Why Being “Knocked Out” at the Dentist is Riskier Than You Think When You Have DID

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So many trauma survivors find receiving dental treatments in the dentist’s office frightening.  OK, maybe not frightening.  Terrifying.  They often opt for being “knocked out” instead of choosing to stay awake and aware during treatment.

I understand why.

And I understand why this is not a solution without some risks.

Many autistic kids receive the same sedation during procedures.  But they have a parent to communicate with the provider, explaining the pattern that lead to the treatment, and receiving instructions on care at home without coming off drugs.  Not being alert and awake removes agency and control in ways that can harm you.  Not fully comprehending instructions could mean you have to return for more treatment.  Coming out of anesthesia can trigger more dissociation.  Being unable to actively close your jaw and give the dentist feedback, or be half-awake when you do, means that you could go home with a filling that wasn’t fully molded to allow for comfortable chewing.

How can you handle things without being sedated?

The better solution is to manage the fear, the pain (and the fear OF pain), and the dissociation that often occurs.  This takes effort, but it rewards adults with DID many times over.  The feelings of empowerment and full adulthood that come from being able to navigate a dental appointment are the opposite of feeling like a victim.

It also has to be done well in advance of the appointment.  For example, you just made your semi-annual dental cleaning appointment.  It is in a month.  You may notice that you didn’t enter it into a calendar, and you keep forgetting when it is.  This is a clue that dissociation and possibly the influence of parts/alters is occurring.  Instead of ignoring it, it is time to review strategies from CBT such as fighting all-or-none thinking and looking at positives instead of discounting them.

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Some systems assume that everyone is bad and out to hurt you.  The reality is more likely that the providers are decent and skilled people, or you are an adult and can advocate for something you need.  You can refuse treatments, you can ask for alternatives, and you can give information about your symptoms and your lifestyle that help providers figure out the best plan of treatment.  NONE of that can happen when you are unconscious.  None.

Dentists are fully aware that many adults have difficulty with their treatments.  Saying that you are anxious won’t shock anyone.  Asking for things like the use of the lead apron as a “weighted blanket” or more local painkillers might not be common, but it could help you stay alert and able to interact during treatment.

One of the best beginning steps on the journey to handling dental treatment is to be able to do daily dental care at home.  Well-maintained teeth need less frequent and less intense treatment.  Some dental issues can stay minor when managed…or they don’t happen at all.  The best possible treatment is not needing any!

Your dentist might have great ideas about preventive care.  Try them all.  Tell your system that flossing IS boring, but it could mean that you all don’t have to return to the dentist nearly as much.  Get them the brushes, flossers, and oral rinses that they like best.  Think about care at home like putting money in the bank.  Not having as much dental pain is the return on your investment!

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Published by Cathy Collyer

I am a licensed occupational therapist and a licensed massage therapist, in private practice in the NYC area. I have over 25 years of professional experience in adult and pediatric treatment, with a focus on sensory processing issues and treating the consequences of complex trauma. I am the author of four books, including "Staying In The Room: Managing Medical And Dental Care When You Have DID" and "The Practical Guide To Toilet Training Your Child With Low Muscle Tone". Over the years I have lectured about trauma treatment and pediatric development.

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