BROKEN TEETH filled her mouth. Infections plagued her each month. Then,
doctors diagnosed Pamela Lerch, of Oakley, with diabetes.
“I reached
a point where there was nothing I could eat,” Lerch, 55, said. “It
had to be soft, which is bad for diabetics. I had to do something.
That was not
an easy realization for Lerch, who suffers from panic disorder. At one
point, she had not left her house in eight years.
An offshoot
of her disorder, dental phobia was rooted in bad dental experiences as a child. She
hadn’t seen a dentist for 20 years.
“I knew
somewhere in the future I was going to end up in a hospital,” Lerch said. “My
teeth were so bad, and my fear so great, that sleep dentistry was the only way
to manage it.”
For the past
decade, dentists have tried to coax anxious patients back into the chair with
more compassionate chairside manners and multimedia diversions, such as music
piped through headphones and DVDs shown through virtual reality video glasses.
But for truly
phobic patients, what really works is the painless approach to dental care available
through “sleep” dentistry.
Traditionally,
dentists have offered sedation through nitrous oxide, also known as laughing
gas.
Sleep sedation
acts on a deeper level, often achieved through sedatives or analgesics, such
as Valium, that are administered by pill or intravenously.
“Sleep
sedation is actually a misnomer,” said Dr. Daniel Leung, a Pleasant Hill
dentist whose office provides sedation options. “The patient is still
conscious, just deeply relaxed.”
Dr. Scott
Pope of Pope Dental in Walnut Creek works with trained anesthesiologists from
Bay Area Anesthesia, who administer intravenous sedation in his office.
“With
the sedation level I do, I can tap patients on the shoulder and stimulate them
enough to ask how they’re doing,” Pope said. “Then, they
go back to sleep. They don’t remember what happened with the procedure
when it’s over. They feel like they have taken a 15-minute rest.”
The Blende
Dental Group takes sedation to the highest level. Blende is one of the
Bay Area’s only dentists who offers general anesthesia in a hospital setting.
His office
specializes in treating phobic patients, as well as the disabled. About 40 million
Americans cite fear or anxiety as the reason for not visiting a dentist regularly,
according to the Dental Phobia Treatment Center of New York. Most intensely
phobic patients haven’t seen a dentist in 10 years or more. As a
result, they often would need multiple appointments and lengthy procedures if
they had work done in a general dentist office.
“These
people are afraid to make the phone call,” said practice manager Amanda
White, a registered nurse, with the Blende Dental Group. “They can’t
deal with that overwhelming amount of work. They need to have it all done
in one day.”
Dental phobias
can stem from a fear of pain, injections, anesthetic side effects, loss of control
or even embarrassment. Most often, it relates back to a frightful childhood
experience.
Such was the
case for Lerch, who as a child had gone to a cousin for dental work. With
a sensitive gag reflex, she panicked every time she had impressions made of her
teeth.
“I remember
every other word being, ‘Whoops, sorry,’” she recalled.
An Internet
search led her to the Blende Dental Group. She joined its mailing list. Finally,
in June 2005, she worked up the nerve to make an appointment. A month later,
she had surgery.
Her extensive
work required general anesthesia at Kaiser’s San Rafael Medial Center. The
nine-hour surgery ended with a deep cleaning, 12 extractions, seven crowns and
eight fillings. Later, she also had five implants.
“It
was a terrifying thing, but I’m so glad to have gone through it,” she
said. “I’m smiling more now. The first taste of salad
and meat, I thought I would never have that in my life again. The first
time I had them, I cried.”
Sedation dentistry
has become like a magic pill for phobics. But most dentists agree, the
real trick to stamping out dental phobias is permanently changing the negative
perception surrounding dentists.
“In
the past, it was like you were thrown in the chair, jabbed with a needle, drilled
and shuffled out,” Leung said. “I graduated from dental school
four years ago. Now, the big emphasis is on patient care and comfort.”
That starts
with the youngest patients.
Videogames,
coloring books and designated play areas in waiting rooms offer an inviting atmosphere
for children. Dentists, such as Leung, use a topical and small needles
to eliminate pain with shots.
“Once
they’ve been here a couple of times, they see we aren’t the bad guys,” Leung
said. “And we give them prizes at the end. That’s become
common practice for most dentists these days.”
It might have
made all the different for Tony Morrow.
Until last
year, Morrow, 53, of Antioch, hadn’t visited a dentist in 10 years. As
a child, he had work done by dental school students.
“Once
they drilled down right on my nerve,” he said. “After that,
I didn’t want anything to do with a dentist.”
He discovered
Blende when seeking care for his 28-year-old autistic son. Then, Morrow,
an Army reservist, was called up for duty. He knew the Army would insist
he have dental work before deployment.
“I didn’t
feel comfortable with dentists, period,” he said. “I definitely
didn’t want any Army dentist doing work in my mouth.”
The availability
of general anesthesia persuaded Morrow to have complex dental surgery in March
2005. He had 12 extractions, 17 crowns/bridges and four quadrants of scaling
and root planing.