Dental fear
Jun. 8th, 2009 03:54 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
urocyonIt's been a rather unpleasant afternoon, with wave after self-inflicted wave of panic attacks. The short version: I've had a toothache in one incisor with a visible cavity for several days, so I'm trying to work myself up to getting some dental treatment. The actual pain isn't motivating me so much as not wanting to lose a front tooth!
The dentist wanted to keep an eye that cavity, but I was too paralyzed to suggest going ahead and filling it then because I might not be able to keep regular appointments. I have not been able to go back for several years since. Appointments there to have a molar extracted and another cavity filled were my first in better than ten years.
I ran across a useful site, Dental Fear Central, so have been riding out the panic attacks from just thinking about this stuff. Not surprisingly, this has also brought the general medical phobia/PTSD to the front of my mind, which has not helped. I know I need to get a handle on this, which doesn't help either, so I'm trying not to brood about it too much.
As struck me months ago, I'm not entirely comfortable referring to my problem as a medical/dental phobia, since that implies that the fears are completely irrational. Since pretty much all of them are based on bad past experiences, PTSD seems to fit better. (That's on top of the existing PTSD, which also complicates matters.) This doesn't necessarily change how best to deal with the situation.
My first reaction to this toothache was to look into a dental anaesthetic clinic just up the road. Probably the least traumatic work I've had done was wisdom tooth extraction under IV sedation. But, I am concerned that this is not necessarily the best option, given that more of my fear these days is based on lack of control over what's going on.
The last straw incident: getting held down by a generally ham-fisted dentist while he drilled right into the root of one tooth, even when I gave a good try at screaming and reflexively tried to kick him off with both feet. (The position I was pinned in, I couldn't get them planted in his chest, thus the "tried".) This was after he'd poo-pooed me for saying that I couldn't feel the local at all; he'd never given me enough local, nor waited for it to kick in, but this time it had no effect whatsoever. Even better, the tooth was in such bad shape in the first place because he'd left decay under a filling, then dismissed multiple reports of serious pain in it over several years; by the time he spotted the crater on x-rays, it really needed a root canal or extraction, but that would have required more time and expense, fixing his mistake for "free". That tooth is probably 75% amalgam, and it still hurts.
The jerk responsible would be the dentist I consistently saw as a kid. As one "minor" example of his skill and chairside manner, he managed to stab me in the tongue with his dental probe on two different occasions--then barked at me about it. I was amazed when I saw a different dentist who did not (a) cause pain, nor (b) get verbally abusive at the drop of a hat. At least the particularly awful visit didn't happen until I was old enough just to refuse to go back. More of that sort of complete disrespect and disregard for any kind of autonomy has piled up on the general medical end of things, but that's another story.
So, in spite of having dragged myself to two other dentists since, who treated me respectfully and took care not to inflict unnecessary pain, I am still afraid of getting bad treatment and being unable to do anything about it at the time. Partly from anxiety/PTSD, partly from the autie processing differences and PTSD from some people's reactions to that. I freeze up and can't give much feedback. (Being physically pinned down is just gravy!) The actual pain doesn't really scare me, but having people ignore it and continue on when I want them to stop does. Unfortunately, IV sedation will not necessarily help with that fear, nor am I sure about nitrous.
It looks like my best bet may well be to find someone who knows how to deal with anxious patients in a nonthreatening manner, with plenty of communication. With any luck, I can make myself admit that I'm scared, instead of playing stoic. (Come to find out, a major reason I need so much local is probably the adrenaline levels, anyway.) A decent-acting dentist shouldn't berate/belittle a patient for saying that things hurt, or that they're scared. Having oral antianxiety meds to take beforehand cranks down my nervous system reactions enough to get me to the appointment--i.e., enough that I can apply cognitive techniques to deal with the fear--and maybe I can find one who will prescribe some. Apparently, meds so you can sleep the night before are also a possibility; the prospect of an appointment does keep me awake, which makes things that much worse.
It's hard to tell what's the best plan, but I do need to work on this. It's become obvious by now that this is another case in which Just Trying Harder is not going to get it.
The dentist wanted to keep an eye that cavity, but I was too paralyzed to suggest going ahead and filling it then because I might not be able to keep regular appointments. I have not been able to go back for several years since. Appointments there to have a molar extracted and another cavity filled were my first in better than ten years.
I ran across a useful site, Dental Fear Central, so have been riding out the panic attacks from just thinking about this stuff. Not surprisingly, this has also brought the general medical phobia/PTSD to the front of my mind, which has not helped. I know I need to get a handle on this, which doesn't help either, so I'm trying not to brood about it too much.
As struck me months ago, I'm not entirely comfortable referring to my problem as a medical/dental phobia, since that implies that the fears are completely irrational. Since pretty much all of them are based on bad past experiences, PTSD seems to fit better. (That's on top of the existing PTSD, which also complicates matters.) This doesn't necessarily change how best to deal with the situation.
My first reaction to this toothache was to look into a dental anaesthetic clinic just up the road. Probably the least traumatic work I've had done was wisdom tooth extraction under IV sedation. But, I am concerned that this is not necessarily the best option, given that more of my fear these days is based on lack of control over what's going on.
The last straw incident: getting held down by a generally ham-fisted dentist while he drilled right into the root of one tooth, even when I gave a good try at screaming and reflexively tried to kick him off with both feet. (The position I was pinned in, I couldn't get them planted in his chest, thus the "tried".) This was after he'd poo-pooed me for saying that I couldn't feel the local at all; he'd never given me enough local, nor waited for it to kick in, but this time it had no effect whatsoever. Even better, the tooth was in such bad shape in the first place because he'd left decay under a filling, then dismissed multiple reports of serious pain in it over several years; by the time he spotted the crater on x-rays, it really needed a root canal or extraction, but that would have required more time and expense, fixing his mistake for "free". That tooth is probably 75% amalgam, and it still hurts.
The jerk responsible would be the dentist I consistently saw as a kid. As one "minor" example of his skill and chairside manner, he managed to stab me in the tongue with his dental probe on two different occasions--then barked at me about it. I was amazed when I saw a different dentist who did not (a) cause pain, nor (b) get verbally abusive at the drop of a hat. At least the particularly awful visit didn't happen until I was old enough just to refuse to go back. More of that sort of complete disrespect and disregard for any kind of autonomy has piled up on the general medical end of things, but that's another story.
So, in spite of having dragged myself to two other dentists since, who treated me respectfully and took care not to inflict unnecessary pain, I am still afraid of getting bad treatment and being unable to do anything about it at the time. Partly from anxiety/PTSD, partly from the autie processing differences and PTSD from some people's reactions to that. I freeze up and can't give much feedback. (Being physically pinned down is just gravy!) The actual pain doesn't really scare me, but having people ignore it and continue on when I want them to stop does. Unfortunately, IV sedation will not necessarily help with that fear, nor am I sure about nitrous.
It looks like my best bet may well be to find someone who knows how to deal with anxious patients in a nonthreatening manner, with plenty of communication. With any luck, I can make myself admit that I'm scared, instead of playing stoic. (Come to find out, a major reason I need so much local is probably the adrenaline levels, anyway.) A decent-acting dentist shouldn't berate/belittle a patient for saying that things hurt, or that they're scared. Having oral antianxiety meds to take beforehand cranks down my nervous system reactions enough to get me to the appointment--i.e., enough that I can apply cognitive techniques to deal with the fear--and maybe I can find one who will prescribe some. Apparently, meds so you can sleep the night before are also a possibility; the prospect of an appointment does keep me awake, which makes things that much worse.
It's hard to tell what's the best plan, but I do need to work on this. It's become obvious by now that this is another case in which Just Trying Harder is not going to get it.
