How can I learn to stop worrying and love the dentist?

November 16, 2005 9:35 AM

Help me not be terrified of the dentist.

I know plenty of other questions like this have floated across Ask MeFi before, but I think my case is probably unique. Or at least I'd like to think so.

I'm 22 years old. By my own admission, I take pretty bad care of my teeth; generally I brush once a day, in the morning, but on weekends or vacations or other occasions where I don't have class (or some other thing that I have a routine in preparation for) I tend to slack off and not bother. Also, I don't floss. Ever. (The hygienist at my most recent dentist visit a few months ago actually recommended against it due to the current state of my mouth.)

The first time I ever saw a dentist was when I was in sixth grade, which is about 10 years ago now. I had to have some fillings (which wasn't too bad) and then in a visit a few months after the first, a root canal. Except for an abortive attempt at a tooth-cleaning a few months ago, I haven't been back since.

I say "abortive" because they had barely cleaned one tooth before I wussed out. The tooth-scraping and gum-poking and blowing-air-on-my-teeth was too much for me to take. (I realize much of the discomfort was likely because my teeth and gums are in shambles from not having seen a dentist in a decade.)

I told the hygienist who was cleaning my teeth that I was extremely uncomfortable, couldn't stand the scraping, etc. (I'm sure I had a white-knuckle grip on the armrests, and I know she kept having to ask me to open my mouth wider because I kept trying to close it, probably because I wanted to reflexively grind my teeth in terror or something.) She stopped and got the dentist, who made a cursory examination of my mouth, told me it was in pretty bad shape but there was still hope, and furthermore told me that we could reschedule my appointment for another time and they'd use novocaine the next time (although it would actually end up taking two appointments because they can't numb my entire mouth at once). This is the option I chose, of course, but obviously I haven't been back or I wouldn't be making this post now.

Injecting my gums with novocaine is all they're willing to do. I asked them; they will not gas me, nor will they prescribe me any drugs. I'm afraid that local anaesthetic will not be enough, because I'm sure I'll still be able to feel the scraping resonating through my skull, a sensation which I found incredibly unpleasant the first time around, and even if I can't feel it, I'll still be incredibly anxious, because I'm not a real big fan of needles either (though I'd definitely choose getting a shot over seeing the dentist; too bad I'd be getting both in this case).

I guess basically my questions are thus:
Should I see if another dentist will drug me, or should I try to face my fear without the aid of pharmaceuticals? If the latter, what can I do to ameliorate the mix of sheer and utter terror and dread that a visit to the dentist (let alone the actual procedure) fills me with? And how can I make myself be less slack about taking care of my teeth?

posted by anonymous to health & fitness (27 comments total)

I have a friend who has a prescription for Xanax for when she flys - she's terrified otherwise. Maybe your GP could give you a scrip that would reduce your anxiety and make it possible to be blase about the whole dentist visit.
posted by garbo at 9:43 AM on November 16, 2005

See another dentist who will drug you. Honestly.

My husband has the same problem, and I finally got him to go when I sent him to a dentist that specializes in fear of dentistry. They used gas, he got to listen to a walkman during the procedure, and got through a pretty long cleaning and scrapping. Gas is the answer, as far as he was concerned.
posted by agregoli at 9:44 AM on November 16, 2005

There are dentists that specialize in, well, you. This link may help.
posted by kcm at 9:46 AM on November 16, 2005

Ditto gas, if you need it. Plenty of dentists don't use gas during wisdom teeth removal, for example, but remember that it's a business. I told the first guy: "I'm going to be unconscious during the procedure -- if not here, then in someone else's office." He took my money.

As for psychological tips, try reminding yourself that it's only going to get worse, the longer you wait.
posted by cribcage at 9:47 AM on November 16, 2005

Set up an appointment date for about three months in the future. In the intervening time take REALLY good care of you teeth. Invest in an electric toothbrush with a built-in timer and brush twice a day. Floss. Get and use a tongue-scraper. Use a gentle mouthwash/rinse. By the time your appointment rolls round you'll be feeling more confident, and your appointment will be much, much quicker.
posted by Sara Anne at 9:49 AM on November 16, 2005

I agree with everyone above - read the dentist ads and see if there is anyone in your area who claims to do "Gentle" dental care (or other words to that effect). There are dentists out there who specialize in treating people like you. If that fails, see if you can find a more modern dentist - ours uses an ultrasonic device for cleaning, and there is very little scraping (although, given your situation, you might need some).
Above all, find someone you can stand, and get your mouth in shape - then learn to care about and care for your teeth. We get one set, they should last a lifetime, and the state of your mouth can affect your entire body. As we age the state of our teeth/gums is even more critical to our overall health - being able to chew good food, for example, makes a big difference in both quality of life and in how long you'll live.
Best of luck.
posted by dbmcd at 9:51 AM on November 16, 2005

Not only does it get worse quickly if you put it off, it gets better even more quickly if you get into the routine. I think the fear is like that of smoking.. I know when I smoked (I quit a long time ago) it felt like I was safer not quitting, because if I quit and got lung cancer, it would be worse! Just, look at it objectively since you know what the logical conclusion is here.
posted by kcm at 9:51 AM on November 16, 2005

There are dentists who do dentistry while you're asleep - I have never used one so I don't know what it entails, but I have seen dentists with signs outside which say exactly that. I had my wisdom teeth out under general anaesthetic and it was a breeze.
posted by biscotti at 9:58 AM on November 16, 2005

Thirding gas (fourthing?). My father has a similar problem to yours. He gets gassed, they put headphones on him, he's fine. Dentists get terrified patients all the time. Your dentist should do everything in his/her power to alleviate your anxiety. If he's not, find another dentist.

Also, try taking a friend to the dentist with you. You can even ask to bring them into the room with you.

Finally, remind yourself that keeping your teeth relatively healthy is important. Do you eat well? Exercise? Could you try telling yourself that since you're taking care of your body in other areas, that you should take care of your dental hygeine as well? (This won't work if you're not generally health-conscious, but it works for me.)
posted by Uncle Glendinning at 9:59 AM on November 16, 2005

I'm tense at the dentist, not like you, but still uncomfortable. If I don't feel like the dentist is on my wavelength [not tense, but at least able to work with tense people] it makes me more agitated. Here are a few things that help me deal with the anxiety.

1. No caffeine before an appointment. If you are a regular coffee drinker, then make a first thing in the morning appointment and have coffee right afterwards.
2. Any time something is happening in the chair that you CAN'T STAND, slowly count to ten. Almost every awful dental procedure that isn't extraction/root canal gets over this quickly. And most of the painful parts of even painful procedures get over quickly if the meds are working.
3. My dentist used to prescribe a half-tablet of valium for some of her more anxious patients. I wouldn't be suprised if you could find a dentist that would do this or something similar.
4. Walkman & sunglasses. You feel like a goon sometimes, but if you're not looking right at the dentist, it helps. If you're not listening to all that scraping, it helps.

Good luck, and good on you for getting on top of this early!
posted by jessamyn at 10:09 AM on November 16, 2005

See another dentist who will drug you. Honestly.

Yes. Absolutely. They are out there.

Also, I don't floss. Ever. (The hygienist at my most recent dentist visit a few months ago actually recommended against it due to the current state of my mouth.)

This is baffling to me. If your gums are bleeding when you floss, it's because you don't floss. I can't imagine a competent hygienist telling you not to floss.

When you find a dental practice that is more willing to work with your phobias, if they don't recommend chlorhexidine gluconate, ask them about it. When I went to my current dentist for the first time, they gave me a prescription for the stuff and an irrigator and told me to irrigate my gums with it every day. (Basically use the irrigator gizmo to squirt the stuff under my gumline for each tooth, and not just rinse with it as if it were regular mouthwash.) I did. Three months later when I went in for my checkup, my gums were in fantastic shape, almost 100% better than they had been when I first came in, the periodontal infections pretty much eradicated. (I hadn't been flossing regularly either, but I do now. No more bleeding.)
posted by Gator at 10:16 AM on November 16, 2005

I hope this is kosher. I work in health care and did a tip sheet for patients a few years ago on how to overcome their fear of the dentist. I'm going to paste it at the end of this message; this text was based on a survey of about 700 dentists.

Before I get to that, though, you definitely need to find another dentist. You need to find someone with more experience and patience dealing with fearful patients. (And please don't pick someone just because they say they practice pain-free dentistry, which is a BS marketing gambit.)

As you have found out, who actually does the cleaning of your teeth--the hygienist--is going to have the greatest impact on your experience at the dentist's office. So when you start calling to interview dental offices, you should ask not just if the dentist is capable dealing with fearful patients but if his or her staff is too.

Finally, I just wanted to say that my husband was absolutely terrified of the dentist and avoided seeing one for 10 years. After I finally convinced him to return, I had to personally accompany him to the office. (If ever I left it up to him, he would cancel appointments and not tell me about it.) As a result, his mouth was in bad shape--broken teeth from decay and advanced gum disease.

It's a vicious cycle. You don't take care of your teeth, so everytime you do scrape up the courage to go to the dental office, they find stuff wrong, necessitating more invasive work, which scares you off.

Break that cycle. The first step is to find a dentist who will work to make you comfortable. If you live in the Chicago area, I'd be happy to try to find you someone. Just shoot me an e-mail. Incidentally, my husband has dealt with about 90% of his dental issues to date and he feels a lot more confident going to the dentist now.

OK, here's that tip sheet.

1. Tell the dentist about your fears. This information will help the dentist determine how to best manage and address those fears. By letting the dentist know exactly why the experience is difficult for you, you will feel more control in the examination chair.

2. Remember that dental procedures have greatly improved in the past few years. Modern dentistry offers new methods and treatment options to make you feel comfortable.

3. Your dentist can explain the entire procedure to you beforehand, as well as walk you through step-by-step while the procedure is being performed. You always have the right to fully understand the work being done on your teeth.

4. Consider additional medication to relax. Many dentists recommend nitrous oxide, sedation or anti-anxiety medicine for extremely nervous patients. Find a dentist who offers these options to help you get through the visit.

5. Find a dentist you are comfortable with and establish a trusting relationship. There are many personalities in the dental profession. Find a dentist who makes you feel at ease and is willing to work with you on your fears.

6. Breathe deeply and try to relax. Some dentists recommend practicing relaxation techniques before and during the appointment. Other dentists find that listening to music, or scheduling an appointment first thing in the morning, before the stresses of the day add up, also help patients to relax.

7. Talk to the dentist about stopping if you're uncomfortable. Many of the dentists surveyed said they establish a signal to "stop" with their patients. This puts you in control of the procedure and alerts the dentist if you're uncomfortable or need to take a break during the appointment.

8. Visit the dentist regularly to prevent problems. For fearful patients, just going for a check up can be nerve-wracking, but the more you go to the dentist for routine cleanings, the more likely you are to avoid larger problems that result in extensive procedures.

9. Visit the office and talk to the staff before your first appointment. You should feel free to meet with the dentist and to ask questions before scheduling your appointment. Meeting the dentist and his or her staff first will help you find a dentist you like and trust.

10. Go slow. Dentists are happy to go slow with nervous patients. If possible, make sure your first visit is a simple one, such as a cleaning. This will help you build your relationship with the dentist before going in for a more difficult procedure.
posted by Sully6 at 10:19 AM on November 16, 2005 [2 favorites has favorites]

I agree that you should find a dentist who will use gas or other techniques to mellow you out. My husband avoided the dentist for 15 years after a series of botched, expensive and painful treatments in university. He didn't ened up getting gas, but here's what he did:

1) He had only one quarter of his teeth cleaned per session when he first went back. He neded more visits, but he also didn't face the psychological hurdle of dealing with one very long session. e now gets all his teeth cleaned per session every 6 months.
2) He took full responsibility for at home care of his teeth: he uses a pre-rinse, brushes, flosses, and uses a final rinse.
3) He keeps going back to the dentist for cleaning, even though he still hates it.
posted by maudlin at 10:22 AM on November 16, 2005

In my experience, the more you see the dentist, the better it gets. It's interesting that when I was in the military we had to do dental visits whether we liked it or not, and in going in for procedures every 6-12 months I got used to all the procedures and never worried much about them. It's been several years since I left the service and I haven't been to a dentist since, and the phobia has crept back.
posted by rolypolyman at 10:26 AM on November 16, 2005

If you get gassed, can you drive home? I know when I had my wisdom teeth out, they gave me an intraveneous sedative (I think, was a bit foggy) and I had to get a ride home.
posted by smackfu at 10:32 AM on November 16, 2005

I Nth finding another dentist. You should have no issue finding one who will work with you, though you might have to work at it. I recently 'fired' a dentist who was unresponsive to my personal requirements* and you should show no compunctions about shopping for the right fit for you. You're the consumer of a service, the fact that it's in the medical arena doesn't make you any less entitled to the service you desire.

I strongly suggest you ask friends and co-workers for suggestions. There's a world of distance in quality for dentists. As a child I saw a dentist hit another kid for squirming too much in the chair. In adulthood I was a patient with Dr Nullman in Miami, Florida for almost a decade and if I had infinite money I'd be flying back and forth to there for my care to this day, I liked him that much.

You may have to consult your general practitioner for any pharma to take to relax you ahead of time. Just don't use alcohol to self-medicate - it makes you bleed more.

*I have sensitive teeth and prefer amalgam fillings to ceramic since they cause less sensitivity and I don't give a crap about the appearance. They actually argued with me because they "will only use amalgam if they're convinced there's sufficient reason." How about the reason that it's my mouth, money and decision, not yours you presumptions jerks.
posted by phearlez at 10:35 AM on November 16, 2005

Get a new dentist. I'm not kidding. You need to have a full set of Xrays taken if you haven't already. Explain to your new dentist that you want the exam and xrays in the first visit and then the cleaning in the second visit. If an office can't set this up for you then they will not be helpful in the longrun. Get to know the doctor, meet the person who will be cleaning your teeth and make sure you are comfortable around that person, because if they drive you crazy, you won't want to sit still for them.

There are lots of options for what we call conscious sedation, you're awake, but not likely to remember what happened, and not likely to care while it's happening. You will need a ride to and from the dentist for this type of treatment, and you will need a prescription from the dentist, hence seeing him first.

If a dentist offers you a prescription for anything before your first appointment, and I mean anything, and he's never seen you before, run. Get the Rx at your first meeting with him.

When you are getting that cleaning, tell the hygienist every time you experience pain while s/he is cleaning your teeth or whatever...maybe even pick a signal. This is important information for the hygienist to have because, well, let them tell you why, I don't need to get into the details about tartar.

The best news I have for you is that you made it in the door once, you are ahead of the game. So many people never go to the dentist until it is far too late. It costs them.
posted by bilabial at 10:38 AM on November 16, 2005

bilabial works in a dental office, by the way. She knows whereof she speaks.
posted by Gator at 10:46 AM on November 16, 2005

I N+1'th getting another dentist.

I had some horrible dentist experiences as a child, and hadn't visited one for about 10 years; cracked teeth (one of which turned out to need a root canal) finally forced me to.

I found one by recommendations from friends and colleagues, and he in turn recommended an excellent oral surgeon for the root canal. All "nasty" procedures involved gas, headphones, and so on. Their hygenists are extremely gentle, and I now have no fear of going to the dentist.
posted by 5MeoCMP at 11:15 AM on November 16, 2005

Just my 2c regarding gas: consider it in light of your personality and/or experience with drugs? I have friends who are fearful of the dentist and won't even get a cleaning without gas, which is cool because it works for them.

I, however, was given gas when I had all my wisdom teeth removed, and I will NEVER take it again. The gas mask smelled like rubber, which I hate, and it made me sick to my stomach; worse, the gas made me feel paranoid and out of control. I kept giggling at things that weren't funny, including a small child screaming in another room; I felt horrible about that even as I did it but couldn't help it. It didn't help that the oral surgeon was very chatty--sort of a hyperactive William H. Macy--and that, too, was heightened by the gas, which was overwhelming given the situation.

I know this sounds like exactly the kind of horror story that might scare the OP away from the dentist--but I think it's an important enough consideration that the example is warranted. Given what I know about myself (i.e., I dislike substances or other stimuli that alter my consciousness and affect my control, and am paranoid about their effects, which only makes them worse!), I now know that taking gas was a big mistake, FOR ME. (I was told later by another dentist that the "awake" wisdom-teeth procedure, with gas, was out of date and shouldn't have been done anyway, especially for all four teeth at once.) I may have done better with another sedative that didn't have the dippy effects or the horrible smell. Talk to whatever dentist you choose about your options and keep your personality well in mind.
posted by dlugoczaj at 11:24 AM on November 16, 2005

Find a dentist who will treat your fears seriously and kindly. I had a mean (and not very competent) dentist as a kid, and it took a while to trust that a dentist would really respect me. My current dentist errs on the side of being oversensitive. It's a good thing.

Wear earbuds or headphones and take music. My dentist keeps a walkman for patients and it really helps reduce the awful sounds of dentistry.

Get the toothpaste with extra fouride. Flouride makes your teeth stronger. Get a sonic toothbrush, and start brushing 2x daily. Poor dental health can cause other health problems. And the better care you take of your teeth, the easier & cheaper dental care will be.
posted by theora55 at 11:39 AM on November 16, 2005

Ditto on switching to a fear dentist. Find one. I couldn't afford dental visits for a couple of years and the subsequent inconvenience of having my gums debrided and deep cleaned for a total of 16 hours over four visits convinced me to *find the money* to visit the dentist in the future. The effect of putting it off will only substantiate your fears, not ameliorate them.

As for taking better care of your teeth, that seems like a no-brainer. The dentist terrifies you. That should motivate you to take better care of your teeth so that you only have a once a year cleaning instead of the quarterly deep clean debriding and the oh-so-exciting biannual root canal/filling.

I floss while watching tv. Kind of obsessively, but hey, it works and my gums don't bleed when I brush anymore. I use a motorized toothbrush two or three times a day. I rinse with the new non-alcohol pro-health rinse--why punish your mouth when you can have a tasty rinse?

It's too bad that your parents waited so long to take you to the dentist. =( When you have kids, take them early and often.
posted by xyzzy at 11:49 AM on November 16, 2005

By no means am I inferring this applies to you, anonymous, but I'd like to note the parallels between the fear of dental work and child sexual abuse victims.

I have known someone that this applied to. The conquering of their past demons went a long way towards getting the seemingly simple task of having their teeth cleaned more tolerable.
posted by negatendo at 11:55 AM on November 16, 2005

Thanks Gator, I hadn't realized that I left out my qualification for answering. A good receptionist will even be a little appalled that you feel the need to ask to have these appointments separated, it should be standard office procedure. Sadly, in order to save time (which equals money) many doctors wait until after the first cleaning to give an exam. Even when they know they have an anxious patient. Obviously, that's not how we treat anyone at this office.

Again, let me focus on how awesome it is that the OP is facing this now rather than waiting for an emergency. It's a total PITA trying to find a dentist for an emergency if you're not already established. If you get along well with your dentist they will meet you at the office in the middle of the night for a true emergency. But that too costs extra, noted by the after hours office visit on the bill. So getting in for an exam is great even if you don't get the cleaning, at least someone knows who you are!
posted by bilabial at 12:16 PM on November 16, 2005

Sully6's recommendations are great -- they're basically what got me through my dental phobia. I now have a wonderful dentist who I genuinely look forwarding to visiting. If you (or anyone reading this) is in L.A. and would like a referral, please drop me a line (email in profile). I've sent one MeFite to my dentist in the past, and I'd be happy to send more.
posted by scody at 3:25 PM on November 16, 2005

I'm one of those people paying for neglecting dental care when I was younger. I get to go to the periodontist 4 times a year now, rather than twice a year to a regular dentist. You don't want to go there.

I concentrated on what I needed to get through those first few appointments. This has included things like working out a signal for "jump back from the chair now!"

I would run from any dentist (or hygenist) who didn't take my needs seriously, now that I've figured out what they are.

Concentrating on how to solve an issue rather than on how scared and vulnerable I felt gave me just enough control to get through the critical first few appointments.
posted by QIbHom at 2:40 PM on November 17, 2005

Try to find a dentist who practices clinical hypnosis. My dad has used hypnosis in his practice for 35 years (until he was forcibly retired by Katrina two months ago, at least). Check out the website of the American Society of Clinical Hypnosis for a referral in your area.

It's apparently worked wonders with regards to relaxing fearful patients. I remember once case where Dad had a patient who hadn't had any dentistry done since childhood, and the poor guy's mouth was a mess. He finally sought help because his teeth were literally rotting away and causing him great pain. The guy came in, sat trembling in the chair and proceeded to freak out and barf all over the place as soon as Dad pulled his cheek back with the dental mirror to take a first look.

After several hypnosis-only sessions they discovered that the guy was a kid his mom used to threaten him when he misbehaved with, "If you don't stop that, I'll take you to the dentist and have him pull all your teeth out!" Needless to say, when the kid finally did have to go to the dentist for the first time, he kicked and fought and screamed, flailing arms and legs. The not-so enlightened dentist at the time responded by putting his arms in restraints, having the nurse sit on his legs, and then pounded a notched rubber mouth-prop between his teeth to force his jaw open.

With the relaxation, concentration and reduction of fear they worked through in the hypnosis sessions, Dad ended up doing about ten grand worth of dentistry on the guy, and he was fine.

Incidentally, I always thought it was really cool that the New Orleans chapter of the ASCH (of which my dad was president for a few years) was until recently called "Le Société du Magnetisme de la Nouvelle-Orléans". It's apparently been renamed to the extremely dull "New Orleans Society of Clinical Hypnosis". Bah.
posted by chuq at 4:12 PM on November 17, 2005