QUESTION

I have PTSD from something unrelated to dental work—but going to the dentist triggers such frightening feelings that I’ve stopped getting even a checkup. How can I make dental visits endurable?

ANSWER

Seeing the dentist is not likely to be on anyone’s list of favorite things to do even without an anxiety issue thrown in. But for people with post-traumatic stress disorder (PTSD), going to the dentist—even just for a cleaning—can literally trigger their worst nightmares. PTSD affects about 4% of men and 10% of women in the US, according to the National Center for PTSD. While it’s caused by extreme emotional and/or physical distress, either a single event or prolonged exposure, not everyone who experiences trauma develops PTSD. Emotional or physical abuse, warfare, sexual assault, being in a serious accident or witnessing a violent crime can lead to the condition. But even something that was intended to be beneficial, such as being held down for a necessary medical procedure as a child, can cause it. Some people may not even realize that they have PTSD until a later situation calls up the distressing memory or feelings. It’s easy to understand how dental visits can be a problem for people with PTSD. Your senses are assaulted by smells, sights and sounds that can raise feelings of alarm—even for people without PTSD—as soon as you walk into the office. When you’re in the dental chair, it can feel like you’re trapped—while the dentist’s and dental assistant’s hands and tools near your mouth and nose can make you feel as if you might suffocate. And if it also seems like your dentist isn’t understanding or appreciating your distress, anxiety can escalate into full-blown panic. Dental patients have been known to grab their dentist’s hands, hit their dentists…even run from the room. As you know, skipping checkups and dental procedures is not a good solution for your teeth or your overall health. Instead, here are some tactics that can help…

  • Try to establish a rapport with your dentist, such as by phone or with an in-person consultation, before your first visit. Explain that you have PTSD…that it can easily come to the fore in a dentist’s office…and that you’d like to enlist the dental staff’s understanding and help to keep that from happening. Even just creating a relationship with your dentist this way can help you relax more when you go back for a cleaning or other work.
  • Explain to your dentist what helps you feel more at ease. For instance, during procedures, do you like to be told exactly what is going to be done before or while it’s happening…or, the opposite, would you prefer not to be told the details? Would you like all of the dental tools laid out within your sight so there are no surprises…or would you prefer that they remain out of your vision? Many patients are more relaxed at the dentist if they wear a headset to listen to music. Working out such details ahead of time can help you feel more in control of the visit. (And discussing it ahead of time gives you the opportunity to assess how well your dentist listens to and understands your needs—or to find someone else if you’re not satisfied.)
  • Since dental work might bring up long-suppressed or forgotten traumas, establish ahead of time that you may need to take short breaks to calm down.
  • Discuss with your dentist the possibility of taking an anxiety medication such as Xanax before appointments, especially before the first few visits.
  • If you’re especially sensitive to pain and are concerned that a local anesthetic won’t be sufficient, taking an over-the-counter pain reliever such as ibuprofen before your procedure can help.
  • Some dentists try to help their anxious patients stay calm by using dim lighting…playing relaxing music…or offering sunglasses, headphones, electric blankets and hand warmers. (When you’re cold, you’re more likely to feel anxious.) If your dentist doesn’t do these things, consider bringing your own headset and/or sunglasses, and dress warmly. Tip: Listening to a story on your headset might be more effective than music.
  • Measured, slow breathing also can help you feel less anxious.
If none of the above help enough, or if your PTSD is complicated by other considerations such as severe dental phobia or a strong gag reflex, discuss with your dentist being sedated during your appointments.