Reactivation of Dental Trauma

by Loolwa Khazzoom • October 31, 2014 • Wellness

My recent visit to a new dentist, Dr. Lee, exemplified both the right and wrong ways to practice medicine. My visit began by filling out the standard intake form – identifying what medical conditions I have and have not experienced. Next the hygienist, Monica – a young woman with gentle energy and big brown eyes – ushered me into the dental chair and started off by reviewing my medical history with me. Her approach was matter of fact and caring – asking me about various conditions that might have a bearing on the cleaning procedure.

Once we were finished reviewing my intake form together, Monica began the cleaning. Her touch was firm but gentle, and I felt totally relaxed – to the point that I could have taken a nap in the chair, had I not needed to be responsive to the opening-closing mouth thing. The cleaning was so gentle, in fact, that it hardly felt like a cleaning at all. It was quite possibly the best cleaning I have had, like, ever.

I was surprised, but also not surprised, to find out that Monica had just graduated from dental school this past summer. On the one hand, it was surprising because she was such a pro. On the other hand, it stands to reason that those who have just graduated are still idealistic, still connected to why they are going into whatever branch of medicine they have chosen, and still practicing with “beginner’s mind” – collectively leaving these practitioners open to, caring about, and responsive to their patients. Those who have been practicing for many years, on the other hand, may have acquired expertise but, with that expertise, become rigid and authoritative in their style.

After the cleaning, I was totally blissed out. My mouth felt great, after weeks of itchy gums, and I was chillin’ in the chair, waiting for Dr. Lee. When he came in, I said hello (he hadn’t bothered). He was looking through my file, and he asked me if I had a Clifford test. I didn’t recognize the name and asked what that was. He referenced the email I had sent him ahead of time, with the recommendations of a holistic dentist I trust – the dentist of my former integrative oncologist (now retired) – who had answered my questions about what composites to use for optimal health and safety. My interest had been in ensuring that Dr. Lee’s office, which is also purportedly holistic, used the same or same class of composites; if not, I would look elsewhere. In the email I had forwarded to Dr. Lee, the other holistic dentist mentioned it was an option to get a test done with Clifford labs, to evaluate what composites would be best for me.

As soon as I recognized the test name, I said, “No, I haven’t [gotten it],” following which Dr. Lee began laughing amusedly while mumbling something about how I really should get that test, given that I had checked off so much of the list of pre-existing medical conditions. He motioned to the paper in his hand, still laughing. I did not laugh or smile in response. “What is this,” he continued, “fainting and headaches? What’s that about?”

Like I really wanted to tell him shit about my medical history at that point.

When I filled out the intake form, my assumption was that it was for clinical purposes. Apparently, however, it was for scoring and entertainment purposes – ie, that any patient who answers yes to more than a certain amount of questions will be ridiculed and otherwise have that information held against her, as if having failed a test. What the fuck.

Unfortunately, this dentist’s behavior was all too typical. In fact, this very behavior is why I avoided going to doctors at all costs, during the years that I suffered from chronic and debilitating pain. A routine part of a medical exam is to ask about any and all pre-existing medical conditions, purportedly so the doctor would know how critical information about new patients. While reading through my medical history, however, doctors would feel entitled to personally comment on and even ridicule me for the number and kind of traumas I had been through.

This behavior – both that of the dentist today and that of doctors in the past – is disrespectful, humiliating, and disempowering. It is a betrayal of the sacred trust between doctor and patient, as well as an insult to the practice of medicine. The first principle of the Hippocratic Oath is “do no harm.” Psychological and emotional harm is just as bad as physical harm.

I considered leaving the office right then and there, but I did not, for a few reasons:

There are many factors involved in looking for a dentist. I had actually been referred to a different dentist, but it had taken six weeks just to make an appointment there, because the office manager kept not calling me back. Then when I finally did get an appointment, it was for six weeks out, meaning a total of three months from the time I first called to the time I would be seen. That’s a whole lot of time to go by for an appointment, and that kind of administrative behavior in and of itself can make someone want to go elsewhere. The exception, of course is if the dentist is overwhelmingly amazing – which I had not yet verified (appointment is still a couple of weeks out). Meanwhile, Jackie – Dr. Lee’s office manager – was super friendly and accommodating, and she got me in to see Dr. Lee immediately – for which my itchy gums thanked her.

In addition, Monica, the hygienist at Dr. Lee’s, was amazing, and not all hygienists are created equal. So there was another incentive to stay. On the practical side of things, Dr. Lee was much closer to my house; the drive out there was pretty; and the drive did not involve any freeways. The dentist I had been recommended to, to the contrary, was freeway distance – making it a pain in the ass to avoid the freeway (something I’m doing these days) to get to him.

More importantly, there are only about four holistic dentists in my area, and one of them is even farther away than the one who had been recommended to me. So while the whole laughing-at-patient thing was super sucky, I did not want to storm out based on that ding alone. I wanted to play it smart. I am new to the area; I need work done on my teeth; because of whole healing-holistically-from-cancer thing, I want to make sure the materials that go into my mouth are safe, as well as effective; and I didn’t know if any of the other dentists would be any better. In a phrase, I didn’t want to burn my bridges.

In addition, people are often a mashup of good and bad. For all I knew, this dentist could have been terrific in all the other things important to me, but simply needing to be schooled on bedside manner – specifically about the way to treat, and not to treat, patients who have experienced medical/dental trauma. So I stuck it out.

Unfortunately, doctors and dentists can be flat-out dangerous, no matter how benign a procedure may seem, and no matter how hard we work to give them the critical information about us up front. Meaning that as patients, we are playing with fire. So despite the fact that I sent an email telling the dentist, ahead of time, that I am hypersensitive, and despite the fact that in that email, I let him know that I had a history of dental trauma – specifically, a trigeminal nerve block that had numbed out my entire head, made my jaw spasm, freeze my mouth more or less shut, to the point that I had to “eat” with a straw for a week, and otherwise caused TMJ for years and severe headaches and jaw pain for a full month – this dentist, without discussing it with me first, got told me to do an underbite, then stick my jaw out to the right, left, and front.

He was all up in my face, especially his hands but also his body, and I felt overwhelmed and shut down, like there was no room to breathe – which in turn threw me off center. I did the motions he advised, and my jaw spasmed and shook. I pointed out to him what was going on with my jaw. He kept telling me to repeat the exercise. He was all up in my face, and I felt like there was no room for me to tell him to back off or slow down or ask him what he was doing or why. It’s like when that kind of energy comes at me, and I’m already in the patient position, lying down, with someone hovering over me and in my face, it feels as if there is going to be a flat-out fight if I’m going to self-advocate. It’s like having to switch out of patient mode, where we need to have a certain amount of trust and receptivity, and get into combat mode. I have found historically that it is incredibly difficult for me. It’s like the two modes are in different parts of my brain, and there is no transportation modality available between them.

Dr. Lee had me repeat this jaw exercise in each direction. I kept saying that my jaw was spasming and shaking, but he kept telling me to do the exercise. I did it twice in each direction but not past where it started spasming, even though he kept wanting me to push farther. Meanwhile he started going on and on about how “unusual” it was that I had such a severe reaction to the nerve block a decade ago. He asked me about it a few times, and kept saying it was so “unusual.” He asked if I had ever gotten any other injury to the jaw. I said no. He could not shut up about it.

Perhaps if he had stopped musing over how much I diverged from his idea of a text book case of TMJ, he would have paid more attention to the fact that he was pushing my jaw too hard.

He asked me if I could move my jaw further out in front. I said no, because I can tell it’s going to hurt. He said ok. I think he then asked me to move my jaw right and left again, but I wouldn’t. I’m not entirely sure, because I was overwhelmed, so it’s a bit hazy. Maybe he just stopped on his own at that point. At any rate, it turns out that the point of this whole exercise was so that Dr. Lee could declare that I had “limited jaw mobility.” Genius. I could have told him that if he had just asked me.

Unfortunately, I often do not know that damage will happen or that it has been done, until after the fact, although even admist the confusion, I had a sense that it was not a great idea to be moving my jaw where it spasmed. By the time I left the dentist’s office, I had intense pain in my jaw. Oh great, I thought. How long will it last this time? How will it adversely affect my life this time? With a history of chronic and debilitating pain, there is so much uncertainty involved when someone injures me or reactivates an old injury. My life has come to a screeching halt repeatedly throughout the past two decades. And each time, I have had to reach into the depths of my being and the depths of my pocket (and the depths of my friends’ pockets) to haul myself out of the latest pit. I do not know that I can put words to the level of despair and agony that go along with being thrown back into the bubbling cauldron after having scratched, clawed, and crawled my way out of it.

I’ll get back to the jaw pain in a minute. The third strike against this dentist was when he started chiding me for not having gotten my amalgam filings replaced, and when he caustically started telling me that I needed to get said work done urgently. I told him evenly that I was not interested in getting all my fillings replaced simply for the sake of replacing them; that as they came of age and needed work, I would have them replaced with the composite fillings. He kept insisting that I needed to get all the fillings replaced – not only not listening to me or respecting me or attempting to understand me, but completely oblivious to the fact that I had been through dental trauma. I have been dancing around work on one tooth for two years, and he thinks I’m going to blaze through my mouth and get a whole mess of fillings taken out and replaced? Clueless. Absolutely clueless. How can someone be in the practice of dentistry for decades and not have this basic level of awareness – especially considering I had taken the time to tell him about it ahead of time?

I remember the first time I started having dental issues. I was advised that I needed two fillings on one side of my mouth and one filling on another. I was told to knock them all out at the same time, because then I could get my mouth numb all at once and not have to keep coming back for more. The thing is, fillings are surgeries. Minor surgeries, perhaps, but surgeries all the same. And while you may not feel it while you’re numbed out, your body sure as hell registers it, and you do feel it full-force when it’s all done. It was a bad, bad idea, and I can’t believe the dentist did not allow for the possibility that while it was more convenient to do all three at once, it could actually inflict trauma on my mouth – which it did.

And I cannot believe this Dr. Lee would not see that someone who has been through dental trauma, whose jaw spasms and shakes when she tries to move it, might not want to have a mouthful of fillings taken out just to get rid of the amalgam, but instead, might want to go about it more gently and as necessary. The thing is, Dr. Lee turned out to be obstinate and kept pushing his agenda on me. I finally said something along the lines of, “I have a mouthful of fillings, and I’m not getting them all done and going through all that, until they are ready to blow.” Then he changed what he was saying, or at least how he was saying it, and responded that I just have three feelings that need to be taken care of. His tone, however, was argumentative, even hostile. What the fuck?! It’s my mouth, back off.

He then seemed to be saying that three fillings were ready to blow. If that’s the case, I told him, then we’re on the same page, I’ll get them replaced. But he did not stop there. He started fear-mongering, saying in graphic detail how the fillings were (Gd forbid) filling my body and hair with toxins, leaking and leeching and all kinds of stuff. “OK,” I said, “I get it.” He would not stop. He just kept going on and on and on with doom and gloom if the amalgam fillings were to stay in, and how here I am concerned about what goes into my mouth, because I’m holistically healing from cancer, and this is the most important concern of all…

Finally, somehow, I got him to stop. I think I just started getting up out of my chair. I then went to the front desk to pay for my visit (I totally want my money back), and I asked what the “initial exam” fee included. Jackie called Dr. Lee over to explain. Apparently I was paying in part for his brilliant declaration that I had limited mobility in my jaw. After informing me as such, Dr. Lee started in again on how “unusual” it was that I had such sensitivity from a nerve block. He also had poked around in my mouth and pulled out my tongue (aggressively), which I guess was checking for oral cancer. Honestly, he hardly contributed anything. The most significant part of the exam was what Monica had done, measuring my gums.

Apparently, however, part of the exam I was paying for was him telling me, in gory detail, what work I needed to have done. And then he started in on it again, as we stood around the front desk. “Yes, I know,” I said, “We had this conversation already.” I think I put my hand up or something, to shut him up. He stopped and went away. By then, I was no longer a patient, but a person again, out of the chair, at a distance from him.

And that’s the thing. I have had numerous experiences where I have beaten myself up, post visit, for not more assertively advocating for myself. But I have come to realize that it’s really not ok to expect a patient to do all the self-protection. When we are patients, we need to be able to relax, trust, and be treated well. We need our wellbeing to be in the heart of the practitioner working with us. We cannot be in two roles at the same time.

When I am with my mom at an appointment or hospital stay, I am hell on wheels. I boss around doctors and administrators. Nobody gets away with doing shit that is not in my mom’s interest. Because I am not the patient. I am 100% the advocate. Shifting back and forth between patient and advocate, hover, is untenable. I mean, I do it, and I’ve gotten better at it over the years, but it’s still a bitch of a struggle. And it does not mean I am weak or unassertive or whatever. It does mean that I am vulnerable as a patient, and that it is exceedingly difficult to have to play defense precisely at the moment when I need to be able to surrender and trust instead of fight.

At any rate, the TMJ was reactivated by this idiot dentist, who is totally three-strikes-you’re out. I couldn’t work from the time I came home. Instead, I lay on my couch, with an ice pack on my jaw. I went straightaway into healing mode, however. I called my mom, who gave me healing energy, and I practiced qi gong and danced vigorously for about an hour. I felt so much better. The next day I was still in pain, but I got better each day. Until Wednesday, when I went to get acupuncture for the mild remaining jaw pain. But that’s a story for the next blog post.

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About Loolwa

Loolwa KhazzoomLoolwa Khazzoom has worked with leading media outlets, including The New York Times, CNN, Rolling Stone, and ABC News. In addition, she has published two books and has lectured at prestigious venues including Barnard Center for Research on Women, the Simon Wiesenthal Center, and Harvard University. Loolwa is passionate about health, music, dance, multiculturalism, and Judaism.

Holistic Media, Marketing, PR

Loolwa Khazzoom is a a public relations manager specializing in holistic media, holistic marketing, holistic public relations, and holistic promotions. Her services include branding and messaging development, image and communications management, website content development and optimization, social media management, traditional media campaign management, book development, and in-house writing and editing.

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