Heidi Greenleaf has spent her entire life in abject fear of the dentist.
You can hardly blame her. When she was 16 years old, a dentist cemented a retainer to the sides of her teeth and then basically forgot about her.
The braces she was supposed to have never came, and for two years, Greenleaf heard excuse after excuse why they weren’t available.
Meanwhile, complications from the retainer caused pain in her mouth — pain she would live with for many years.
“At 18 years old,” Greenleaf says, “I went to the office myself, explained the situation and how the retainer was causing extreme discomfort to the roof of my mouth and my teeth. They removed the retainer but what I was left with was an extremely sore, decaying and impacted tooth from where the cement corroded away. I was newly an adult, no health or dental insurance was available to me, and I started having severe tooth pain.”
There was nothing more that dentist could do, apparently, so Greenleaf was sent on her way, the pain in her mouth occasionally flaring into red hot agony.
“I went to the ER more than once,” Greenleaf says, “and was told they don’t treat dental emergencies, but that I had an impacted tooth, and left with a prescription of antibiotics. I called around to many dentists who would not provide services without insurance and had a wait-list longer than a year. I lived with the pain, unable to overcome those hurdles. The severity of my impacted tooth caused extreme pain, swelling and infections. I had to take days off from work whereas I couldn’t speak, eat, sleep or function. I was stuck, hyperfixated on the pain.”
Greenleaf, now of Jay, moved to Maine when she was 23 or 24 years old. By then, that bum tooth would flare up a couple times a year. And then the tooth decided to make pain a full-time gig.
“I am now 29,” she says. “I noticed the tooth has been acting up nearly every two weeks, with the pain being relentless.”
She lived in fear of the dentist, yes, but now Greenleaf desperately needed one to relieve her of the agony in her mouth.
She begged for help. She cried and called dentist office after dentist office, hoping to get an appointment, only to be told there were no openings for weeks or months.
“I felt defeated,” Greenleaf says, “still in agony and left again, like no one cared. I was starting to think the only way I would find relief was if I had an infection from my tooth kill me!”
Finally, in late August, a Waterville dentist agree to see her. He looked over her X-rays and booked her an appointment at once.
Greenleaf was going to get what she wanted. And she was terrified.
TALKING ABOUT FEARS IS ‘FIRST STEP’ TO RELIEF
By some estimates, between 5% and 8% of Americans avoid dental work altogether because of plain old dentophobia, the fear of visits to the dentist and all the whirring, scraping, crackling and crunching work that some dental procedures entail.
What are they afraid of, exactly? A little bit of everything. For some, it’s the needles, for others the drills.
For some it’s the noise, for some the smells.
“I just hate the sound of the drill,” says Janet Malia Descoteaux, of Rumford, “and waiting for the random ZING of pain.”
One woman said she learned to fear the dentist as a child when Novocaine didn’t work for her but the doctor didn’t believe her.
Finally, she said, a dentist figured out that she had bifurcated nerves that made Novocaine less effective for her.
“It was too late though,” she says. “All of those years of excruciating pain gave me a fear of dentists.”
For people like Greenleaf, too, fear is a learned behavior.
“Some people have had experiences in the past where they had pain during their treatment, and that tends to evolve,” says Tyla Flagg, a registered dental hygienist at The Center for Advanced Dentistry in Auburn. “They think every time they come into the dentist’s office, they’re going to have that pain, so a lot of our patients are fearful because of that.”
“For a lot of patients,” says Dr. Jonathan Bernstein, who owns the business, “sometimes it’s just the injection of local anesthesia. Some of them want some form of relaxation for that part alone. They don’t mind the treatment, but instead their focus is on that injection.”
Let’s face it: Inviting a stranger to enter your mouth in order to tug at, poke and scrape you teeth provides plenty of basis for fear and loathing.
But times are changing in the world of dentistry and much of that change evolves around new philosophies about confronting fear in patients.
Dr. Peter Drews, of Drew’s Dental Services in Lewiston, sees a lot of patients who come to his office only because dreadful pain has made avoiding the dentist an impossibility.
“I meet a number of new patients that tell me how they are full of anxiety about going to the dentist and have procrastinated for years,” Drews says. “They get to the point where the discomfort of their teeth was the motivator to make their initial appointment instead of the desire to maintain good oral health. I always thank these patients for communicating, because the first step to overcoming dental anxiety is to acknowledge and understand why it’s there in the first place.”
Drews agrees with Flagg that pain in the past can establish a pattern.
“Since that terrible experience, this patient has only gone to the dentist when there is pain or swelling,” Drews says. “This will create an emotional trigger every time the patient thinks about the dentist. Thankfully, modern-day dental techniques and treatments are far less invasive and much more gentle and comfortable than in the past.”
Much of Drews approach to dealing with patient fears involves a soothing nature and a gentle approach. But there are other modern technologies available that also help to calm the jangled nerves of a patient who might be recalling dental horrors of the past.
Gone, he says, is the traditional shot that numbs the patient’s entire mouth. His office has transitioned to what is called the Single Tooth Anesthesia System, which discreetly numbs only the tooth being worked on.
“Patients benefit . . . with less discomfort and will not have collateral numbness in their lips because we have the ability to numb a single tooth,” Drews explains.
He also says the common process of making dental impressions — for creating mouth guards, retainers, crowns, dentures, etc., — causes some patients to gag. “We now have intraoral impression systems. This is a sensor the size of a sharpie marker that scans the inside of your mouth in 30 seconds.”
DENTISTRY IN THE TWILIGHT ZONE
Technology is wonderful, but so is chemistry.
Sedation, once considered dubious in matters of dental work, is also becoming more commonplace — why go through a complex dental procedure on edge and stone cold sober when you can bear it much more easily with nitrous oxide, an IV sedative or even general anesthesia to put you out completely.
The concept of sedation dentistry has gained such traction that some dentists these days will do a residency in anesthesiology, making a specialty out of it.
The Center for Advanced Dentistry is best known for using moderate sedation to ease their patients through difficult procedures — or even minor ones.
By Dr. Bernstein’s estimates, between 35 and 40 percent of his patients choose to go that route. Some choose oral sedation, taking a pill from the Valium family, and that’s enough.
“I never used to be afraid of the dentist until the past couple years,” says Kendra Gendron, of Lewiston. “I was going in for a root canal and I was pregnant. I started to get some anxiety because I was afraid I couldn’t feel the baby. Probably stupid. I asked for them to stop but they wouldn’t. They held me down to finish. For some reason, now I freak out, crying and everything. I start to feel like I’m dying and I can’t breathe. I have my doctor prescribe me medicine before I go in now. My primary care physician prescribes me medication, something like Xanax. It does help.”
“I’m terrified of the dentist so bad that I have to be slightly sedated just for a cleaning,” says Tara Ruth, of Lewiston. “Thank God I have no cavities.”
But not all fears are equal, and more squeamish patients with more in-depth work to be faced will choose IV sedation, which works quicker than a pill and can be monitored and controlled during the entire dental procedure.
For most patients, that’s plenty to get them past their fears and through the work at hand.
“For some of them, with moderate sedation, their sort of in the twilight zone,” Bernstein says. “They’re not unconscious; it’s not general anesthesia. But they’re calm, comfortable and cooperative. The three Cs. That’s the goal.”
For decades, Novocaine, and now lidocaine, have been a salvation to many who just don’t want to feel the pain and trauma of having their teeth fixed. A blessing, they are, yet some dread the bite of the injection above all things dental.
Those folks may choose to breath in nitrous oxide — the so-called laughing gas — to get them through the trauma of taking that Novocaine needle in the mouth. Nitrous oxide provides a soothing or even euphoric sense of well-being, and it lasts as long as the gas is flowing.
LISTEN TO LED ZEPPELIN INSTEAD OF THE DRILL
Like other dentists, patients in Bernstein’s chairs are also offered headphones through which they can listen to soft music, nature sounds or even full-blast rock and roll if that’s what they choose for blocking out the crunching and crackling sounds of dental work . . . not to mention the buzz of those drills.
And all of this isn’t just for those suffering through extreme surgery, either. There are plenty of folks who dread the dentist chair even if the work at hand is relatively simple.
“It’s not always restorative work,” says Flagg. “Sometimes it’s just hygiene work, so we do sedation for routine hygiene maintenance, as well. For all spectrums of dentistry, we can sedate our patients and make them very comfortable and very relaxed for their treatment.”
Whether they’re using sedation or not, modern dentists just seem to use a more gentle approach to their work, with the understanding that a large segment of the client based suffers anxieties.
“If you have the personality that could be described as a ‘control freak,’ being in the dental chair can be intimidating,” says Drews. “Sitting back in a dental chair makes some people nervous and claustrophobic. Not knowing exactly what to expect and feeling out of control can be unnerving. My philosophy is to communicate prior to starting the appointment what steps are in the treatment. Once I start the treatment I give the patient permission to raise their hand to stop at any time during the appointment. This gives the patient control over the appointment and helps lower the level of anxiety.
In Drews’ view, the best thing a timid patient can do to combat his or her fears is to talk to the dentist about them in frank terms. Why tough it out in silence when so much is available to ease those dreads?
“Dentist offices today take anxiety into consideration and offer solutions,” Drews says. “Amenities like eye masks, blankets, and headphones to help . . . your visit be as comfortable as possible. Throughout your appointment, be sure to voice any concerns, questions, or discomfort. Want to know about a specific instrument or treatment? Ask! Are you beginning to feel anxious and need a moment before continuing treatment? Let your dentist know.”
Drews’ office will consider sedation, but only as a last resort. Sedation or sleep dentistry is considered a “next level” option. Typically, he says, a patient’s fears can be overcome without it.
“In our office we have not faced an adult dental phobic we could not handle,” Drews says. “In our experiences we have found that communication and patience is key to overcoming this roadblock for many patients.”
Locally, most people seem to have found a dentist with whom their comfortable, which, when you get right down to it, is half the battle.
Some use sedation, some don’t.
“Maple Way Dental (in Lewiston,)” declares Glenn Gagne of Lewiston. “Had a wisdom tooth and an abscessed molar pulled at the same appointment, never felt a thing. Everything that I have had done there was them just using Novocaine. Fillings, extractions, crown, no pain. Also they play music — they sing and hum while working on you and during the holidays they play instruments in the lounge. Very talented with music as well as dentistry.”
Several other dentists in the area were mentioned by readers, with an emphasis on the gentleness of their approach to dental work. It leads one to believe that by and large, most dentists and their staff are taking seriously the many fears suffered by patients and taking pains to alleviate those fears in a variety of ways.
As for Greenleaf, her dread of the dentist was dwarfed by the relief she felt at having her dental woes fixed at last. It happened on the last day of August when she went in to have that impacted tooth fixed once and for all.
It wasn’t easy, she said, sitting down in that chair and turning her mouth over to the man in the white coat.
“I was scared and shaking out of my mind,” she says, “but I’ll tell you: Melissa, the assistant to the dentist, knew I was afraid and in pain. She did everything possible to make me feel safe and validated. I am so happy to say, I woke up this morning with zero pain! The first time in years! That is what got me past my fear — the physical pain was unbearable to the point I was considering death by infection being my only solution.
“It has been unreal living with debilitating pain for nearly 10 years,” Greenleaf says, “and today it was gone! That made facing my fear and anxieties worth it.”
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