How to Deal with Dental Anxiety in Recovery: An Interview with Dr. Tasha Bollermann

Lying in a dental chair and having someone work on something so vital to survival is a very vulnerable position to be in, especially for those of us in recovery from addiction who have neglected our health and self-care.

In my heart I knew that there had to be a dentist out there for me.

I suffer with near-debilitating dental anxiety. Every time I visit the dentist it affects my whole body: I struggle to articulate how I feel and the issues I’m experiencing, I become so tense that I have to be reminded to breathe, and I typically lose the whole next day due to exhaustion and an emotional hangover. And I’m not alone. Almost everyone I speak to in recovery has some kind of dental anxiety — so much so that many avoid the dentist altogether, neglecting care they desperately need.

Thankfully, I have a great therapist. She suggested that I mindfully explore the process of receiving dental care, advocating for my needs, and recovering my ability to self-regulate my fight or flight response. I have complex PTSD, which makes this whole process more challenging.

Since moving to America I’ve spent thousands of dollars on dental care. I had no choice but to deal with months of dental pain by having a whole host of procedures, including root canals and crowns — all of which were unpleasant, to say the least. During one procedure I even had a panic attack, and I left many doctors’ offices feeling like I was too sensitive, an inconvenience.

In my heart I knew that there had to be a dentist out there for me. I was so tired of feeling dismissed by doctors who roll patients in and out like they’re on a conveyor belt, only treating the symptom and never looking deeper.

I had to find a doctor who understood the complexity of my situation and medical history and was thoughtful and patient enough to look at my experience holistically. After four dentists, I finally found one who demonstrated listening and compassion on a scale I’d never experienced. She had me when she told me that it was an honor to do her job.

Curious to find out more about why people in recovery neglect their oral health, and the impact that drugs have on our teeth, I interviewed Dr. Tasha Bollermann for The Fix.

The Fix: Thank you for taking the time to participate in this interview.

Dr. Bollermann: I would like to thank you for giving me the opportunity to participate in this dialogue. The work you are doing to help people in recovery is important and powerful. My goal is to help people who are suffering live healthier and happier lives. I would also like to thank the reader for showing up and being ready to take the next step in their journey. Whether you know it or not, some part of you brought you to this article. Some part of you wants to break the cycle and pattern of where you have been and move into wholeness. You are ready for the next level of growth and healing. Otherwise you would not be reading this right now. Some of what I say might make you uncomfortable. This could be a signal that it is an area you are ready to begin to heal. So, congratulations on being here. I hope my words help you make progress in your journey.

In your opinion, why do you think there is a tendency to neglect oral health even when the person is in recovery? What do you think are the main barriers preventing necessary treatment?

Substance use may stem from a lack of self-love and self-respect. The basic needs for survival were not met, and therefore self-respect was not able to develop from a very early age. Often people show signs of self-loathing. This can lead to a desire to numb the shame with substances.

I have witnessed the transformation from self-loathing to self-love. The habits of self-neglect need to be replaced with habits of self-care and nurturing. Teeth are vital for our survival. A person with a nice smile will get a job that a person with obvious dental diseases will not. Statistics show that the first thing we notice about a stranger is their eyes, and the second is their smile. So, breaking the habit of self-neglect and replacing it with a habit of self-care is essential to success. In my experience, the biggest barrier to oral health care in recovery is the lack of desire to care for yourself, and the lack of good habits. Neglect can lead to severe damage to the teeth and other organs. Often the damage to teeth is obvious without the expert opinion of a dentist. It is blatantly obvious to everyone you meet, as well as yourself when you look in a mirror. In comparison, the damage to the internal organs is less obvious. A return to overall health can be costly in time and money. There are financial obstacles in some cases and location obstacles in others, but a lot can be done with a toothbrush, some floss, a healthy diet, and a desire to get better.

What are some of the effects that certain drugs have on the teeth, like meth for example? Are these effects from the drugs themselves, or rather from neglect?

First of all, most drugs are harmful to teeth, so I don’t want you to think that this is a complete list of problems. However, some drugs deserve a mention here. Meth, for example, is one of the most destructive drugs I have encountered. It destroys the teeth rapidly. To my understanding, the drug itself is corrosive, which means it dissolves the teeth. Second, it creates extreme sugar cravings, which accelerates the process of tooth destruction. Ecstasy causes permanent neurologic changes in the brain. These changes create severe clenching and/or grinding of the teeth during sleep.

Another substance use-related challenge is not being able to get adequately numb for comfortable dental treatment. This is most commonly seen with heroin and cocaine, but I also see it with alcohol consumption.

Alcohol, marijuana, and tobacco are probably the most common drugs I encounter in my practice. The risk of losing the teeth to gum disease is significant, not to mention the risk of oral cancer. The more you drink and smoke, the higher your risk.

Dental phobia is prevalent within the recovery community. How can people deal with that?

Severe dental anxiety is best addressed before the dental appointment with a skilled practitioner of hypnosis, EMDR, neuro-linguistic programming, or other anxiety and recovery therapy. Once the patient can step into a dental office, it’s important for them to understand that they are not alone in their fear. The majority of people have fear around dental treatment. The stories my patients tell me are often heart-wrenching. Lying in a dental chair and having someone work on something so vital to your survival is a very vulnerable position to be in. Finding a dentist you can trust will help you build habits of success to manage your anxiety.

Some patients are so terrified of communicating with their dentist that they often experience a frozen sensation, unable to articulate their fears or level of discomfort. What would you recommend to a patient that is even terrified to raise their hand to ask you to stop?

This is tricky. As dentists, we rely on our patients to give us feedback on how they are doing. If the patient knows that this kind of freezing up has happened in the past and they share it with the dentist, then together they can work out a plan of action. A touch on the shoulder to reassure and check in can break the spell, so to speak. However, some patients don’t want to be touched. Again, I would say that needs to be discussed, and some kind of signal has to be arranged. Everyone has to be involved in the conversation. The dental assistant is, more often than not, the person who sees and acknowledges the signal, so the patient needs to include the assistant in the conversation as an important part of the team. If the patient is intimidated by the dentist, they should talk to the assistant about ways they can signal a concern that needs to be addressed.

Many people in recovery will refuse pain medication stronger than Tylenol and local anesthetic. What do you recommend as a way to ease dental anxiety, and how would they compare to say traditional anxiety medications like benzodiazepines?

The patients who refuse strong pain or anxiety medications are very wise. Benzodiazepines and opioids are highly addictive and can interfere with the recovery process. There are alternative ways to achieve relaxation and pain relief. Double-blind studies show time and again that ibuprofen and Tylenol are better pain control medications than prescription narcotics. Some of my patients visualize a safe and happy place that they escape to in their mind. Others take a combination of over-the-counter relaxation aids. Another approach is the use of acupuncture, aromatherapy, or naturopathic treatments before or after a dental appointment. Anyone in recovery should be careful about what they take for relaxation and pain control.

L-theanine reduces anxiety. It promotes relaxation and stress reduction without sedating. L-theanine can help foster a state of calm, attentive wakefulness. It has positive effects on both the mental and physical symptoms of stress, including lowering heart rate and blood pressure. It is available in most health food stores.

GABA (Gamma-Aminobutyric acid) is an amino acid produced naturally in the brain. It reduces the activity of neurons in the brain and central nervous system, which in turn has a broad range of effects on the body and mind, including increased relaxation, reduced stress, a more calm, balanced mood, alleviation of pain, and a boost to sleep. It’s available in most health food stores. It should not be used by patients already taking gabapentin.

Brainwave entrainment works for almost everyone. It is a great way to lead your mind into states that you might usually have difficulty reaching, allowing you to experience a sense of calm relaxation without medication. Instructions are available on YouTube.

If you plan on using any of these alternatives, I recommend you try them out in the comfort of your home first to see how it affects you. (Editor’s note: Consult your physician before taking any supplements. Even benign substances may interact with other medications or have unintended side effects.)

What are some dental advancements that people may not be aware of since their last visit, but which would make the experience a whole lot less stressful?

While most of the advances in dentistry are technical in nature, many shorten the time you have to spend in the chair. These include digital X-rays. You used to have to wait 15 or 20 minutes for the dentist, hygienist or assistant to process the films and bring them back, leaving you waiting and worrying. Now they are instantly available. The biggest advancement I would recommend is exercising your personal choice in dentists. Many dental offices today are very patient focused, virtually gone are the days of little to no concern for patient comfort. Choose your next dental office carefully, with the assumption that you will find a compassionate office.

Tell me what similarities you see between dental disease and substance use disorders.

Both dental disease and substance use disorder are lifestyle diseases. You can overcome both by creating small lifestyle changes that build on themselves. Achievement in oral health, or in substance use recovery, is a practice in the art of daily living. People who grow up in an environment of brushing and flossing daily are more likely to continue doing those things into adulthood. Those who grow up in an environment where the basic needs of survival are either not met or are minimally met are likely to continue those patterns into adulthood. Sponsors help keep the substance use at bay, and in a way the dental team is a sponsor for oral health. Regular checkups allow connection and repetition, which build habits of success. Habits of success build self-respect and self-love.

Dr. Tasha Bollermann is located at Heart of Gold Dentistry in Portland, Oregon.

Article originally featured in The Fix.

Olivia PennelleMarch 8, 2019