Thursday, 4 October 2007

Dental Treatment, Agoraphobia & the NHS

Since I've known Marie, she has always had trouble with getting dental work done. For example, she would have benefitted from having a dental brace, but couldn't deal with having a permanent structure fitted inside her mouth.

However, having a caring, sympathetic dentist, and knowing that her diet was about as good for her teeth as heat was for ice cream, I eventually persuaded Marie to have a checkup.

One of the Marie's first symptoms of heightened anxiety is the "dry mouth". Next comes the feeling that she won't be able to swallow. To obviate this, she carries a bottle of soft drink, sometimes just water. For years, Coca Cola was the drink of choice, to the extent that she began to believe that only Coke would be able to help her when her "dry mouth" was starting. What is the best thing you can give to your healthy teeth if you want holes in the enamel? Yes, sugary fizzy drinks - e.g. Coca Cola.

There was good news from the dentist - she wouldn't have to have work done on all her teeth. The bad news was...well, you've guessed it, work needed done on most of them. And even worse - some might have to be extracted. The dentist took x-rays to complete the examination and we made another appointment.

Marie was doing quite well on her return visit to the dental surgery. The dentist gave her local anaesthetic - lots of it! This was the problem...the local anaesthetic administered to the rear of the roof of her mouth caused her to lose feeling in her throat. She couldn't feel herself swallow; she wasn't sure she WAS swallowing; she wasn't sure if she COULD swallow. Result - panic.

Marie managed to hold back the panic enough to avoid a full-blown attack. The dentist caried out some of the necessary work. However there was no way she was going to go have that type of local anaesthetic again! So she didn't return to the dentist for a couple of years. And then it was only because she had a pain in her jaw which, by comparison, made the pain of childbirth dwindle into insignificance. The pain was the result of the mother of all abcesses.

The dentist looked into her mouth and spoke in a monotone. This tooth would have to come out...and this one...oh, and that one too....and probably that one. Oh! and maybe that one too. This one needs a major filling, and so does that one. This one needs attention and that one needs attention... And on and on and on he droned. Marie asked him if she would need a local anaesthetic in the roof of the mouth again, and he said yes. She told him that she wouldn't be able to cope with this and explained why. What was the alternative? The only alternative he could offer was to refer her to the dental hospital, 25 miles away, where the gamut of dental treatment alternatives was available. It would probably be a few months before she could be seen. In the meantime she would have to take antibiotics.

So it was that a few months later Marie set out with trepidation to the dental hospital with her chauffeur (me). We had already carried out a reconnaissance of the facility and organised a parking space right beside the entrance. I reported our arrival to reception, which was too far away from the door for Marie, while she fidgeted at the entrance, frequently sipping bottled water to alleviate her "dry mouth" (she doesn't have Coke any more). After a couple of minutes to me, but a couple of hours to Marie, we were ushered into "our" dentist's treatment room. The dentist, a sensitive and empathetic 40-something lady who was five feet in height AND around the waist perched on a typist's chair with only one bum cheek - the other wouldn't fit - and explained the choices of treatment. These involved various local anaesthetics with different effects, a spray that freezes a specific area, a mixture of nitrous oxide (laughing gas) and air, various mixtures of the aforementioned or the full-blown general anaesthetic. The last option was the least favoured by the dentist because it carries the most risk to the patient.

After 45 minutes, Marie chose the local anaesthetic which, she was told, wouldn't affect her throat so much. Much to our surprise, we were told that was the end of the consultation. We would have to make another appointment for the treatment.

More antibiotics and another few months later, we were back at the dental hospital. The nice lady dentist (who I noticed only just fitted through the door-frame) led Marie into the treatment room and told me to wait in the waiting room. "We won't need him" she told Marie.


An ashen-faced dental nurse rushed into the waiting room. "Robert, please come straight away. Your wife has had a panic attack!" Trying to hide my anxiety, I followed her into the treatment room. Marie, seated, looked OK.

"Ah Robert (giggle, giggle)" said the dentist looking guilty, flummoxed and knackered simultaneously and sounding dangerously like the doctor on The Simpsons. She was greeting me as if I was her long lost brother, "Marie has had a little (giggle, giggle) eh...turn." And she added quickly, "But she's alright now" and then "She'd probably better go home now." Marie got up and we left.

Once in the car, Marie told me that the local anaesthetic had affected her almost exactly the same as the one our family dentist had administered. It had made her panic and she wouldn't let the dentist near her mouth, screaming and flailing all around her. The hospital dentist told her that she'd never had anyone take a panic attack in her room before. I don't think she wants it to happen again, either!

This time the hospital made another appointment for Marie. No more options, it was to be a general anaesthetic this time. Operating theatre. Seven teeth were to be removed. The rationale was that all the teeth which might need to be removed in the next few years would be removed at this time. "We don't want you coming back in six months' time and have to do this all over again." Fair point. The operation was to be in a different building and I couldn't park right outside the entrance. Marie had very heightened anxiety for the entire six weeks' wait for the procedure and became quite difficult to live with. However, the big day eventually arrived. I stopped outside the entrance door to the building which houses the operating theatres and led Marie to the very helpful receptionist just inside the door. She looked after Marie until I parked the car and returned. Then we had to go about 20m (22 yds) to wait for the dentist and change into a hospital gown. This was already much further away from the entrance than Marie was comfortable with, but she coped. Ten minutes later, the dentist arrived, all scrubbed up and clad in a (very large) pea-green outfit c/w miniature wellies and we had to walk yet another 20m to the room where Marie's anaesthetic was to be administered. Amazingly, Marie was fine walking there, but her anxiety rose sharply when she was presented with the needle. Seconds later she was unconscious and I took her handbag with me to the waiting room - the first time she had been separated from the bag in several years.

After a few hours, dental treatment complete, Marie (now reunited with her bag) was giving a good impression of a drunk woman trying to get into a car, and then we went home. Within a week Marie's gums had mostly healed and her anxiety level returned to normal (Marie's normal, that is). Without examining the inside of Marie's mouth, you wouldn't know that she is missing any teeth at all. Quite amazing!

She's just had a checkup. Everything is the way it should be.

The National Health Service may be slow, but the care that Marie received in this matter was definitely world class - and free! I was pleasantly surprised how much consideration was given to Marie's unique requirements and cost was never an issue. Well done NHS!


HSP Woman said...

What an exciting read! I was glued to the post, trying not to panic as I related to Marie's adventure! You are a wonderful, supportive, caring, loving husband to help her get through this ordeal. I am so glad it ended well.

I am so proud of you, Marie!!

I just had a little experience of my own at the dentist. Marie, this web site really helped me. You should check it out!

Dental Fear Central:

Phew! What a story!! Again, I am sooo proud of you Marie!

Aff said...

Yes, ditto HSP Woman! Well done, Marie and the NHS.

Despite the fact that when I had a dental operation several years ago, they scratched the back of my throat with a tube and didn't tell me until I almost coughed a lung up and all but lost the ability to breathe several hours later!


MrsC♥ said...

Hi there and WELL DONE MARIE!!!!!

I had a horrendous experience with a specialised dental clinic for phobics. You can actually read it at HSP Womens blog!

If its not bad enough having a dental fear, but having a dental fear with panic and agoraphobia on top, no one could possibly understand how awful it is.

I STILL have about 10 teeth needing urgent attention. I am thinking i may suggest having it done under a GA. Get it all fixed up at once.

Have a good weekend :)


Robert said...

Hi hsp w -

(Pink with embarrassment) Thanks for your comment. I read about your dental debacle - it made me very angry with your ex-dentist.

Thanks for the useful link!

Robert said...

Aff -

Typical NHS - a post-code lottery. We are lucky in this rural part of England. Marie also had excellent treatment during 2 pregnancies (earlier posts).

Robert said...

Hi Sarah -

You can be referred to your local dental hospital by your regular dentist. It's your right. If you explain your problems there, you won't have any trouble getting treatment under a GA. I expect that, like Marie, they'll take out ALL your dodgy teeth in one go.

Good luck!

Elanor said...

I am so glad that this turned out well for Marie, it must have been a relief for both of you to have this over and done with.
Lovely photo of you and your daughters as well in your previous post.

Robert said...

Hi Elanor -

Thanks for the compliment about the photo!

The entire household was relieved that Marie's dental treatment was complete. The prospect of it was always hanging over her and caused her to have increased anxiety. Afterwards she and we were able to relax.