Sensory hell at hygienist - is it avoidable?

June 21, 2024 3:19 AM

Is there an alternative to the dental hygienist's ultrasonic scaler or hand scaling? They are pure sensory hell for me and completely overwhelming.

I have sensory issues due to neurodivergence. The ultrasonic scaler used by dental hygienists is horrific and overwhelming for me. Unfortunately hand scaling is also a very bad experience. I've tried noise cancelling headphones and CBD but the issue is those sensations in my teeth overwhelm me.

Is there any modern tool that can remove tartar and plaque which can avoid this? Or a dental hygiene practice at home that can make it unnecessary?

Or am I just screwed and needing to find sedation/medication of some sort if I don't want gum disease?

I am phobic about dental anaesthetic injections and live in a part of the UK where nitrous oxide use for dentistry is very rare, so these probably aren't options

posted by Flitcraft to Health & Fitness (21 answers total)

When i go to my dental hygienist, she uses a purple dye on my teeth to show where plaque is. Disclosing tablets are chewable tablets that make dental plaque visible, marketed for children to learn how to properly brush their teeth. It's basically a vegetable dye. You basically brush until all the purple is gone... So, you could be doing that at home, to be super diligent with your own brushing and flossing, so you would not need the hygienist to scrape anything off?

This would probably work best if you start the dye routine AFTER you've just had your teeth freshly cleaned, hopefully for the last time. Otherwise, you'd have to basically do the scraping at home yourself. Plaque is not easy to remove by just brushing once it's very established.
posted by PardonMyFrench at 3:25 AM on June 21 [1 favorite]

My hygienist uses a gum numbing product that helps a little.
posted by SemiSalt at 4:23 AM on June 21 [4 favorites]

Try a valium. My doctor prescribes me 3 5mg valium a year (2 dental appointments, 1 gynecologist) and my dentist even keeps 10mgs on stock (which is too much for me personally, YMMV). It doesn't stop the dental cleaning from happening, but it turns off the part of your brain that lets you care about it. Neat.

a dental hygiene practice at home that can make it unnecessary

Unnecessary no, but you can certainly significantly reduce the amount of work that needs done at the dentist by having exemplary home care. I take very good care of my teeth, and even so I leave the dentist every 6 months with a few more notes. Angles to hold my brush at to reach particular spots, certain teeth that I'm flossing at 90% instead of 100%, etc. I always ask what I can do better at home and I always get some kind of note. Every cleaning appointment I go to requires less and less scaling.
posted by phunniemee at 4:24 AM on June 21 [6 favorites]

After my appointment in the fall I purchased an electric toothbrush and my cleaning a couple days ago was drastically reduced. A nice bonus is that my teeth always feel post dentist smooth.
posted by onebyone at 4:38 AM on June 21 [3 favorites]

I purchased an electric toothbrush

My teeth always have the post dentist smooth feeling and I use the (free) manual toothbrush my dentist stocks me with and a flosser.

Not a call out of onebyone in specific my only point is that home dental care is more about technique than anything else. An electric toothbrush is great, but if you have bad brushing technique it's just an expensive way to continue brushing your teeth poorly. Get good home care advice from your hygienist first, then upgrade your tools if you want.
posted by phunniemee at 4:47 AM on June 21

Response by poster: This was with the gum numbing product which adds to the overwhelm with its powerful taste and fear it will mix with saliva and drip down my throat because of being forced to lie back for the scaling. Being forced to lie back with that in my mouth added to the problem. Sensory problems with the suction too. It's just overwhelmingly awful. Are there any alternative methods?
posted by Flitcraft at 6:04 AM on June 21

I've started using earplugs (Loop Quiet) during the ultrasonic scaling and taking them out during the hand scaling. (From hand scaling the sound comes mostly via bone conduction, and I find that the earplugs make that louder.) I also quit getting polishing (which is unnecessary), which reduced the overall sensory load of my dentist appointments. I also refuse gum numbing (ugh).

Have you disclosed to your hygienist and had a discussion about your sensory issues? How receptive are they to accommodating your sensory needs? Have they tried adjusting any of their techniques to reduce the sensory badness? One of my previous hygienists let me hold/control the suction tool, which helped compared to just hanging it in my mouth the whole time; my current hygienist uses suction more selectively. If your current hygienist blows you off, can you ask to see a different one?
posted by heatherlogan at 6:11 AM on June 21 [3 favorites]

the only other alternative i’m aware of is sedation dental.

i’m sorry this is so hellish for you. honestly, well done for continuing with the dentist— kudos for sure.
posted by tamarack at 6:20 AM on June 21 [11 favorites]

I used to be terrible about keeping up with regular dental visits, so several times in my life, I've had to get super long cleanings or two or three visits to finish the descaling. Highly don't recommend. This terrible experience meant I didn't want to go back and causing a terribly feedback loop.

Once you get through one thorough cleaning, there is hope. I started using a Sonicare electric toothbrush. Some say you can do just as well with a manual one, but one of the no brain secrets is now I always brush for two minutes twice a day. I also found that a tartar control toothpaste seemed to work better for me. I'm partial to the cheap Crest with baking soda one. I also started flossing nightly. Now that I do these things, a cleaning never takes more than 20 minutes.
posted by advicepig at 6:22 AM on June 21 [3 favorites]

If you don't have any specific gum problems, you likely don't need to do it as often as your dentist says - or perhaps at all. A common standard is every 6 months, but "there is no evidence of a difference in bleeding between 6-monthly, 12-monthly or no scale and polish over three years." It obviously depends on your preferences, but since learning that, I'm planning to go only annually. And if you do have any dental problems, do not delay in getting them checked and treated.
posted by Mr.Know-it-some at 6:29 AM on June 21

I've spoken with my hygienist and asked them to use the lowest setting on the ultrasonic scaler as the ringing in my ears is unbearable. It's helped a little, and honestly I just grip the arm rest and bear it as best I can. It's worth it as gum health is directly related to heart health. My grandfather died of heart disease because he didn't take care of his mouth health.

I also use a sonicare brush every day, and my hygienist just complimented me on my flossing. I floss maybe three times a year, at most. So it helps if you can bear the feeling of having that in your mouth

I agree with above posters about talking with your hygienist beforehand and share your needs. These are patient needs, not buggy little things you are asking them to do. If the hygienist can't make adjustments, ask for a different person next time. Speak with the dentist about it. Let them know they need to be trained in patient needs. Maybe it's time to research a new dental practice if they cannot make accommodations for your needs. And you are not the only one.
posted by archimago at 7:01 AM on June 21 [1 favorite]

I have similar struggles. It still isn't pleasant, but has improved from hellish to just unpleasant due to:

-finding a hygienist with a gentler method - skill/technique seems to vary a lot
-taking an oral painkiller beforehand
-not going too long (especially multiple years) between dentist visits
-electric toothbrush (very highly recommend - my cavity rate and dentist comments dramatically improved since switching to a cheap oralB electric, without changing my probably-poor technique and lower than ideal frequency)
-regular waterpik and/or flossing (flossing is best if you can manage it, but waterpik is much better than nothing)
posted by randomnity at 7:18 AM on June 21 [4 favorites]

The purpose of scaling, whether it's with hand instruments or the ultrasonic, is to remove the calcium deposits (like scale in a sink) that are called tartar or calculus. When calculus builds up it traps bacteria between it and the gums, and it's an irritant to the gums, and these things cause the gums to swell and bleed (gingivitis). Plaque is soft and while it also contributes to gingivitis, it often doesn't require the same energy to remove.
Plaque is easier to prevent than calculus, because calculus is largely dependent on the make-up of each individual's saliva. (more minerals, more deposits), whereas plaque is mostly food debris. calculus will bind plaque as well.

So, good hygiene and frequent cleanings can and will minimize both and make cleanings easier.

For your situation, I would carefully explain your situation to your hygienist. A good hygienist will recognize that freshly sharpened instruments will really help minimize the sensations you get from hand scaling, and will recognize that they don't have to touch every tooth, just the ones with calculus or very heavy plaque. Many hygienists feel that patients don't think they're being thorough if they don't touch every tooth or take long enough to do the cleaning. Likely you can avoid the ultrasonic altogether.

I'm not a huge advocate for nitrous, but this is one of those situations where it can help, as well as premed with something to relax you.

Counterintuitively, seeing the hygienist, the one who knows your situation and can adapt, more often, will help the most.
posted by OHenryPacey at 8:10 AM on June 21 [6 favorites]

Just a counterpoint to the “go less often” - I have dental phobia issues and going more often keeps cleanings shorter and I stay more used to them. I’m not sure this would be the same for purely sensory issues but sharing that experience in case it’s helpful.

I agree that talking to the hygienist can really help.
posted by warriorqueen at 8:32 AM on June 21 [8 favorites]

Every appointment I remind* my hygienist that I’m anxious with sensory issues but certain things will help me settle in and get through the appointment:

Minimize clattering tools around in my mouth.
Minimize spraying cold water against my teeth.
Cover my body with a small blanket that they offer.
Use the warm flax neck pillow that they offer.
Ask them to raise the angle of the chair so that my head and upper body have a slight elevation rather than flat or “downhill”.

These things all help me feel more relaxed. I’d bring my own lap blanket and pillow if they didn’t already offer it.

* After several appointments where I reminded my hygienist of these things, I directly said that I didn’t expect her to remember all of my requirements each time and would it be ok if I said them each time. Fortunately she is friendly, understanding and receptive to this. Other times where I’ve been unexpectedly assigned an unfamiliar hygienist, I also start by telling them, “these are the things that help me relax.”
posted by veneer at 9:11 AM on June 21 [4 favorites]

The saliva collecting in the throat gets to me too!
I now ask for a dam that's made of rubber and as long as you're cool breathing through your nose, made a huge difference for me.
Also, I just bought a SLATE flosser (I hate flossing and am not good at it, also some of my teeth are so tight I struggle to get the floss in between the) and it seems like an improvement in my cleaning routine.
And Xanax (2mg is enough for me, but some folks need more.)
posted by mmf at 11:41 AM on June 21 [2 favorites]

My dentist told me that since I've started using a magnetic toothbrush (Oral B iO6) I can downgrade to cleaning once every 3-5 years, it removes so much. This was a marked improvement even though I was using a regular electric toothbrush before and supplementing with manual brushing every time. I do floss religiously and cleanings are also less arduous since I had my wisdom teeth removed and everything else spread around a bit so my jaw isn't as crowded.
posted by I claim sanctuary at 12:21 PM on June 21 [1 favorite]

Once your teeth have been scaled, you can keep them pretty clean and hugely minimize tartar by:
- Using plaque disclosing tablets periodically (Chew them and then swish them around your mouth, and the dye will stain your plaque, so you can see the spots you tend to miss and teach yourself to brush better).
- Brushing with an electric toothbrush for the full 2 minutes twice per day
- Flossing often. Floss picks are bad for the environment, but losing my teeth because I hate floss so much would be bad for ME, so I do use them. And if you store them wherever you relax, you may be more likely to floss often than if you keep them in the bathroom.
posted by nouvelle-personne at 8:16 PM on June 21 [1 favorite]

Before ultrasonic tools (e.g. Cavitron) came along, the old school way to do it was with abrasive paste in a tiny rubber cup. The cup, smaller than a pencil eraser, was on the end of the dentist's spinning tool, and they'd use that to polish away the plaque etc. All dental offices absolutely still have that method, and typically all you have to do is ask them to use that instead. You're not the first to have this problem, and they probably serve such patients every day who need the abrasive paste method, for precisely the same reason.
posted by intermod at 10:46 PM on June 21 [2 favorites]

I don't know how widespread this is, but there's an alternative treatment for plaque removal -- the dentist sprays a baking soda solution on your teeth to clean them. It's much less unpleasant than the scraping. My previous now-retired dentist (who didn't have a technician, he was a one-man shop) used this method.

My current dentist hadn't even heard of this and uses the old-fashioned scraping method.
posted by neckro23 at 11:14 AM on June 22 [1 favorite]

Response by poster: Wow thank you all for such great answers! Looks like I need to change my hygienist (she wasn't responsive to my problems) and up my home care routine while exploring those alternative routes. Purely by coincidence I bought the exact same brush I claim sanctuary mentioned because I saw it half price while shopping. This is so helpful. Thanks!
posted by Flitcraft at 6:33 AM on June 23 [2 favorites]