Find me a DDS, stat!

August 19, 2006 7:39 AM

Help me choose a new dentist that won't make me fearful!

I'm looking for what to look for in a new dentist. For reasons you'll see below, I plan to leave my present dentist. He's the only one I've had. These are my issues, and I wonder what to ask a prospective new dentist that would get me the best one possible:

(a). Doctors (and, of course, dentists) scare me. Partly because I loathe needles, but the atmosphere is also unpleasant. My family doctor even notices the difference when takes my blood pressure when I arrive and when I'm about to leave.

(b). While needles don't normally hurt a lot, for whatever reason, I have always found the needle they use to freeze my gums excruciatingly painful. It's probably about 75% as painful as the time I sprained my ankled and hobbled on it for 30 minutes.

(c). My present dentist managed to hit the wrong nerve, temporarialy damaging it and leaving my face half numb for about 3 months. He was, well, IMHO, been less than sympathetic about it. Probably because I'm such a baby about these things...

(d). While I don't mind being put under (in comparison to the pain of that damn needle), my last experience with that when my wisdom teeth were removed left me ridiculously dazed for about 4 - 6 hours, and the only thing I remember was having to push myself off walls to leave the place and my inability to speak (at all) left them with a pile of blood puked on the floor of their recovery room. I was told I had woken up earlier than that (had been in the recovery room a couple of hours already before vomiting) but my mind is blank on that. Later that night I experienced the oddest heart rhythm and stopped taking the pain killers (which, funny enough, didn't help with any pain, which was minor really). Everything was fine the next day, except for being bed-ridden still. Doctor had me call in a couple of weeks later to see if I was still ok.

(e). I have no dental insurance and will have to pay with cold, hard cash. Perhaps some dentists will give a discount for that? I'd probably even put up with horrible pain if I can save enough (yeah, I'm that cheap/broke). I'm at the point of considering the local dentists school for deals right now anyways. Being between jobs sucks.

(f). The novocaine never really seems to take away the pain when drilling for cavities. Which brings me to why I need a dentist...

The filling I had the dentist rush because it was starting to really hurt appears to have fallen out and now I have this sharp "valley" missing from the side of one of my molars. I need to get it fixed. I could probably use a cleaning on my teeth since it's been 3 years already.

FYI: If you have specific names of dentists to go to, I am in the Kitchener-Waterloo, Ontario area. I don't mind driving up to about 30 - 40 minutes if it gets me the best dentist.

Any suggestions? Thanks for reading!

posted by shepd to health (17 comments total)

As a teenager, I went to an extraordinarily gentle dentist (not in your area, sorry). After puzzling this over a bit, I started noting the other clients; many were children. Perhaps looking for a pediatric dentist would help? Mine had a soothing but jovial manner and an amazingly deft touch with the needle and the drill.

Later in life, a different dentist scoffed gently at his assistant, who had been preparing to swab me with numbing gel prior to an injection. "She doesn't want the baby gel!" he scorned jokingly. I stopped him cold, saying, "Anything, and I mean anything, you can do to save me pain, I want. I don't mind being a baby!" His treatment from that visit on was markedly more gentle.

That taught me to let the dentist know, in a clear but non-confrontational way, that I fear the experience. They may be more gentle in manner and in technique. It worked for me. (In fact, my current dentist gives me a very low dosage of muscle relaxant for more serious procedures, because he knows I get anxious, and the medication makes it easier for both of us.)
posted by Elsa at 7:56 AM on August 19, 2006

Have you ever had nitrous oxide? The dentist I go to offers it and it made all the difference for me. The nice thing I've noticed about nitrous is that even though I notice the painful bits, I just can't rouse myself enough to care. The last time I had to get a cavity filled, I had them give me nitrous and I brought my ipod and I was more than fine, and I am oogy about needles in the first place.
posted by sugarfish at 8:38 AM on August 19, 2006

No, the dentist I have been using isn't licensed for NO or anything else like that. :-(
posted by shepd at 8:56 AM on August 19, 2006

Nitrous will however add further expense.

My best luck has always been getting personal referrals from friends/coworkers. My current dentist is super, a coworker referred her. Good technique unquestionably reduces the pain of the shot. You should not feel pain in drilling. Discomfort, vibration but not pain. Tell your new dentist that you have had problems with not being numbed enough.

A dentist should be attentive and responsive to a patients concerns and fears. Lots of people have a tough time at the dentist and good dentists are sensitive to this. I had a girlfriend who seriously needed twice as much novocaine as a normal person. There are dentists in the yellow pages, at least of my urban area, who advertise no-pain or cater specifically to nervous clients - but I bet they charge more.

And it must be said - if avoiding more unpleasant and invasive procedures is your goal get your teeth cleaned more frequently. At least once a year and more often if your dentist tells you to. It will save you money and pain in the long run.
posted by nanojath at 8:57 AM on August 19, 2006

I just want to second what nanojath said about alerting your dentist to the fact that you haven't been numbed enough in the past. Up until a couple of years ago I endured excruciating pain every time I got a filling because I thought that's just how it was supposed to feel. One day I happened to mention this to a new dentist I was seeing; she wasn't surprised at all and explained that some people just need extra novocaine in order to truly become numb. She gave me a little more than the usual amount and I didn't feel a thing during the filling. It totally changed the way I think about getting cavities worked on (which is a good thing because I get the damn things all the time thanks to unfortunate genetics).
posted by purplemonkie at 9:22 AM on August 19, 2006

If you're willing to trek to Toronto, Don Ducasse is good. I can't vouch for the specific gentleness, but he and his tooth-cleaning minions are all very friendly and positive, which goes a long way towards making the whole thing pleasant.

He does seem to be very good about saving teeth and doing what's necessary instead of what makes him the most cash. My bride had a bit of pain related to a partial thing that had popped off, and the local dentist in TX told us that she needed that filled, but they couldn't get to it, so they'd have to cut off half of the tooth next to it and then crown both of those teeth and then crown the tooth next to it so that it would match -- we were looking at USD 6000, USD4000 out of pocket. Don looked at the tooth and said, "That's tight but I can fix it," and the problem was solved for CAD150.

My bride has reported that when she was in nursing school he was willing to make allowances for an inability to pay.

We live in Dallas/Fort Worth, and Ducasse is our dentist.
posted by ROU_Xenophobe at 9:34 AM on August 19, 2006

Ditto on some people needing more novocaine. I avoided dentists for more than a decade because of my terror of painful drilling. My current (and fabulous, soothing, and supportive) dentist just gives me plenty till I'm totally numb.
posted by scody at 10:19 AM on August 19, 2006

i literally feel your pain. i'm a phobic with a fear of needles and breakthrough pain, and had had a series of pretty sadistic dentists until i found the the one i use now, who specializes in folks like us. he had to fix all of the abandoned/broken work others had done. i'm putting his kids through college and grad school, i suspect ...

i would suggest seeing if there are any dentists with a practice specializing in phobics. or, as someone said above, a pediatric dentist.
posted by sdn at 10:22 AM on August 19, 2006

nanojath is right -- nitrous does add further expense. At my dentist, it's $45 extra. My insurance doesn't cover it.
posted by sugarfish at 10:52 AM on August 19, 2006

Our dentist is Dr. Bensky. He came highly recommended. I don't know about discounts for cash, etc., but you could certainly call and ask. We have had painless, gentle, and quite competent treatment there so far from both him and the hygenists. I dislike going to the dentist myself but my cleaning went as comfortably as a cleaning could go. He does pediatrics too; my 3-year-old son just went yesterday and they did a fabulous job handling him. No tears at all.
posted by Melinika at 10:57 AM on August 19, 2006

I too am one of those people who doesn't freeze with the "standard" level of freezing. I also metabolize it really quickly, which means it only lasts about 20 minutes, if I'm lucky.

I have an amazing dentist, she is really, really understanding, and keeps giving me freezing shots every time i feel the tinest thing. Seriously, a cavity filling should never be painful. If it is, you need a new dentist. Keep trying out dentists until you find one you're comfortable with.

Another thing I've learned however, is that anxiety reduces the effectiveness of the freezing. It's a vicious circle - the pain from not being properly frozen once causes anxiety the next time you go, the anxiety compounds the effect, it's even more painful, causing more anxiety, etc.

Ask any potential dentist if they offer sedation dentisty. I think thats what they call the nitrous gas as well, but I've been given a Valium-like drug (Halcion, actually) that relaxes me to the point where I'm almost alseep, don't have a care in the world, and it sometimes can have a insomnia-effect such that you don't remember anything about the procedure. I will never again have any major work done without it, and frankly, my dentist doesn't want to work on me without it ever again, either. :)
posted by cgg at 11:10 AM on August 19, 2006

Shoot, not an insomnia effect, a memory loss effect. The drug Halcion was originally a cure for insomnia. Damn it! Sorry about that.
posted by cgg at 11:11 AM on August 19, 2006

If there is a dental college at a nearby university, one of the teaching dentists with a private practice might make a good choice for you. It worked for me.
Alternately, you might try being a practice person for the students. Disclaimer:I have no personal experience of student dentistry, but I understand that there is always supervision by a licensed dentist.
posted by Cranberry at 12:44 PM on August 19, 2006

I'm not sure if 1-800-DENTIST can find dentists in Canada, but it helped me find my wonderful dentist here in the US.

When I went in I made it VERY clear that I was scared of dentists and scared of pain. I told the receptionist, I told the hygenist, I put it on the intake form, and I told and retold my wisdom tooth horror story. I didn't care what they thought of me, but they were very understanding and made an extra effort to be gentle. Just let them know.
posted by christinetheslp at 1:36 PM on August 19, 2006

Dr. Dulski makes people like you (and me) his target-market.

Check out his website and give his office a call. Perhaps he can refer you to someone in your area.

The magic phrase is 'Sedation Dentistry'.
posted by Wild_Eep at 6:19 PM on August 19, 2006

OK, I've waited to weigh in awhile, to let the thread develop. What I have to say is based on practical experience, and the sound advice of a 70 year old dentist from Nashville, TN, who would be about 105 if he were alive today, but he isn't.

I went into his office for a replacement filling about 30 years ago. It was an old office, tiled in 1950's green bathroom tile, with woodwork of unfashionably light finished, but solid, American red oak, but he'd been recommended as a guy who did great work cheap. I sat down in his old time leather and porcelain chair, he did X-rays with a machine that could have jump started Frankenstein, and then he did a first cleaning (for that practice) himself, which also seemed to be the most extensive oral exam I've ever had, and said "You've got 2 fillings that need to be replaced in addition to the one that brought you here. You want me to do them now?"

"OK, if you can today." I said.

"Sure. You want to be deadened?" he asked. That was fairly novel, I thought, as he explained that he wouldn't be doing a lot of new drilling, just knocking out the old filling material, and cleaning up the teeth to accept new fillings. Mostly, it would just be some noise, and if I found it painful, we could always stop, and he'd shoot me up. But he didn't think it was necessary, if I could put up with 8 or 9 minutes of drill noise. He seemed pretty confident that he wouldn't be hurting me, and so I said:

"Sure, go ahead."

So, he did. And the noise was as bad at is usually was, and the vibration from his first generation air turbine drill was pretty awful, but, surprisingly, there wasn't any real pain. A couple of quick twinges when air hit fresh dentum, a time or two, but nothing major. Just noise, and vibration, and that funny smell that decay makes when a drill is cutting it out.

And then we were done with drill, in about 10 minutes, and I rinsed and spat.

"Wasn't too bad, was it?" the old dentist asked.

"Nah." I said, a little proudly.

"Well, since we're all done with preparation so soon, we've time, if you want, to make impressions. Or, I could just put in amalgams. Up to you." he said.

So I asked him what the difference was, and he explained how inlays differed from fillings, as I sat there with my tongue probing the remnants of my prepared teeth, and he recommended inlays, and I thought that sounded pretty good, and so he took impressions, and I was out of there 45 minutes later, with 3 temporary fillings, and no hangover numbness from Novocaine.

I went back two weeks later, and he fitted and adjusted 3 gold inlays in another 45 minutes, without any Novocaine, and I was pleased as punch with the result, and happy to pay the bill. I still brush those 3 gold inlays every day. Never had another problem with any of those teeth.

Since then, I've asked both the primary dentists I've had since, to forgo Novocaine injections, if they don't mind, and aren't going to be working at or below the gum line. They've both agreed, but the guy I saw in Atlanta for 13 years was always nervous about it. In the last couple of years I went to him, I let him inject Novocaine for minor procedures, because my insurance paid for it, and he seemed a lot surer about his procedures if he thought there was no chance I'd feel anything gone amiss. He admitted to me once that working on an un-anaesthetized patient was a very unusual experience for him, and it did make him nervous.

I think it kind of broke his rhythm to just start in, without doing the injections, and waiting 10- 20 minutes for me to "numb up." I know it made his assistants nervous.

At any rate, I dropped into this thread to say, painless dentistry doesn't require a boatload of injected analgesics. It just requires a bit of understanding from you, a commitment from your dentist to proceed sensibly and with skill and a deft drill hand, and a mutual willingness to have the minor unpleasantness of dentistry over and done with, as soon as it is over. It's less expensive, less dangerous, less painful overall (since you don't have lingering soreness from injection sites), and faster. After you and your dentist get through the first appointment without Novocaine, you'll both think more of each other than you ever will, deadened. And you get better work, sometimes cheaper.

The only times I've ever had real dental misery, some dentist injected me with a ton of analegisics, and proceeded to botch things badly.
posted by paulsc at 8:08 PM on August 19, 2006

Well, sorry for not marking any best answers! They're all quite good and helpful, honestly.

Anyways, I've been to a new dentist (not the one Melinika suggested, but thanks for the suggestion anyways: I was in a rush to get a checkup done at least, and didn't read your suggesting in time). Seems that my last dentist (who will remain unnamed) may not have been all that great (or I might just have unlucky teeth). I have at least 3 fillings that have fallen out over the past 2 - 10 years through no apparent fault of my own. Of course, due to my own lazyness and also just bad genes I have two new cavities to fill as well. Ugh.

I'll buck up and get them done. The new dentist I'm seeing is Dr. Narayansingh, and this one (or at least his assistant!) seems much more interested in discussing with me about dentistry and more specifically about the results of my checkup, making me more comfortable there, oddly enough. Hopefully the several fillings I'll be getting will go smoothly and won't fall out this time (argh!)

And, what the hell, in the end I guess it's only money. I can make more of that, even if it is debt right now. But I can't grow more teeth no matter how much money I have (YET).
posted by shepd at 9:29 PM on August 22, 2006