Dear Dr. Dentist and Staff

I realized I have not communicated well with you about my issues with coming to your office. One reason is that I when am at the dentist’s office, I am using all of my coping skills to show up! I may not be calm enough to talk to you. Here’s the points I want to share with you, while I am at home and able to articulate them:

My health records include that I have PTSD. I haven’t been articulate about how the diagnosis of PTSD impacts my dental care. Upon reflection, I am realizing you haven’t asked me that either. You might want to consider asking that next question. My PTSD is a result of childhood sexual abuse for most of my childhood. Before I had therapy for PTSD, any stressful situation I encountered meant that I experienced it as trauma. One such moment as a kid was when I was at the dentist’s office for my first filling. The dentist had difficulty numbing the area. How did we know? Because I could feel the drilling! It took six numbing shots before it was effective. And this was before they used topical numbing for the shot. The end result is that getting a filling at the dentist’s office became it’s own place of trauma.

A dentist’s visit requires that I hold still and have needed, but unpleasant procedures performed on me. Or, done to me. It’s easy to feel “done to” which can take me to the victim mode. An aspect of recovery from trauma is to stay empowered, not default to victimization. While the adult me understands these procedures are for my health and well-being, I tend to default to my childhood trauma response of fight, flee or freeze. I have responded with all three modes. The “fight” part is me questioning the need for the next procedure you tell me I need. Really? I need a crown? I haven’t noticed anything wrong. Two crowns? You have got to be kidding! After you show me the X-Ray with the hairline fracture on tooth, I see the evidence/need. But I’m not ready, and I say is that the procedure is expensive and I will need to put the finances together. That’s true, but the other dynamic is that I will need to mentally and emotionally prepare myself to show up for this. The flight/flee mode is when you don’t see me as I don’t make, or cancel appointments. When I was in my twenties and just starting my trauma healing, I didn’t go to the dentist for ten years. It took a wisdom tooth breaking and crumbling in my mouth to get me to a dentist’s office.

The freeze mode is what I do in your dental chair. I don’t move. You compliment me on doing a “good job” and holding still. Which feels like you are congratulating me for being in an active trauma-response moment. I feel defeated, done to, not encouraged. I have come to dread being told I’m doing a good job holding still. I have commented that I can’t imagine NOT holding still, and you all tell me there are adults who squirm. I have empathy for those adults.

Showing up to your office takes all of my coping skills. These are some of the techniques I use: I tell a friend or spouse that I have committed to this appointment. I use self-talk about the necessity of the procedure, for my dental health. I don’t work with strangers; I have used the same dental hygienist and dentist for twenty years. (My dental hygienist recently retired. While I am a proponent of retirement, I realize I will need to build a trusting relationship with another hygienist.) I make sure to prepare for a procedure by meditating, preparing my music on my phone and grabbing my ear buds. While in the dental chair I use the relaxation breathing I learned in Lamaze class several decades ago. I have appreciated the use of nitrous oxide while having these crown procedures. The effects seem temporary and do not trigger a craving for mood altering substances. I have learned to ask for that warm blanket one dental tech offered me one time. Wrapped in warmth feels so safe and calming.

In addition, I include alcoholism/addiction on my medical history. When you ask how long I have been sober, you all are relieved when I say forty years, that it isn’t a current problem. No, I haven’t recently been drinking and you don’t have to work with dental neglect, easily bleeding gums, lowered immunities and other impacts of alcoholic behavior. However, I believe I am one drink away from active alcoholism, that I am granted a reprieve based on my daily maintenance of my condition. My addiction information is relevant today as mood altering drugs have the same impact as alcohol in my system, meaning it can re-activate a dormant craving. We need to decide as a team if my dental treatment includes mood-altering medication while in the office, and how to manage it if it is imperative to send me home with mood altering drugs. So far I haven’t had a dental procedure that needs more than OTC pain medications when I go home.

What I want to convey is it no small feat that I show up for dental procedures. You work on my mouth, but I am a package deal. My emotional part has to be stable enough to bring my mouth to your office. I am getting that done. I don’t need accolades, but I appreciate kindness and understanding on your part. I am currently preparing myself for needing two more crowns. I’ll get there!

Sincerely,

Lorna Larson