Paul's Heart

The Dentist

Being diagnosed with cancer and having to go through chemotherapy, pretty scary, right?  Having to undergo open heart bypass surgery… definitely scary, right?  But going to the dentist, the anxiety produced is more than the total I felt between the cancer and heart surgery combined.  That is right, up until one point, I was more terrified of going to the dentist than when I had gone through cancer treatments and laying on the table next to the machine that would keep my body alive while the bypasses were performed.  And believe it or not, there actually is one good reason to be concerned about going to the dentist, but not what you think.  My reasons for delaying my appointments bordered on ridiculous.

My earliest memories of the dentist were not too bad.  Sure I had cavities, but Dr. Weaver was good working with kids.  My first reaction to receiving novacaine did not go well as I reacted like an eight year old might, legs thrashing about in pain.  A little nitrous oxide took care of that.  To make sure that the laughing gas had taken effect, I remember Dr. Weaver taking aim at an airplane mobile hanging from the ceiling in the corner, with his water gun which would be used to irrigate my mouth as needed.  But in the years that followed, I had no issues with getting to the dentist, or having cavities.

But somewhere along the road, a fear, and anxiety developed.  I cannot even explain it, but it led to me not being seen for over six years.  And even then, I had gone through two more dentists due to the fact that I had moved to a new city, plus, that same anxiety was becoming an issue.  I cannot say that at that point, my long term cancer survival issues had played any role, because those late developing side effects had not appeared.

In 2008, eighteen years after my diagnosis of Hodgkin’s Lymphoma, I faced open heart surgery.  All went well, and I was introduced to the world of long term cancer survivors and the many issues that many face due to the toxicity of what we were treated with.  I had broken a tooth.  I knew I needed to get seen before anything went wrong, such as an infection, so made the call to a local dental office.  It was during this appointment that I met Dr. P.  She is a young woman, but very skilled, knowledgable, and empathic with her care.  She had advised me on the risks I face, sepsis with the abscess that had been discovered examining the broken tooth.  An infection in the blood (sepsis) traveling to the heart, can be fatal, possibly within hours of being discovered.  To make matters worse, from my diagnostic plan in 1988, my spleen was removed to see if I had signs of Hodgkin’s Lymphoma in the spleen.  This procedure left me “asplenic” which means that I cannot fight off infections, or as well as a normal person.  She had mentioned root canal for this tooth due to an abscess, followed by a crown.  My anxiety level hit the roof, and out the door I went as I decided to just have the tooth pulled as this was going to be needed to be done by an oral surgeon.

Following the tooth extraction, despite knowledge of how important good dental hygiene is, especially to a heart patient, I made a conscious decision not to return to the dentist for regular check ups.  I had done a lot of reading concerning the issues of not just asplenic or cardiac issues, but how frequently heart issues are discovered just by going to the dentist.  Simply put, if you are someone who does not floss regularly (and who has not gone to the dentist and not been asked or told to floss regularly), it is not just the risk of gingevitus developing, but the bacteria could just end up in your bloodstream, leading to sepsis.  Septic shock is fatal if not caught soon enough.

It had been a couple of months past the six month check-up window that had been assigned to me.  I just kept delaying the appointments.  Then something strange happened, and often.  Until I finally relented the phone calls kept coming.  It was Dr. P calling personally to follow up on me, and the importance that I get into her office to be seen, regularly.  To make sure that I understood her sincerity, she hit me where it would make me pay the most attention.

Dr. P. acknowledged my late term side effects, and the concerns with the jaw, mouth, and teeth due to the various treatments I had received for my Hodgkin’s.  She stressed that it was important that I come in for the regular cleaning and check-up.  I actually lost count on how many times she called me personally.  But Dr. P. was not going to give up.

When I finally made the decision to come into her office for the cleaning and check-up, Dr. P. took the first half hour of my appointment, just listening to me.  Listening to me babble on about my irrational anxiety about going to the dentist.  In what may have been her last opportunity, she began a discussion about pain management.

When you get a tooth cavity filled or the tooth itself pulled, the dentist has various means to numb the nerves and surrounding gum area to eliminate or minimalize the pain.  Dr. P. does not use nitrous oxide, but she does use Ambesol along with novacaine.  The Ambesol topically numbs the gum area to be injected.  The novacaine will do the rest.  But what if you have not been given enough novacaine?  You ask for more.  The chances are probably close to 99% that you can have a booster of novacaine, in fact, several boosters if that does not work.

It has been three years since Dr. P. convinced me she was not to be stressed about.  During a recent visit to have a cavity filled, my gum was not cooperating and it took seven stabs of the novacaine before she could proceed to fill my tooth.  But she took that time.  I trusted her.  I think I am finally over my dental anxiety.  As a cancer survivor exposed to radiation therapy to my lower jaw, the structure of my upper and lower jaws is crucial.  And she knows that.