How to deal with terror surrounding dentists.
November 11, 2013 11:13 AM   Subscribe

I'm terrified of going to the dentist. I need significant amounts of dental work. I am having difficulty with my dental providers insurance and have the option to switch insurance providers, but have no idea how to navigate this emotionally, or financially.

I've never liked the dentist, and not having dental insurance for the past...8-9 (?) years has lead to plenty of problems that need to be fixed. The problem is that I've got an inappropriate level of anxiety surrounding the dentist. I can't make a dental appointment on my own, without having a full on 100% panic attack. It's terrible. My wife has to call in my dental appointments, and leading up to the date of the appointment I have crippling anxiety.

I am a naturally anxious person, and have been medicated for it in the past, but with loads of exercise and therapy, i'm pretty good to go most of the time...just not around this. It's not something that comes up everyday, but when it does, I'm wrecked.

The current situation and timeline of events:
-Three months ago, two of my teeth basically collapsed in on themselves and I needed to get crowns put on. This was harrowing for me. I was given Halcyon by the doctor, and it didn't do anything but take the edge off the panic attack; I was white knuckled throughout the procedure and was shaking, and sobbing pretty hard. I didn't have insurance at this point, so I had to pay cash, at a private dentist clinic. This ran me about $2k. The job he did was terrible, and I'm not sure if you can ask a dentist for your money back for shitty work, or if he'll just blame my terrible teeth, and move on.

-One month ago, one of the crowns is messed up, and I go see my current dentist (Kaiser dentist, on Kaiser insurance plan) about it. I can't brush on one side of my mouth because the crown isn't seated properly and is super sensitive. I've been told by my current dentist that I need a root canal. The dentist had me on gas the entire time. The gas didn't do anything for my anxiety at all, and again, I was shaking by the end of the procedure and couldn't walk well after. I felt spent for days afterwards. I promptly never call him back to schedule anything, because I'm terrified of another procedure. My mouth hurts, but it's not so bad I can't operate yet. I fully realize this is irresponsible and childish.

-Early this morning, I woke up to swelling and pain surrounding the site of the 2nd crown, which was fine up until this point. I have to go in. My wife sets up an appointment for me, for tomorrow. The dentist calls me back (which, again, just him calling me back sends me into a spiral of confusion, anxiety and panic, so I can't really communicate with the dude. I get really combative, because I feel like the dentist is actually out to hurt me...which i realize is irrational). He says that since halcyon didn't help much, and gas didn't help much, they're going to stack them on top of each other and try that. However, to do this, he needs to have a consultation with me, then schedule another appointment. It's quite problematic for me to be missing work-days to do this, and to basically be losing double time for each procedure isn't financially plausible. I'm an hourly worker, so each appointment dings me twice. It turns out to be $150 bucks+ lost hours at work (or +childcare costs on the days I take care of the kid) for each visit.

We have the opportunity to switch to a non-kaiser dental plan for me, but i'm not entirely sure the details yet. This is my first time working with the Kaiser dental system (and medical system) and we've been wholly unimpressed with everything but the price so far.

My specific questions are-
How on earth do I even start to emotionally navigate this? I do not feel capable of dealing with this at all.
Once I actually get to the dentist for work, what exactly do I need to be telling them, or asking for to prevent feeling like i'm going to die in the chair?
Is this a Kaiser specific protocol? Will a non-kaiser dentist have any more leeway in procedure or technique? Assume I know nothing of dentistry. Because, I don't.
Is there some sort of cocktail that will put me out and make me believe i've been sleeping on a cloud of rainbows for a couple hours?
posted by furnace.heart to Health & Fitness (14 answers total) 10 users marked this as a favorite
I can't speak for the U.S., but where I live there are dentists that particularly specialize in anxious patients or patients with special needs, and to that end primarily use IV sedation. If it's an option in your area, I'd recommend searching or calling around for a recommendation to someone for whom your needs are the focus and not an incidental complication.
posted by northernish at 11:18 AM on November 11, 2013

I have significant dental fear, which led to me avoiding the dentist, which led to major work being needed. I also had Halcion for that work, but I had an ENORMOUS amount -- so much that I basically slept through the procedure, all six hours of it. I have no memory of it at all.

These days, when I need dental work, I am enough better that I don't need massive doses of Halcion (I think they gave me six in total, three an hour before the procedure and three immediately before), but I still take Valium and get the gas. They give me big doses of valium too, 10 mg the night before and 10mg an hour before the procedure, and the gas is turned up to maximum. This combination for me, yeah, essentially makes me feel like I'm sleeping on rainbows.

Obviously these are big drugs, and a lot of dentists are reluctant to prescribe them in these quantities because they're such big drugs. But it made it possible for me to take care of my teeth, so I'd say it's a win. The magic phrase in my case was "sleep dentistry."
posted by KathrynT at 11:19 AM on November 11, 2013

You want a dentist who will do twilight sedation. In other words, you will be knocked out for the entire thing.

Have your wife call around. Getting a few Xanax to take the day of, may help as well. I know someone who used Xanax just to get to the dentist, then the twilight sedation once there. It made the process manageable.

Hang in there, the more you do it, the better it gets.

As friends and family for dental referrals.
posted by Ruthless Bunny at 11:22 AM on November 11, 2013 [1 favorite]

Have your wife make the appt. for you, and not tell you about it until 2 days before. No sense losing that much sleep. There is such a thing as sedated dental care; I have no details. Putting you completely out has risks. I had to have a complicated root canal, lots of mouth anesthesia, but wasn't out. Felt nothing in my mouth for quite a while. My anti-anxiety med is Xanax. Talk to your primary care doc about it, and talk to your dentist. Find a dentist who specializes in anxious patients.

This is not uncommon, although it sounds like your situation is quite severe. Once you get the critical work done, please get help for this - hypnosis, therapy, whatever, as it must be really awful for you.

You were pretty brave to go to the dentist, and to be facing this head-on. I know it's hard, but do give yourself a lot of credit for having work done despite your terror.
posted by theora55 at 11:26 AM on November 11, 2013 [1 favorite]

How on earth do I even start to emotionally navigate this? I do not feel capable of dealing with this at all

I know it's tough, but you've really got to distance the bureaucratic aspects of this stuff from what you've experienced in the chair. Getting your insurance in order is not the same as having teeth pulled. It's just a bunch of numbers and money and rules that you've got to read and understand in a place totally separate and away from actual dental work. And getting it sorted is step-1 on making sure your future visits to the dentist (as well as the resulting dental work) are to your satisfaction and peacefully off your mind.

Is this a Kaiser specific protocol? Will a non-kaiser dentist have any more leeway in procedure or technique?

Possibly, maybe. With my PPO dental insurance I found the dentist I wanted to go to, then got an insurance plan that would have him in-network. That way I could make sure the person I was seeing, the person operating on me, was already on the same page as me regarding my preferences. If that's the option you're looking at when you're considering a switch, just make sure you find a dentist first who will 1. Offer you the care you require (twilight sedation) and then 2. Take your provider's plan. But 2. isn't wholly necessary, it might just be a little more expensive. Contrast with Kaiser (HMO), where you and whomever is paying for your dental is getting a decently cheap rate, but you're stuck within their system and have to settle for the care they choose to provide. I like Kaiser alright for general health stuff, but I love my PPO dental coverage.
posted by carsonb at 11:34 AM on November 11, 2013

Hi, I was you up until a few years ago. I went to a terrible dentist as a kid (so bad that he didn't even use novocaine on me while doing fillings!) and thus became untrusting and fearful of the dentist. I thought they were all callous torturers who didn't care if their work caused pain!

All of this came to a head when I turned 18 and my wisdom teeth came in (crooked, impacted, and infected no less). I had a ton of cavities at that point in addition to searing pain from the wisdom teeth. What I did really saved my mental sanity - I went to a dentist who specialized in kids (really) and told her "look, I am scared shitless of you and I am going to have a full-on screaming panic attack in the waiting room before you do all this work, and I can't control it." She gave me a prescription for valium to take the day before and day of each visit. For the heavier work she sent me to a pediatric dental surgeon who was qualified to use gas and twilight sedation. In both cases, the dentists knew that if at any point I started crying or shaking while in the chair they needed to stop immediately, ask me if I was in pain or anxious, and then do something to correct it.

Since taking these measures my anxiety has reduced significantly (granted, over the course of about 12 years) and I can now go to the dentist without any valium or anxiety concerns. I still get a little nervous about fillings, but listening to loud music has helped distract me during those procedures.

My suggestions to you are:
1. Find a dentist who specializes in kids and/or anxiety. These are professionals who understand what you're going through and are capable of offering solutions
2. Tell your dentist what it looks like when you are panicking in the chair (crying, shaking, etc) and tell them to please not ignore it when it happens
3. Ask for valium or xanax or something you can take in the hours leading up to the appointment. Bonus points if you can get something for the night before so you get a good night's sleep.
posted by joan_holloway at 11:36 AM on November 11, 2013 [1 favorite]

I went through this. I found a dentist who had worked with children, and who I talked to about being uncomfortable/anxious. He wasn't shy about topical painkillers, novocaine, or even the heavy stuff when necessary.

I will tell you that dentistry isn't as bad as it used to be! For example, we just met with the orthodontist to talk about braces for my oldest, and he spent most of the time explaining how Things Have Changed. New materials, new methods, better planning=less re-work…all in all, very comforting to me on her behalf!
posted by wenestvedt at 11:37 AM on November 11, 2013

Nthing getting a prescription for just a few Valium or Xanax to take just for dental work. So many people do this that your dentist and/or doctor shouldn't bat an eye at the request.
posted by Jacqueline at 11:39 AM on November 11, 2013

Google "sedation dentistry" in your city. You are not alone in this phobia!
posted by cecic at 11:44 AM on November 11, 2013

Man, I'm you, at least with the anxiety of the actual procedures. My mouth is also in constant need of major work.

I've found a dentist who is A BLAST. Really, so fun. He also gives me valium to take before I get there, and laughing gas during the procedure. So by the time he even gets my mouth open, I couldn't give a single shit.

Also, he has a TV hung above the chair so you can watch Judge Judy, which he makes fun of with you.

I've gone from sheer terror to kind-of-sort-of looking forward to it, in less than a year.

It's really all about finding a dentist you fit with, like anything else.

Your questions:

How on earth do I even start to emotionally navigate this? I do not feel capable of dealing with this at all.

You put yourself on autopilot. When you're making appointments, pretend you're making a dinner reservation. Just do not think about it. You can do it. It gets easier with practice.

Once I actually get to the dentist for work, what exactly do I need to be telling them, or asking for to prevent feeling like i'm going to die in the chair?

My dentist was a referral from my awesome GP. I told her about my anxieties, and she found the right fit for me. I also told the dental receptionist. And the tech. And the dentist when I finally saw him. Tell everyone everything, and early. Feel no shame, make a fuss.

Is there some sort of cocktail that will put me out and make me believe i've been sleeping on a cloud of rainbows for a couple hours?

Valium. It won't put you out, it just makes you really, really not care.
posted by ulfberht at 11:47 AM on November 11, 2013 [2 favorites]

I have had a really bad time with dentists. I had a really bad dentist for a long time, and a lot of really bad things happened with my teeth, the worst of which is that I had to have a tooth extracted when I was pregnant, and I couldn't be out for it, and I couldn't take a sedative.

Here is my advice: First, talk to your GP and get a prescription for Xanax and take the max dose when you go to the dentist. Ask your doctor what that dose is. It's not necessarily what's on the label. Life is way to short to fuck around with panic attacks at the dentist. No one will give you a medal for it, and it will only make it worse. Second, get some headphones, and when you're at the dentist, listen to music. Ask the hygienist if s/he minds. They won't; they'll be delighted at not having to make conversation with someone while they have tools in their mouth. Third, ask and ask and ask again until you find a dentists' office you feel comfortable and you feel like they're trustworthy, and then go there.

Here are some things I looked for when I set out on the incredibly onerous task of finding a decent dentist: up to date bathrooms and decor. If they're cheaping out, they're cheaping out in other places as well. Good, modern equipment: those little monitors where they can look at your teeth digitally. Digital records, not a manilla folder. High standard scheduling equipment. Competent phone answering. Professionalism. Intellectual curiosity about teeth. A sense that some of their profits are being invested in upgrades. And in human terms: someone who talks to you like you're an intelligent person with the same investment in good teeth that s/he has.

Floss, rinse with salt when your gums are tender, get an electric toothbrush and brush for the full two minutes. Read the internet while you're doing so.

If it helps at all: you're not at all alone. I and many other people know exactly what you're talking about.
posted by A Terrible Llama at 11:53 AM on November 11, 2013 [1 favorite]

A member of my family is also terrified of dentists, but one stern talking to via email by her doctor made her realize how irrational her phobia is. The doctor said to her, "You need to start treating having dental work done as vital to you going on living. It is officially on par with breathing and drinking water in terms of importance. You refusing to go get work done because you are afraid is literally going to be a death sentence for you, and how ashamed will you be to lose all that matters to you because you cannot get it together long enough to take what you need to in order to get yourself taken care of? Let it go and get in that chair so you aren't miserable for the rest of your life."

Harsh, but man, it did the trick. Oral health isn't optional for you anymore, so don't let your anxiety tell you it is. You are in charge of you, not your anxiety. You can do this.
posted by These Birds of a Feather at 12:22 PM on November 11, 2013

I am a fellow dental-phobe (thanks to unpleasant childhood dentist experiences - there seem to be a lot of us!). I found my really terrific dentist through googling "sedation dentistry" and searching in my area. If you were in my area, I'd send you to her!

I had to have a whole bunch of dental work all done at once earlier this year (thanks to that dental phobia) and I was given a Valium the night before and Halcion the day of. I am very tolerant of sedatives and it apparently took a whole assload of Halcion to put me under (that Valium the night before might as well have been a sugar pill, but I am unusually tolerant to sedating drugs). You want to find a dentist who is certified in sedation dentistry in case you need more than just a Valium or Xanax beforehand.

But I got all my dental work caught up and now I floss every day and go to my twice-yearly cleanings, where I get laughing gas, because I am just that sensitive.

Dental care is not what it was thirty years ago. There is a lot more sensitivity to dental phobia and pain control. Go and find a dentist who does sedation dentistry and get your mouth taken care of. Get CareCredit if you have to. You won't regret it.
posted by Rosie M. Banks at 2:04 PM on November 11, 2013 [1 favorite]

Sedation dentistry FTW. My neighbor who hadn't seen a dentist in 40 years because of fear had to have close to $20,000 of dental work done after a heart attack (it was NON OPTIONAL because bad oral health can lead to heart problems). He was terrified. He went to a sedation dentist and they knocked him right out. Doesn't remember a thing. After the first appointment, he was MUCH less anxious for later appointments because while he wasn't thrilled about waking up with a sore mouth (mouth stuff being still not his favorite), he felt no pain and remembered nothing, and by the time he finished up his two years worth of rescue dentistry under sedation, he was so much calmer about the dentist he has been able to get cleanings since then with just a xanax.

If it would help you, you can make an appointment to go talk to the dentist about your fear and find out what they do for sedation and how it will work, on a day when nothing will get near your mouth and it will be just talking. The guys who do sedation dentistry are really sensitive to people with a lot of dental fear and are happy to talk to you about it in advance. That might make you feel more in control. If, however, that would just add another emotionally-difficult step you could procrastinate, then just have your wife research and pick someone.
posted by Eyebrows McGee at 3:50 PM on November 11, 2013 [1 favorite]

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