' stuff .....they should be willing to discuss the options so you can agree a suitable way forward based on your medication change and the extra issues it throws up.

If you just want local, your CDS dentist can probably do it without involving the surgeon is another thought?

Wish a dentist would chip in....usually when they don't it means they don't dispute the advice already given. It is your right to send a letter to the people treating you...end of story..send what you are comfortable with.:grouphug:
 
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overcame_1t

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Sorry, more questions for dentist/dental surgeon pls

Thank you brit for your post.

Unfortunately, given that low blood sugar, due to not eating vastly increases my withdrawal symptoms, I feel that GA would be the most stressful option for me.

Yesterday, I was not able to eat for three hours as I was out.
I had a severe panic attack, so you can imagine how i would feel after not being able to eat for eight hours.
Although you advise that this would be the least stressful way, given how I reacted yesterday I feel that it would be the most stressful option.
I do not mean any disrespect to you by this post.

Is there a dentist/dental surgeon on here who can advise please?

thank you kindly
 
Gordon

Gordon

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Already advised in your other thread.

I think your letter is fine as a starting point to further discussion with the treating dentist.
 
A

annie778

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have you considered hypnotism combined with the local? I think some community dental services provide it for people who are unable to cope with anaesthesia. I think a dentist on here practices it. No idea if it works but just a thought...
 
DrMike

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hi
i think that your letter is really good and i hope you get the response you want.
i think most community dentists would be happy to take the time to read it all ok.

certainly hypnosis can work very well- but your dentist may not offer it.

Have you ever had any experience with Nitrous Oxide inhalation sedation?
That may work very well for you as it helps to relax you, has some analgesic (painkilling) properties, and as it doesn't dissolve in your blood, is quickly and fully reversible. You'd still want some local anaesthetics however.
Usually you don't need a chaperone (although some practices require one at least on the first visit and possibly for others)- ask your dentist if they have nitrous- and what their chaperone protocol is. Its worth a thought.

Regards
Dr Mike
 
O

overcame_1t

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have you considered hypnotism combined with the local? I think some community dental services provide it for people who are unable to cope with anaesthesia. I think a dentist on here practices it. No idea if it works but just a thought...
That would be nice, maybe my surgeon can tell me if it is available.
 
O

overcame_1t

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Feb 26, 2009
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Dentist who is filling my teeth got my letter

There was an answerphone message on my phone from my lovely community dentist, she rang to advise that a non epi-adr injection would not be a problem, and that she just wanted to reassure me.

Bless her heart.

I telephoned the CDS and got an answerphone, I left a message thanking her for letting me know and reassuring me.


Dr Mike

Thank you for your suggestion about nitrous.
I don't know if it is the same as the old gas the dentists used to use to put parients asleep. While I know that many have had positive experiences from nitrous, I remeber being traumatised by it as a little girl and I remember having an 'accident' and my mum being told off for not taking me to the toilet beforehand, although she did take me, as I remember. Sorry for the information overload.
 
brit

brit

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Re: Dentist who is filling my teeth got my letter

Thank you for your suggestion about nitrous.
I don't know if it is the same as the old gas the dentists used to use to put parients asleep. While I know that many have had positive experiences from nitrous, I remeber being traumatised by it as a little girl and I remember having an 'accident' and my mum being told off for not taking me to the toilet beforehand, although she did take me, as I remember. Sorry for the information overload.

It is more like the 'gas and air' used in childbirth (which I have used - reasonably pleasant) - I also found the gas GA at the local dentist's traumatic in 1960s and 1970s...so know where you are coming from. If they do offer it, you could always just try it and then change your mind, it gets out of your system very quickly. I understand the dental version comes in different scents and flavours but just got plain old stuff in maternity lol!

So glad you got a nice message from CDS dentist, that's what I would expect from them...they are there to help you after all ;).
 
Gordon

Gordon

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The old dentist gas was a full out general anaesthetic agent called Halothane. Nitrous oxide is not related in any way.
 
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