By Donna Stewart
Learning to trust and depend on others for our well-being can be one of the hardest lessons to learn for some of us. In the dentist office, sometimes a trusting relationship makes all the difference in a treatment’s success or failure. For me, allowing myself to trust my hygienist, my dentist and my periodontist saved my teeth and maybe even my life. But it didn’t come easy and that trust had to be earned, to a certain degree, on both sides.
Due to a particularly tumultuous parental divorce and a father suffering from PTSD and alcoholism, I had been on my own from the age of 16. As a result, I had learned to be suspicious and distrustful as I struggled to overcome some pretty tough situations. These characteristics afforded some protection earlier in life. However, as I learned to avoid the types of situations that called for them, they were starting to prove self-destructive.
Case in point, I had been diagnosed with gum disease two years before I started treatment. Because of my trust issues, I didn’t believe the dentist. His manner fluctuated from distant and detached to brusque and bullish, and his failure to look at me while he spoke was one of the tell-tale signs I’d learned to associate with untrustworthiness. I thought he was just trying to take advantage of me and make money. After all, I was young and I’d always brushed my teeth at least twice a day.
No, I didn’t see a dentist regularly. In my family you only went to the dentist if you were in pain, and most of my relatives had great teeth well into their 80s, at least on my mother’s side of the family. Later, I learned that periodontitis was near epidemic on my father’s side, but that side of the family tended to be black sheep who partied hard and died young, gray and in a cloud of cigarette smoke. I’d never even had a cavity (and I’ve still only had one). How could I have periodontitis?
Two years later, my symptoms could no longer be ignored and I had to see another dentist, Dr. Jeff Nelson. I didn’t share the previous dentist’s findings, as I was still operating on a low trust threshold. I wanted to see if Dr. Nelson’s office would make the same diagnosis. He did, and he also found that in those two additional years, the disease had been aggressive. He looked me right in the eye and paused before he said anything. His expression was exactly like one someone would wear right before they said the words, “I’m going to level with you.” Without sugarcoating, but also without a hint of judgment he told me what he had found. I had gum disease. This wasn’t gingivitis. It was about-to-lose-my-teeth, gum-line-dropping periodontal disease, presenting with class III Periodontitis, with pockets ranging from 4mm to 7mm and significant bone loss.
Then he talked about some of our treatment options. His direct, honest approach left me with no doubts and I appreciated that he neither treated me like a leper, nor a child. It was true: I had gum disease.
I was stunned. My perception was that only the backwoods, the elderly, the homeless, and drug addicts lost their teeth. One of my great fears was that the rest of society held the same opinion, including dental professionals.
Mentally frozen in fear, I couldn’t begin to imagine how I could possibly afford the treatments. There were nights that I lay awake at night, writhing with anxiety. I imagined losing everything as my teeth fell out and my smile became something I had to hide behind a hand. I worried that the bacteria were moving into the rest of my body, setting me up for diabetes, pancreatic cancer and heart disease, as I’d recently learned could certainly happen.
Worse, I felt completely isolated. My previous experience with dental professionals was limited to an orthodontist I saw for a couple of years from ages 12 to 14 and the dentist I mentioned previously. I didn’t view the dentist as being a possible supportive partner and friend, but as a greedy businessman who had me at a complete disadvantage. Furthering my isolation, as I researched my disease I was learning that the causes of periodontitis are often self-inflicted, one of which is smoking cigarettes, which I had done since the age of 13. At my appointment, Dr. Nelson had stressed the connection between smoking and periodontitis and that it was critical for me to quit if I hoped to keep my teeth. I quit smoking and haven’t touched them again, but since I may have brought this on myself, I was too ashamed to share the burden with my friends or my then boyfriend and future husband, Darren, fearing their judgment.
However, I was shortly forced to tell Darren because the first recommended treatment was scaling and rootplaning in all four quadrants. Since Darren and I lived together, it would have been difficult to hide such an intense treatment. At first, I still tried to be vague in my explanation but at the next three-month periodontal maintenance cleaning, my hygienist, Susan, found a few localized spots that were not responding to the SRP. Dr. Nelson the referred me to Dr. Mark Blue, a periodontist, who determined that three separate, localized degranulation and osseous surgeries were necessary.
After that evaluation, I tearfully told Darren the whole story. With the prospect of my possibly going toothless in the not so distant future, I half expected him to gracefully exit the relationship. Instead, he held me as I cried and became my greatest supporter — now my husband of four years. The walls so carefully constructed were beginning to crumble.
I quit smoking, I had the SRP and the degranulation and osseous surgeries and kept up with the prescribed cleanings every three months, slowly daring to hope the professionals could help me. As it happened, Susan turned out to be a neighbor of mine, and initially that may have been a big factor in enabling me to open another tiny crack in my wall. Ultimately, however, I believe it was her openness and sincere desire to help that began to break through and make me feel as though I had another strong ally who wouldn’t judge me and was fighting in my corner. She became a guide chaperoning me through a foreign land and helped it look a little less frightening. From the beginning, she asked questions and encouraged me to ask questions as well, helping me understand possible factors that contributed to the disease’s development and ways to mitigate those factors. There really was no such thing as a stupid question either. When I sheepishly asked if she could show me the correct way to floss, she acted like all 30 year olds asked this question and showed me to scrape muck down, instead of sawing back and forth which is what I had been doing.
What’s more, like me, Susan was interested in complementary adjunctive therapies and had done much of her own research. She suggested therapies to research and listened to the ideas I had encountered out in the ether of the Internet and helped me sort through the “hogwash” and the hopefuls. These treatments cost very little and her willingness to share options that didn’t enrich the business, yet worked very well for me, the patient, began to further erode barriers to trust. Quite a difference from another dental professional I had visited who told me cheerfully that he might be able to save “most” of my teeth and then just as cheerfully suggested I might enjoy having them whitened, recommending a very costly treatment. To this I responded, “Why don’t we see if I’m going to keep them first.”
Like a soldier up against a far larger foe, I was throwing everything I could. Between the two of us, Susan and I came up with some effective complementary therapies that I feel, when used with the mechanical and surgical therapies, greatly contributed to the complete stabilization and arrest of my periodontal disease. In my case, we discovered the following to be quite beneficial: using an electric oscillating toothbrush and flossing after every meal and snack; rinsing with Natural Dentist mouthwash (a combination of herbals and essential oils proven as effective as the strongest prescribed rinses); eating foods with herbs that fight bacteria like hot spices, cilantro, and peppers; chewing gum with xylitol; eating plain yogurt; brushing with a combination of spearmint, peppermint and almond oil; taking multi-vitamins and high doses of vitamin c; using an NTI device to stop grinding at night and meditation techniques to stop grinding during the day.
The results have been better than I (or anyone else) hoped. My case has been referred to as an exception. On the verge of losing most of my teeth, my team helped me reduce those pockets back to 2, 3 and 4 mm over the course of five years. We continue seeing gains in healing even now, with the gum ligaments continuing to tighten. A year and a half ago I was placed back on a bi-yearly periodontal maintenance cleaning and six months ago released to normal twice a year cleanings, with the disease in full arrest.
I feel very fortunate because I know how rare of an outcome this is, but from what I’ve learned and experienced, I don’t think it has to be as rare as it is. When I asked my dentist and hygienist what they felt made the greatest difference in my case, both of them cited patient motivation as the primary factor. But I think there’s much more to it. The disease had become one of the great blessings in my life. I found faith and trust in others. I had outside love and support from my husband, and by a couple of years into my treatment, I had come to feel that Jeff, Susan and Mark and I were partners. They were every bit as motivated as I was. They took the time to educate me, patiently and respectfully, and I took the education into my home care. We were a team. I feel like my belief, as well as the truth, of this statement was every bit as essential in the success of our efforts.
Susan moved away two years into my treatments and at first I worried that a new hygienist might be less thorough, encouraging and open-minded, but Dr. Nelson chooses his staff carefully and the new hygienist, Trish Thomas, easily moved into a partner role and has become a trusted friend. My dentist, Jeff Nelson, with his direct, honest and no-nonsense approach, certainly looks me right in the eye and never made me feel like the 18th century leper the first dentist had. I trust him and despite the credit he gives me, I couldn’t have done this without that.
So why am I sharing all of this with you? I’m sharing this because I want to give you the story from the patient’s perspective. I want you to know the kind of impact you can have on a patient. Also, I wanted to give you some idea of who that person in your chair might be. In the event that you might have become jaded, as some dental professionals understandably might after encountering countless patients who do not listen and aren’t able to be proactive in their own care, for reasons we aren’t given to completely understand, I wanted to humanize the patient. I wanted you to know that there are some of us eager for your guidance and lost without it. We need you to keep trying.
Donna Stewart uses writing as a tool to explore the world. A voracious learner, she writes on a broad range of topics, including health and healing, psychology, yoga, travel, and family.
By Donna Stewart