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Thursday, February 9, 2012
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Thursday, February 9, 2012
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Dental Anesthesia |
Dental Phobia Cause of Military Discharge10/24/2005 |
Help, I have been diagnosed as a dental phobic. I have been in the military 27 years with a long history of uneventful dental procedures. In Nov 2003, I experienced a very painful root canal procedure where the root would not numb. The dentist tried repeatedly to numb without my consent. His demeanor quickly became frustrated and angry at the time delay to get me to a comfortable level in order to complete the procedure. Finally, he said if I would just sit still and take it, he could kill the nerve and I could go home. I actually left the dental chair, his office and almost the building before 3 other dentist caught up with me. I consented to another try with another dentist that was also unsuccessful. A temporary was placed and I was given heavy narcotics for 2 months. The pain medicine ceased to be effective. IV sedation was performed in Nov 2003. I woke off and on during the procedure and remembered quite a bit afterwards. Later, a dental technician told me that they had to strap me down during the procedure because I was so combative. I had nightmares for months and refused to go back to the dentist since though I still had 3 other caries to take care of. The military requires an annual exam. Dec 2004 through March 2005, the dental clinic tried various means to get me in for an exam. The nightmares restarted and I worked hard at avoiding them at all costs. The same tooth treated in Sep/Nov 2003 was cracked and the same tooth on the opposite side now needed a root canal. I refused treatment because I was terrified of a repeat/no pain control. In May 2005, I was offered general anesthesia in order to do two root canals and a possible extraction. I was still terrified, but was threatened with discharge from the military if I did not undergo treatment. After the procedure, I woke up with no pain medicine other than a prescription for motrin. The nurse at the time said I would have to eat something before taking a 400 mg of motrin. They indicated it would take some time to locate the dentist to prescribe me something else if I really felt I needed it. The pain was tremendous coupled with severe nausea from the general anesthesia. Eating was the last thing I could do. Finally, I called a friend to discharge me and I left the hospital to self-medicate. I still need more dental work. The dental phobia is 3 times worse. I saw a military psychiatrist who only wanted to give me drugs that would dope me up enough to get me back in the dental chair. I have not been able to do that either. Now, I am undergoing a medical board for "refusal of treatment" and will quite possibly be discharged. I do want to overcome this phobia not for the military but for me. I have tried self-hypnosis and have been able to quell the nightmares...however, every time I think about dental and try to use self-hypnosis... I can`t unblock the anxiety to get on a path to help. Since the last oral surgery...a filling fell out of a deep cavity. The pain is climbing...I tried to put a temporary filling in using the emergency dental kit, but it made things worse. I feel as if there is no hope.
I am sorry to hear that you have had such a difficult time with your recent dental care. It is not unusual for patients to be very anxious during dental visits, and you are definitely not alone.
It appears that you have already tried a number of approaches, including premedication, sedation and general anesthesia, along with hypnosis, with varied success. Of these, it seems that you have had the most success with general anesthesia, as the procedure itself was not uncomfortable for you. You've mentioned that it was difficult to numb one of your teeth in the past, and pain control may be easier for you under general anesthesia as you usually do not need to be completely numb with local anesthesia in order to be comfortable.
I do not know what you were given during your past anesthesia appointment, but there are medications which can help prevent nausea and pain afterwards, which might make general anesthesia a better option for you in the future. We routinely provide general anesthesia with a very rare incidence of post-operative nausea and vomiting, along with good pain control. Depending on your health and dental treatment needs, general anesthesia could still be a good choice for you to have your dental care completed in one or a minimal number of appointments.
Although we are not mental health professionals, it appears you may have a variation of post-traumatic stress disorder coupled with a severe situational anxiety disorder. In fact, it is so severe that it is stopping you from an activity which is beneficial to your health (and your job). As such, it is critically important that you see a psychologist, perhaps rather than a psychiatrist, who can help you manage and hopefully overcome your fear and anxiety.
Establishing a longer-term relationship with a regular dentist who can ease you through your appointment and work with you and your psychologist will help them help you, as they will be more familiar with your past experiences. Premedication and hypnosis can still help you prepare for your dental visits, so I would discuss these with your dentist and psychologist. If needed, your psychologist and dentist can consult with a psychiatrist for potent premedication. Having a friend or relative accompany you to these appointments may also reduce your anxiety.
We hope that your dental visits become a little easier, and that you are able to continue with your dental care both for yourself and for your career.
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M Cynthia Fukami, DMD, MS Clinical Assistant Professor Children's Dental Clinic College of Dentistry Nationwide Children's Hospital The Ohio State University |
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Steven I Ganzberg, SB, DMD, MS Chief of Dental Anesthesiology Clinical Professor Section of Dental Anesthesiology College of Dentistry Nationwide Children's Hospital The Ohio State University |
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