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In November, 1997, the Director of the National Institute of Dental
Health, Harold C. Slavkin, D.D.S., published a paper in The Journal of
the American Dental Association titled “Chronic Disabling Diseases and
Disorders: The Challenges of Fibromyalgia.”
It had been a long seven years since my diagnosis, and Dr. Slavkin’s
paper was most welcome. While many colleagues told me they “finally got
it,” they freely admitted that they were not eager to treat a patient with
total body pain.
There have been a handful of studies presented in dental publications
concerning orofacial pain in the FM patient, but none address the general
comfort of the patient while undergoing treatment. Much of it is common
sense, but some suggestions are specific to dentistry.
The first hurdle to decent dental care is finding the right dentist.
There are no national or state lists of dentists that are known for treating
fibromyalgia patients. I called the American Dental Association, Oregon
Dental Association, Oregon Health and Sciences University (Dental School and
Fibromyalgia Research Clinic), local “pain clinics”, and several insurance
companies in search of a referral. No one had a list, or any idea of whom
to call.
There is no “Pain” specialty in dentistry. Dentists are theoretically
trained to treat all patients, including those in chronic pain, but my small
survey of local dentists indicated that many are confused about the needs of
fibromyalgia patients. Dental literature is lacking, so it is important
that the FM patient know their own bodies and express their specific needs
in a calm and organized manner to optimize their dental experience.
Finding a Dentist
The best way to find a dentist is word of mouth. Ask everyone you know
(and like) which dentist they go to. If they have a dental specialist they
love, that specialist might know a good general dentist.
Ask how much time their dentist spends with them; your needs will not
be met in a production mill. Does the dentist come in, look them in the
eye, and sincerely ask how they are feeling? What their concerns are?
Studies have shown that patients complain more of pain and anxiety if the
dentist seems cold, disinterested or uncaring. If patients feel like they
are just a number, they are.
Ask about the staff, and especially the hygienist. The people we keep
around us indicate something about our values and priorities. The staff
should be pleasant, concerned and efficient. Discord and chaos can make for
tense, unpleasant appointments.
Are most appointments on time? Dentists that are chronically late may
not be able to give you the quality time you need, and you don’t want their
stress to “rub off” on you. Neither do you want the added anxiety, and
possible added pain, of sitting too long in a waiting room. Emergencies do
happen, but they shouldn’t happen often.
Do the surroundings look clean? Proper sterilization is critical. It
is not inappropriate to have a tour of the office space designated for
patient care. Dentists should be proud to show off their facilities.
If you get a referral from a person you admire, tell the receptionist
when you call to make an appointment.
Choosing a dentist from a preferred provider list can be more
difficult. If no one you know recognizes any of the participating dentists,
then ask your insurance company if they can refer you to someone. Chances
are company policy will not allow them to recommend any one individual.
Then it will be up to you to call, or visit each office. I suggest walking
in to get a “feel” for the practice before making an appointment.
If you have to resort to the yellow pages, consider the way the
practice is advertised. “Cosmetic Dentistry” can mean an emphasis on crown
and bridge, whitening teeth and composite fillings. Ask if the emphasis is
“family dentistry”, and how many “generations” the dentist treats. If
grandma and the grandkids come in, too, there is a good chance the practice
will suit your needs. Not all dentists are “family” oriented.
When you first contact an office, do not label yourself as a
“fibromyalgia” patient. Stress that you are interested in good oral care,
and that you are looking for a new dentist to help you with your goal. Once
you know the practice is accepting new patients, ask if the dentist is
familiar with fibromyalgia. Pay attention to the receptionist’s reaction.
If she/he sounds negative, move on. If they don’t know, it still might work
out. Assure them that the necessary work can be done, but that you might
need short appointments, or stretch breaks, and then judge the reaction.
This is not the time to complain about other dentists. For all you
know they all play golf together every Wednesday.
First Appointment
Once you have picked a dentist, you need to do your homework. Do not
rely on your memory.
Bring a written health history, general and dental. You are not
a walking set of teeth. A chronically infected toe might indicate an immune
problem that could affect how the jaw heals if you have a tooth pulled.
Briefly outline significant or reoccurring problems. Have a section for the
head and neck, and include previous dental work (do not list every filling
or tooth pulled), earaches, headaches, sinus infections, sore throats, a
broken nose, etc.
Tell them if you are, or might be, pregnant.
It is critical to list all allergies--to medications or anything else.
If you are allergic to peanuts, or something that might be around the office
(even if it is in their lunch room), tell them before your first
appointment. Be sure to warn them if you have a known latex
sensitivity. Non - latex gloves are available, but if the office does not
routinely keep them on hand change dentists or buy your own box and bring
them with you.
Bring a complete, up to date list of all drugs and supplements that you
use. That includes any over-the-counter pain medications, allergy
medications, herbs, vitamins, diet supplements, etc. List toothpastes and
mouth washes, too. To avoid unforeseen drug interactions, do not lie about
alcohol or drug abuse. Know why you are prescribed the drugs you take, and
why other drugs did not work for you. If possible, know the name of any
dental anesthetic you have had problems with. Some patients have
trouble with epinephrine making their hearts feel racy, but there are
anesthetics without epinephrine available.
Write down any questions and concerns you have. If I don’t write it
down I forget.
Bring your insurance information with you.
Know the names and phone numbers of all health care professionals you
have seen.
Bring one of Dr. Bennett’s articles on fibromyalgia. Ask if it would
help the dentist understand your pain condition. Do not go in with an
“attitude”, do not lecture, and do not insist she/he read it. Be prepared
to give a short explanation of your symptoms when asked. If the dentist is
indifferent or dismissive, do not go back, or leave at once.
Maximize Your Comfort
The following suggestions are based on my experiences as both dentist and
patient, and answers to an informal survey I posted to a fibromyalgia chat
group.
Arrive a few minutes early. Give yourself time to relax.
Try and have someone you like bring you if you are especially
nervous about appointments.
Do not load up on caffeine or sugar before appointments. I find
that I “numb” more quickly if I am not buzzing from a sugar or caffeine
high. Even I can get a bit nervous when the needle heads my way, and
caffeine makes me feel worse. I find it best to eat a nutritious snack
before a lengthy appointment.
Turn off the cell phone! It can startle you or the dentist
holding that drill.
Visit the restroom before treatment starts.
Bring earplugs or a music headset if a whining drill irritates you.
Ask in advance if the headsets are available.
Wear sunglasses if bright lights hurt your eyes, but do not wear
them to try and hide pinpoint pupils. Drug abuse and dentistry do not mix.
Bring socks, gloves and/or a blanket if you feel cold easily.
Most dental offices have blankets, but they might only have one. If you are
too hot, ask if they have a small fan.
If you have a bad back, wear pants if you need to keep your knees
bent. Moving your legs occasionally is a good idea anyway, but skirts
are not a problem if a blanket is available to cover with.
Bring pillows to place under your knees. The office might have
something on hand that can be used in place of a pillow, but ask in advance.
Wear comfortable clothing made from a fabric that wicks perspiration.
Bring a small cervical pillow if you have neck problems. Not
all dental chairs are created equal, and some are downright uncomfortable.
Make short appointments if necessary.
If you get dizzy when the chair moves, or if you have back problems,
have the dentist slowly lower the chair first and then lay you back. My
dentist’s patient chair goes down and flat in one movement, so I “ride” it
with my knees bent and elevated to prevent back strain.
If you have trouble breathing or swallowing when you are on your
back, the dentist can adjust your position. If she/he cannot modify
their sitting position for your comfort, get a new dentist.
Plan stretch breaks if the appointment is a long one.
Have prearranged signals if you need to move your head or upper body.
You should “wiggle” periodically, but do not make any sudden moves.
If you are difficult to numb, tell them up front. For years I
had to go in 30 minutes early and sit in a side room to wait for the
anesthetic to work. I also need more anesthetic than most people do. From
what I hear this is not uncommon with FM patients, but my problem may just
be an anatomical deviation from the norm. There are various methods of
administering the anesthetic.
You may need to be pre-medicated for pain or anxiety. Drugs
(such as valium) are taken before an appointment, and the patient must be
driven to and from the office. Oral pain medications can be taken before an
extensive appointment to ensure adequate pain control during and after the
procedure, but the dentist must know about it in advance.
Some dentists advertise that they use hypnosis or other relaxation
techniques. It might work for you.
Nitrous oxide is available at some offices, but insurance companies
typically do not pay for it. It can cost $25 or more.
A bite block will keep your mouth open if you are too sore, or too
tired, to stay open for long periods of time. You do not want to
overstretch the muscles, so be sure the block is not jammed in.
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