Tomorrow I have an appointment for a dental exam and referral to an oral surgeon. This is a continuation of a process that started more than a year ago. To say I’m not amused with the way it has taken shape so far would be a gross understatement.
Most people hate going to the dentist, but I dare say I hate it more than most. I have a long history of distress with all things dental, going back to childhood. Most obviously, my social anxiety makes any such visit emotionally stressful in the extreme. On top of that, I seem to be one of those few for whom local anesthesia doesn’t work well. I’ve had teeth extracted as a child and as an adult, and felt major pain every time.
Most of my life I have received inadequate dental care, principally due to the logistics of managing the process with my anxiety. Even picking up the phone to make appointments is usually beyond me, let alone actually keeping the appointment. As a result I have some major issues and a rare opportunity to get something done about it. While I have case management and daily living support services, I am in a position to take on this problem. When those limited duration services end, my window of opportunity slams shut.
Last summer, after a particularly bad dental infection, I went to a dental clinic for an exam and referral. I was hoping to get a recommendation for full mouth extraction so that I could get full dentures and not have to worry about more bad teeth and complications in the future. I went in hopeful and emerged furious. One of my workers accompanied me to aid communication, since it is a given I will communicate ineffectively and retain little in such a high anxiety situation. As part of the intake paperwork I was asked to sign an agreement stating that no patient is allowed to have anyone accompany then into the operatory, except for the initial visit. I had no problem signing it since I expected this to be my one and only visit, and it said the first visit was excepted. I suspect that exception is intended for children, but it did not state so. Under the circumstances, to say nothing of “reasonable accommodation” under the Americans with Disabilities Act, I think I should have been allowed to have my worker with me throughout the process. Some of the staff seemed reluctantly willing to allow that, but the dentist doing the exam flat out refused. Their policy also says no animals, but while I was there an unsighted person was allowed to have his canine assistant with him throughout the facility. I tried to make a case for full mouth extraction on the basis that would be best for my overall mental and physical health, but came away with a referral for 18 extractions with the expectation I would have much work done on the remaining 11 teeth in order to keep them. The dentist was obviously unprepared to accept that there could be any situation in which a patient would not have that work done. He did consent to specify general anesthesia in the referral.
I sent a letter to that clinic shortly after my first visit. In it I stated my views about not being allowed to have my assistant with me despite the agreement I signed. Of course, I got no response.
The short version of a long, complicated story is that during several contacts with the office of the oral surgeon to whom I had been referred, the issue of whether or not I would actually be receiving general anesthesia was not resolved to my satisfaction. They seemed to frequently waver on that subject. This is non-negotiable with me and needs to be absolutely decided in advance. Anything less will result in me being unable to keep the appointment, at best. At worst it could result in my becoming self destructive. During all of the delays with this process, I subsequently had several other infections, having to frequently take antibiotics and then deal with unpleasant side affects.
I finally decided I cannot work with that particular oral surgeon. The decision was made to start the entire process over again, this time going in better prepared to argue my case for full mouth extraction. The bottom line seems to be that no oral surgeon will extract any teeth that are not specified by the referring dentist. Therefore I need to go back and get a new exam/referral if I am to have any chance of getting what I need. To help prepare for this second time around, I got a list of oral surgeons to whom I could get a referral. I observed with considerable displeasure the notes pertaining to the oral surgeon I had been referred to last time said he is not good with special needs (which I think I am) and that he and he alone makes the decision about general anesthesia (the implication being that it is decided at the time of the procedure, not before, since he doesn’t do consults).
When contacted about this, my primary care provider / physician insisted it is absolutely unethical to extract any tooth that can be saved, that no dentist will recommend it and no oral surgeon will do it. Frankly I find that to be bullshit, as I know many people have perfectly healthy teeth extracted (along with bad ones) in order to get full dentures.
The therapist I have been working with for well over 15 years, on the other hand, has written a comprehensive letter to the dentist who is scheduled to do the repeat exam. It details my inability to manage dental care, the prospects for future problems after my current window of opportunity closes, and the benefits of full mouth extraction for my overall health. Whether this will make any difference remains to be seen.
Needless to say, I am very stressed about going back there. Since this is not my first visit, there is no “exception” which might allow me to have my worker with me throughout the process for communication purposes. Not that the “exception” seems to be worth the paper it is printed on in the first place. I have to admit, rather than going in hopeful this time I’m going in with a chip on my shoulder, expecting problems.