If you are like most Americans, going to the dentist is not your idea of having fun. However, for many of us who are psychiatric survivors and/or survivors of physical/sexual/emotional abuse, going to the dentist can be more than just scary or uncomfortable. It can be re-traumatizing. In order to avoid retraumatization many of us avoid the dentist completely and eventually find our teeth in various state of decay or disease.
Two researchers from New Hampshire have pulled together a brochure entitled, “Dental Tips for Individuals Sexually Abused as Children.” These women suggest three major strategies. The first is doing anything that increases your sense of control, such as asking your dentist to explain all procedures before beginning them, or developing an agreed-upon “signal” that indicates to your dentist that you want to stop. The second suggestion is using “mental techniques that you can practice ahead and while at the dentist.” One such technique is deep breathing through your nose to relax yourself. The third suggestion involves a list of “other things to do” such as bringing a friend to be with you during the dental procedure, wearing pants rather than a skirt to the dental appointment, educating your dentist, bringing a soothing audiotape to listen to, etc.
Although this brochure is intended for survivors of sexual abuse, the techniques suggested will help anyone with high levels of fear of the dentist. For those of us who have been abused in mental institutions, who have been tied up in restraint and seclusion with staff hovering over us, or who have been force fed or medicated against our will, the dental experience can have similar symbolic/triggering aspects. These include having to lay in the dental chair with the dentist hovering over us; being in a relatively helpless position while alone in a room with a professional/doctor; having intrusive procedures without warning; etc. Thus, even though this brochure is advertised as helpful to survivors of sexual abuse, I think it is also quite applicable to psychiatric survivors.
If you would like to order this free brochure, write to Kate F. Hays or Sheila Stanley at Womankind Counseling Center, 21 Green Street, Concord, NH 03301
One final note. In my long struggle to feel more skilled and safe in using dental services, I have found out an important point that is not mentioned in the brochure but that may help you. When children/people are abused, our bodies react with a heightened sense of vigilance, fear, or what is called “hyper-arousal”. One of the long-term effects of abuse is that our bodies did not develop the capacity to modulate levels of affective arousal. We seem to jump from 1 to a 10 if a car backfires and startles us. And we tend to stay at “10” or a high level of arousal long after the car had backfired. Our bodies can’t “settle down” as quickly as people who do not have trauma histories.
For years when I would go to the dentist and get Novocain, my heart would start racing. I was filled with feelings of panic, and I felt like I was going to die. I wasn’t afraid of the needle. It was only once the Novocain drug was in my body that I had trouble. Finally I discovered that drugs such as Novocain, which are used by dentists to block pain signals from the nerve, also contain another drug called epinephrine. Epinephrine causes the blood vessels to constrict and can simulate a startle response or “fight/flight” response in the body. In effect Novocain was simulating the human bodies reaction to trauma by triggering a state of hyperarousal.
Once I understood this I talked it over with my dentist. We tried using Novocain-type drugs with no epinephrine in it. This definitely helped to eliminate my hyperarousal and the feeling of panic. However, the numbing effect only lasted a short time and this was bad news when I was halfway into a root canal procedure. So then we tried a numbing drug that had some epinephrine in it, but the dentist injected in very, very slowly so my body could accommodate slowly. We made sure to tip the dentist chair way back so I didn’t feel dizzy. The dental assistant kept her hand on my shoulder while the dentist reminded me to breathe deeply. To my joy I avoided the hyperarousal effect and could continue with my treatment without being re-traumatized. Maybe it will work for you!