Dealing with Dysautonomia at the Dentist

As I sit here dreading my upcoming dentist appointment tomorrow afternoon, I wanted to remind myself of a few important strategies I can use to cope in the dental chair. Luckily, I have a very gentle and compassionate dentist (with very small hands) who lets me rest my jaw when needed. She also maintains a very clean and comfortable office atmosphere with televisions on the ceiling, headphones, and sunglasses: all things which serve to make the patient comfortable and ease potential anxiety. Most importantly, she knows I have a severe epinephrine sensitivity and gives me a special pain injection without epinephrine. She is also willing to work around my TMJ issues by giving me regular breaks to rest my jaw.

As I child I guess you could say I developed a severe phobia of dentists. I absolutely detested my childhood dentist and began to associate every dental appointment with pain and anxiety. Now that I'm a rational adult, things are a bit better. I know that my dentist is not out to get me and that regular treatment can help prevent pain and complications in the future. Going to the dentist the last couple years has become a lot more complicated though, partially due to my TMJ, and partially due to my case of POTS. Here are a few important things that have helped me get through recent dental appointments:

-No epinephrine! Epinephrine is an additive commonly found in pain injections like Novocaine. It can induce tachycardia in normal individuals. It actually makes me involuntarily shake and develop hives (an allergic reaction). Even if you are not allergic, ask your dentist for an epinephrine-free pain injection. They are just as effective without the potential side effects. Also, be aware of any other potential allergies and sensitivities including latex, and if you have any kind of allergy, inform your dentist or hygienist prior to treatment.

-Hydrate yourself long before your appointment (Gatorade is a great option). Bring a water bottle inside with you but be sure to ask when it is okay to take a drink.

-Eat a protein-rich snack right before the appointment. Bring something soft to eat afterwards like a pudding cup in case you get low blood sugar issues.

-Speak up for yourself. If you're uncomfortable or in unbearable pain, don't be afraid to tell your dentist. They want to keep the patient as comfortable and relaxed as possible. I opt to remain calm without the use of meds or laughing gas because of the side effects. Something as simple as listening to music or having a comfy blanket may be just enough to make your appointment more bearable.

-Close your eyes. Don't look at the giant needles as they enter your mouth. Keeping your eyes closed also helps keep that pesky bright light out of your eyes. If you want to keep them open, be sure to wear full-coverage sunglasses.

-Ask your dentist to explain the steps of the procedure to you as they go. Most good dentists will do this naturally. They will talk you through the procedure and alert you when you may feel extra pain or pressure so it doesn't come as a surprise.

-Ask your dentist if you should take any special care or precautions after the procedure. Sometimes patients will be advised to take ibuprofen or Tylenol for a day or two to minimize pain and discomfort. Others, especially those with heart conditions like MVP, will often be prescribed antibiotics to take as a precaution to avoid infection. Sometimes an ice pack or muscle relaxant will even be prescribed, especially for patients with TMJ or related conditions.

-Several shorter appointments are always easier for your body to handle than one or two long appointments. Pay careful attention to your scheduling needs. It is best for POTS patients to avoid early morning appointments at all costs, late afternoon or early evening is usually best. If there is one secret I have learned about dental offices it's that the late afternoon appointments are only going to last a couple hours at most because the offices always close down at a set time each day. Find out when the office closes and schedule your appointment two to three hours before closing time.

That is about it for my extensive knowledge of the dental world. Tomorrow I am going to try something new and ask my dentist if she will lay my head a little further back and keep my legs elevated a little higher in the air in an attempt to avoid woozy spells. My guess is that should help minimize my POTS symptoms a little more. Wish me luck!

I gleaned some more helpful information from an article on POTS and dental treatment which I will be printing out to share with my dentist:

http://www.dynakids.org/Documents/Brooks_April_2006_JADA.pdf.