Inspired by Milan Cvitkovic’s article, Things You’re Allowed to Do.

Going to the dentist can be uncomfortable. Some amount of this is unavoidable.

Yet most dentists and staff care a lot about patient comfort. Tell them what you need, and you may very well get it!

The hardest part is figuring out what’s on the menu. Below are some items that I’ve discovered.

Caveats:

  • available options may vary a lot by dentist
  • options sometimes have tradeoffs, which you should discuss with your dentist

You can control the suction

Every time I go to the dentist, there is a segment featuring a water hose, a suction hose, and a third or fourth bonus tool in my mouth.

I find this uncomfortable for many reasons:

  • the suction hose is badly positioned and water is accumulating
  • the suction hose hits the back of my throat and I gag and cough
  • I am nervously anticipating any of the above

Luckily, if I ask, I can hold the suction hose myself. I can position it exactly as needed for my comfort.

Dentists seem to like this too since it frees up one of their hands.

You can get smaller x-ray films

I have a small jaw and find the bitewing x-rays to be super large and uncomfortable. Sometimes they make me gag, and that usually means I am more likely to gag on the next try. I don’t like it.

It turns out that my dentist has smaller bitewings on hand. They are designed for children but work for adults too, and I find them to be much more comfortable.

The main downside is that they might make it a bit harder for the dentist to get the specific images they want.

You can refuse polish

I don’t like the feeling of having my teeth polished, and often the sickly artificial flavour gives me a headache afterward*.

Usually the stains on my teeth are mild and have already been removed during scaling**.

So do I really need to have my teeth polished?

* I find that flavourless polish also helps here.

** Some people loathe scaling and tolerate polishing. Maybe you can trade more of one for less of the other?

Misc. roundup

  • ask for different painkiller options to get something more personally effective or less aversive (e.g. needles)
  • decline painkillers to save time during mild procedures
  • ask for water or a tissue at any time
  • ask to pause for a minute
  • decline the crappy free toothbrush they give you at the end
  • ask for a free brushhead that works with the electric toothbrush you use at home
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16 comments, sorted by Click to highlight new comments since: Today at 11:03 AM

I have a terror of people sticking sharp things inside my head. Like most phobias, it is an exaggerated fear of something actually dangerous. On two occasions, I have been overcome by fear, leaped off the dentist chair, and cowered in the corner of the room. That’s only happened twice in forty years, so I think my self control is pretty good.

f you dislike having needles driven into your head (as I do) you can ask for topical anesthesia. They put some anesthetic goop on a cotton ball and put it against the tooth that they want to numb. It takes about five minutes to numb the tooth.

I don’t always get this when I ask for it; topical anesthesia is not feasible to use for all procedures. But it usually works.

Dissociative anesthesia may be available. It’s a drug they give to you in advance. It does a weird thing: you’re conscious, it still hurts, but you don’t care. It interrupts the circuit somewhere between the pain and the aversiveness. It also gets rid of the fear response. The time in the chair becomes a boring interlude of no particular importance. If you drive home, you need someone else to drive you, because you’re not thinking straight.

I haven’t had good results with taking a tranquilizer before hand; it’s still subjectively very unpleasant.

I've used two different benzodiazapenes at the dentist with very different results. Halcion is great, I hadn't realized just how traumatic each visit was until Halcion made it stop. But Xanax suppressed my coping mechanisms more than my anxiety, so it made it worse. 

Doesn't dissociative anesthesia cause amnesia? If so, how could you know that you were hurt but felt indifferent to it?

Different people react differently to different drugs. Also, amnesia isn't usually all or nothing, it's a gradient of fuzziness of memory. Midazolam (Versed) is often given to patients prior to anesthesia to relax them, and can inhibit memory formation. For me, I had an adverse reaction to it, and it gave me a panic attack, but also left me unable to voluntarily move or speak. So I just laid there, eyes wide and staring in horror until they finally gave me the true anesthesia. Blech.

Circa 2008, I don't think we had great methods for detecting such cases, so I'm curious how your surgeons realized that you were awake. And there's a term for that state in the literature: Inverse-Zombies. That happens about 0.13% of the time with some anaesthetics. And surgeons paid less attention to this stuff until about 1.5-2 decades ago, and you'd get some cases where people were awake, paralyzed and in pain. Some proportion of those had PTSD. 

Perhaps you misunderstood my story. With surgery, they usually give a 'relaxant' (which can also inhibit memory formation) before the anesthesia which actually puts you asleep. In my case the anesthesia worked normally. The 'relaxant' had the perverse effect of giving me a panic attack and temporary inability to intentionally move or speak. A few minutes later, they gave the anesthesia and I went unconscious as per normal.

A few minutes later, they gave the anesthesia and I went unconscious as per normal.

You mean, you remember nothing after a few minutes into the anesthesia and so you assume you went unconscious as normal, despite the previous abnormality.

After all, as you said, it's not like you could talk or make any kind of voluntary movement which might indicate to observers unaffected by anesthetic memory loss that you were conscious...

True! I have no evidence either way beyond that point of the anesthesia being administered. I don't have any traumatic memories beyond that point though, so I feel good about it.

Either I’m wrong about what kind of anesthesia it was, or it doesn’t always cause amnesia.

It has some other negative side effects, rare for it to be serious, but possible. So it really is just better to 'toughen up' in this case.

I had nitrous oxide once at a dentist. It is a dissociative anesthetic. It may have caused something like selective amnesia. I remember that the dentist was drilling, but I have no clear memory of pain associated with it. It's a bit hard to evaluate exactly what it does, but it definitely has some benefits. Maybe the pain seemed too distant from me to be worth my attention?

Some can get you a prescription for an antianxiety med beforehand.

The slow drill hurts less but takes more time than the fast drill. You may want to ask the dentist to use the slow drill when it starts hurting.

If you don't like fluoride polish you can instead bring your own nano-hydroxyapatite tooth polish. (It's essentially tooth polish made from [synthetic] teeth.) I ship this one from Japan (it's also sometimes available on US amazon).

Oh yeah, I love nano-hydroxyaptite japanese toothpaste. I've been buying it from Amazon for years.

I once had a really hot female dentist and basically everything she did to my teeth was mentally fine even if it was objectively painful. It's a really strong effect.

Something to bear in mind when choosing a dentist.