dentistry

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Drilling Into Our Fear Of The Dentist — And What To Do About It

(AP Photo/Michael Probst)

For the estimated ten percent of Americans with dental phobia, research suggests therapy and other options may help. (Michael Probst/AP)

When I arrived at the dentist’s office for my implant procedure, I was already sweating and on the verge of tears.

After several shots of Novocaine, I felt no pain whatsoever. But that didn’t matter. I squirmed as I sensed incisions in my gums and heard drill collide with bone. I panicked about how intrinsically wrong it felt for someone to put titanium in my body. I worried: Would I be able to eat? To talk? Would I get an infection?

After an hour and a half, I returned to the receptionist swollen and tear-streaked. The periodontist joked, “She was shaking like a leaf, it was like a moving target!”

Not long afterward, I checked out my score on the Dental Anxiety Scale. My whole body tensed up when I read the first question: “If you went to your dentist for TREATMENT TOMORROW, how would you feel?” I scored a 21, which qualifies me as a “highly dentally anxious patient, possible dentally phobic.”

I have a lot of company. In fact, the Diagnostic and Statistical Manual of Mental Disorders estimates that almost 4 percent of people are “dental phobics.” According to the DSM, the prevalence rates for dental fears are similar to the rates of people who fear snakes or heights.

But we’re not quaking alone in the chair. Of late, researchers have been seeking to understand dental fear better, from its prevalence to the disparate elements that add up to phobia. For example, one recent brain scan study found that the buzz of the dental drill is a particular source of distress. And they’ve been exploring and testing potential remedies, from therapy to sedation.

Dr. Matthew Messina, a Cleveland dentist and consumer adviser for the American Dental Association, estimates that the rate of dental phobics is even higher than 4 percent. Around 10 percent of the adult population in the United States, Dr. Messina says, have a dental phobia so paralyzing it prevents regular dentist visits.

Dr. Lisa Heaton, a licensed clinical psychologist who treats patients at the University of Washington’s Dental Fears Research Clinic, says that up to 75 percent of adults have at least some anxiety about going to the dentist. Continue reading

Poor, Sick And Cut Off From Dental Care

By Dianne Finch
Guest Contributor

Mike Bush eats only one meal a day to avoid chewing (Photos: Dianne Finch)

Mike Bush is 45, unemployed and struggling with paranoid schizophrenia. But he has an even more pressing problem at the moment: lunch.

Bush’s teeth are so bad that he eats only one meal a day to avoid chewing.

“I shy away from meats and things. I told my dad that I’m running out of teeth to chew with. No big deal,” he said. “I’m probably going to end up with dentures.”

Bush, who lives in Bedford, Mass. started seeing a dentist three years ago for the first time in decades.

But his timing wasn’t ideal. In 2010, just after getting his initial dental exams and cleanings, MassHealth, the state’s program for low-income residents, cut its budget dramatically. Critical dental benefits were eliminated from the plan: fillings, crowns, root canals, and dentures were no longer covered. Extractions, for better or worse, were spared.

The problem isn’t isolated to Massachusetts. In states across the country, adult dental services provide an easy target for cash-strapped lawmakers looking for cuts, according to a 2011 report by the Institutes of Medicine, “Access to Oral Healthcare for Vulnerable and Underserved Populations.”

One reason, the report points out, is that Medicaid requires dental coverage for children, but not for adults. It referred to a February 2011 letter to states from the U.S. Department of Health and Human Services reminding them that Medicaid savings can be achieved via adult dental cuts.

“While some benefits, such as hospital and physician services, are required to be provided by State Medicaid programs, many services, such as prescription drugs, dental services, and speech therapy, are optional,” the HHS letter said.

So, many states are scaling back on the adult programs. Others are already moving to restore certain dental services after struggling with some unintended consequences due to earlier cuts.

Heading To The ER Instead Of The Dentist

For example, some states that track dental-related emergency room visits are seeing much higher costs. And physicians unable to treat dental problems are generally handing out opiate painkillers and antibiotics, according to Centers for Disease Control data cited in The New York Times.

Dental problems are sometimes perceived as less important, or somehow distinct, from overall wellness and good health, studies show.

But the 2011 IOM report advised governments and universities to integrate oral health into overall health programs in order to improve access to services and remove disparities.

“The enduring separation of oral health care from overall health care has marginalized issues related to oral health,” the report said.

An elderly woman on MassHealth exhibits the results of poor, erratic dental care over the years.

An aside: I know this from personal experience. A close relative who is mentally ill and on MassHealth has black front teeth due to multiple, untreated cavities and old fillings that are falling out. After waiting two years for a dental appointment, she recently had the two most painful teeth pulled, though they could have been saved with fillings. (She also has 40-year old fillings that need replacing, but has no disposable income to pay for treatment.)

Another close relative, an elderly woman, also on MassHealth, has been trying to get dentures for several years because she only has five teeth left. She can’t afford care, though, and today I’m taking her to my own dentist for an emergency appointment, paying out of pocket, because her teeth became so jagged they were stabbing her in the tongue. Continue reading