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Finding and Working with a Dentist

Jane L. O’Ban Walpole, DMD
(retired dentist)

 
 

 

     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. 

     Periodically move your lower jaw side- to- side, or partially close down.  Discuss this in advance and prearrange a hand signal.  It is not be possible to move during some phases of treatment.

     Talk to your hygienist about ultrasonic scalers versus hand scalers.  For your six- month check up, ultrasonic cleaners are faster, but they might be too intense for some patients.  It is reasonable to only clean one half of the teeth in one sitting, or the patient may choose to be numbed.  This is not unusual, even in non- FM patients.

     Electric toothbrush or the old fashioned kind?   At home I use a child- size toothbrush because I tear my gums up with the adult size.  Use a soft bristled brush.  I recommend an electric toothbrush for the days when you are feeling better and can tolerate the added stimulation in your mouth.  Some brands have smaller heads than the Sonicare that I use, so you might want to start with them.  Whatever you choose to use, be sure and use it.  Some drugs that FM patients take cause dry mouth, and that can lead to an increase in cavities, especially those along the gum line.  Artificial saliva is available by prescription.  

     Use toothpastes with fluoride.    I use ControlRx  (available at many dentist’s offices) because it has a higher fluoride content.  After I got sick it was very hard for me to brush my teeth thoroughly and I had a new cavity every time I went to see my dentist.  ControlRx made a big difference.  Fluoride rinses for home are also available by prescription, and I always have a fluoride treatment when I go in for my cleaning.  Because I am at higher risk for tooth decay, I go in for cleanings every four months.  

     Floss every day.  Even the electric toothbrushes can’t reach every food particle between your teeth.  There are floss aids if you have trouble holding the floss, and there are thicker, waxed flosses that are easier to use. 

     Your mouth is not isolated from the rest of your body.  Abscessed teeth or infected gums can affect the whole body, including the heart.  Papers are being published about a possible relationship between periodontal disease and diabetes.  It is clear that good oral care is a necessity, not a luxury.      

     The dental office is a second home to many dentists.  Start your appointment with kindness and a positive attitude and you just might find a “family” along with  a healthy smile.    

 

 

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