Bipolar 2 From Inside and Out

Posts tagged ‘dental-phobia’

Down in the Mouth

Tomorrow I’m going under the knife (forceps, pliers, whatever) to get teeth removed. I’ve written before about my severe dental phobia, but this time there is no other solution. My teeth are bad; my gums are bad. Hell, even my breath is bad.

For this procedure, I will have IV sedation, which is a great relief. Nitrous oxide has never had any effect on me. I have had IV sedation for a dental procedure once before, so I know it works for me.

Due to COVID restrictions, my husband (my emotional support animal) is not even allowed to come into the building or the waiting room. For other, less drastic procedures, he has even been allowed in the treatment room with me, to pat my foot and offer me encouragement. This time he has to wait in the car until the nurse brings me out. That means he stays in the car for up to two hours while I am worked on. I’m glad he has an e-reader and that it’s recently been updated and charged, but still I would prefer a pat on the foot to knowing he’s several doors and a parking space away.

Oddly, I was not nearly this fearful when I had two operations (microlaminectomies) on my back a number of years ago. Perhaps that was because the pinched nerve caused me untold physical pain. That was pain I could understand. All I have with my teeth is emotional pain. For now. I’m sure physical pain will come later, after I regain consciousness.

My memories of dentists and former dental procedures are not good. There have been both physical and psychic pain, shaming, guilt, assorted bodily reactions, and a creeping physical numbness that had nothing to do with Novocain. I have been through procedures both with and without IV sedation. I’ve had my wisdom teeth removed, and another tooth removed and replaced with a partial bridge. I had a tooth that broke and I had a tooth bonded in place, designed to get me through a month or two until I could do a reading from my book. Through careful eating, I made it last five years.

Now, though, there is no getting out of it. I was unable to get these expensive procedures in the past because of a lack of money. Now I don’t have that excuse. Money has been set aside and no other emergency has arisen that requires using it for something else. Needless to say, my insurance doesn’t cover this, and especially not the traveling anesthesiologist. Once I had to abandon fixing my teeth because our transportation gave out, but that’s not a problem this time.

Do I want to get out of it? Yes and no. Dentistry is one of my major phobias (which has no doubt contributed to how bad my teeth are). This has been true since I was a child, and has only grown more extreme. It would be understating the matter to say dental procedures are a major trigger for my anxiety and panic attacks.

I’m also unnerved by how the procedures will resonate through my life for an unknown time. That dental bridge was a significant factor in my self-esteem. If I forgot it, I had to turn around and go home. More tooth extractions will no doubt feed into my isolation. And then there’s the indignity of eating applesauce, soft-boiled eggs, and chicken broth until my poor, abused gums heal. As little as I leave my house now, I will be even less willing to do so for quite some time.

So, wish me luck. Both my husband and I are taking a few days off work, on the theory that the sedation and analgesics may leave me woozy. At least I will be able to keep up with my blogging, since that doesn’t require going outside.

I’ll get through this. But I’m afraid it will leave my emotions as disordered as my mouth.

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Forced to Face My Fear

A little while ago, I posted about my severe dental phobia (http://wp.me/p4e9Hv-cG). So of course fate pushed me to the wall and left me no choice but to confront it.

tooth fairy illustrationHere’s the backstory. My teeth are awful, and my dental phobia has a lot to do with it. Realizing this, we borrowed some money and put it aside for my dental work. The reason that we had to borrow that much money was not just because we’re broke (we are) or that our dental insurance is so crappy as to be nonexistent (it is), but the fact that the last time I got any dental work done (years ago), I was so terrified that I had to have a traveling anesthesiologist brought in to put me completely under. And that approximately doubles the cost of already-pricey, though necessary, procedures.

Then another disaster ate the money we had put aside. There was no choice in the matter. The dental money had to be sacrificed.

Then fate stepped in. Last Saturday I got a toothache. Of epic proportions. Not realizing that the dentist had a 24/7 emergency number, I toughed it out till Monday, when my face was hideously swollen and the combined powers of Anbesol and Tylenol were insufficient to let me sleep. I got in to see the dentist on Tuesday.

That one tooth was definitely going to have to come out and the abscess drained (did I mention there was an abscess?). And there were a few other highly recommended procedures that needed doing as well. None of which the crappy insurance would pay for.

But that wasn’t the real problem, or at least not the only problem. The traveling anesthesiologist was out. The dental slush fund no longer existed. Normally (that is, for normal patients) the dentist offers “oral sedation,” which turns out to be triazolam (Halcion). But since I already take lorazepam (Ativan), that wasn’t considered safe.Apparently the two don’t work and play nicely together.

“You’re going to do this without anesthesia AND without oral sedation?” the dentist said.

“I have no choice,” I replied. He had given me Vicodin for the pain (as well as an antibiotic for the abscess), but I couldn’t really take that long-term. And so I was cornered. I had to have the procedure, no matter what. (My husband offered to get a rubber mallet and knock me out, or knock the tooth out, or something. I politely declined.)

The plan we worked out was this: On Thursday, when they were to do the procedure, I would take two Vicodin and increase my lorazepam from .5 mg to 1.0 mg. (with my pcp’s permission). Then I would have nitrous oxide, which had never worked for me before, but hey, worth another try, right?

And I would have my husband there in the procedure room, as my comfort animal. He had to stay out of the way, but was able to reach over and pat me on the ankle. Which was comforting, actually.

Double Vicodin (I was permitted two but had been taking only one) and double Ativan (plus one prophylactic Immodium) left me suitably stoned. I was totally confused when the hygienist asked me, “Bubble gum or orange creamsicle?” I was stoned, but that made no sense. Turns out nowadays they have scented nose cones for the nitrous. (I chose mint.) I could barely feel the numbing shots, and the extraction went smoothly. I didn’t hear/feel the terrifying, sickening crunch that went from my jaw directly through my brain when I had my wisdom teeth out. My husband said I didn’t even flinch. He patted my ankle anyway.

Then we paid about the same as we recently had for two vet visits for our ancient cat, but nowhere near what we had borrowed, put aside, then spent.

I didn’t even disgrace myself, though I had spare underwear in my purse, just in case.

All in all, it went way better than I expected. Have I conquered my fear? I don’t honestly know, and probably won’t until the next time. (And there will be a next time.)

But at least I’ve proved that I can do it. I can have a dental procedure done without anesthesia and without oral sedation, if it’s really, really necessary. Pain is surely a great motivator. I am no longer a huge wuss, I guess – just a regular wuss. I do hope, however, that when the clot heals and the infection clears up, and the swelling has gone away, that I do not have to go through this again for a very, very long time.

(At least this time I did better than when I faced my apiphobia (http://wp.me/p4e9wS-7H).)

 

Dental Health and Mental Health

I still remember one of my earliest episodes of panic, which happened in a dentist’s waiting room. As I said in the uncomfortable chair, surrounded by Highlights for Children magazines that I had already read, I felt dread moving up my body from my toes. It crept up my legs into my hips and on into my abdomen. I was convinced that when the feeling of terror reached my heart, I would die. I was called into the doctor’s office before that happened.

This is a memory I have shared with only one other person before now. Just thinking about it still brings back a visceral body memory of fear.

It really bothers me that some people think that good teeth are a sign of moral superiority. Some other people, like me, are simply born with bad teeth, or at least weak, cavity-prone little tooth buds embedded in our infantile gums. Brush as diligently as we might, we are never going to have pristine white teeth like the people on TV.

While my dental phobia can possibly be attributed to the general pool of my anxiety triggers, there were also some outside factors that contributed to it.

My parents were never good role models for dental health, as my mother had gotten dentures at age 16 and my father chewed tobacco.

There were also bad experiences with blame-and-shame dentists and hygienists, one of whom scraped a bit of tartar off my teeth, stuck it in my face, and asked, “If I put that on a piece of bread, would you eat it?”

I used to loathe the public school practice of making us chew little purple tablets to see how clean our teeth really were. My teeth were – and still are – considerably crooked, so it was difficult for me to brush in a manner that wouldn’t leave glaring purple spots all over my mouth.

My teeth have only gotten crookeder, since my parents were not able to afford orthodontia for me. When and where they grew up, braces were a luxury for the well-to-do; rural children like they were simply did without. By the time my sister and I came along we lived in the suburbs, but braces had never become a priority for my parents compared, say, to eyeglasses, which were deemed essential.

My last and most recent experience with a dentist was a number of years ago. I don’t remember what prompted me to go, but I did tell the dentist about my phobia and he was very considerate. (I always look for a dentist whose advertising says, “We Cater to Cowards.”)

He did my exam and treatment in the kiddy room with the bright, nonthreatening murals of cowboys and western scenes on the walls. Just the x-rays and routine cleaning proved alarming enough to trigger one of my worst stress reactions – diarrhea. When it came time for the actual procedures the dentist brought in a traveling anesthesiologist so that I could be knocked out rather than conscious and terrified. My husband was there for driving, moral support, and decisions that needed to be made while I was out cold.

I have not been back to the dentist since. However, it’s becoming increasingly obvious that I need to. My teeth ache. My fillings have fallen out. One tooth is broken. Because of that, my teeth are moving in directions they were never supposed to. And that makes my dental bridge (acquired at the aforementioned last experience) fit poorly. I look like the stereotypical Willie Nelson fan. (I am a Willie Nelson fan, but I don’t care to reinforce the popular image.)

This week I was trying to convince myself to call a dentist just for a consultation. I still haven’t managed to do that. Just saying the word “dentist” gave me a spasm in my chest. Maybe I’ll be able to make the call during this coming week.

The only person in the world who is a worst dental-phobe than I am is my sister. She too had childhood dental issues. Once she even bit a dentist and he slapped her. Needless to say, that experience did not improve her attitude toward dental care.

She is also ultra sensitive to (or afraid of) pain and quite terrified of needles. Even as an adult, she has been known to scream so loudly and lengthily that she has cleared an entire dentist’s waiting room. (She then sent the dentist a Halloween card that screamed when you opened it.)

Still, I am a grown up. I need to do this. I cannot convincingly tell myself that waiting will improve the situation. I just have to pick a day for my appointment when my husband is available to take me and I have had my prescription for Ativan recently refilled. And some Immodium on hand.

Wish me luck.

 

ETA: I now have an appointment with a dentist for some serious work, and with a traveling anesthesiologist for IV sedation. I tried to get the doc to prescribe roofies, but some guys have no sense of humor…

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