Here in full is the testimonial I received from Matt after he had attended my last RA teaching course on May 6th, to read this out to the delegates and answer their questions on his experiences.

Many thanks Matt, you were a star. All the words are his. I had no idea he would come with this prepared.

Interestingly some of the sensations or feeling Matt describes are not often mentioned or noticed but we are all different and subjective feelings and sensations do vary

Testimonial

Background

I am a 38 year old male. Due to early epilepsy (last seizure at 15), I take 200mg Epilim daily as well as 20mg Seroxat. I occasionally use Ventolin. As a child I was always taken to the dentist regularly and had very few dental problems and no real fear of the dentist until I was about twelve years old.

The whole family attended a dental practice in Cambridge from my early teens. Whilst technically appearing to be very competent (feedback from later dentists confirmed the quality of his work), this dentist would perform fillings at time of check-up with the rest of the family in the room. No injections were ever offered and if there was pain or discomfort I was just told – quite harshly - not to make a fuss. This led to a feeling of a real lack of control and constant anticipation of pain.

A different dentist (attended when I was in my early 20s) told me that it was probable that I would loose all my teeth by the age of 40 due to the anti-epilepsy medication. This dentist also performed two very painful fillings.

The experience of a very close friend re-enforced my view of dentistry – she had dental work completed under intravenous sedation which resulted in a large hole which became severely infected and which required two operations under general anaesthesia along with regular visits to a maxillofacial surgeon with weekly visits for “packing” – there was eventually a legal case which she won.

The net result of this was a real phobia of any dental treatment or experience, a lack of trust in the dental profession and the avoidance of treatment wherever possible.

I only attended again due to a cracked tooth and the associated pain.


Richard and Chris

I cannot stress enough the importance to me of my initial telephone contact with the surgery through a telephone call answered by Chris who was very understanding. She offered a clear explanation of both intravenous sedation and NO options. Her qualification as a dental nurse gave her a lot of credibility. It was also encouraging to learn that I wasn’t the only nutter around.

Equally important was my initial experience of meeting Richard; he was calm, controlled, professional and kind. I was also very impressed by the surgery which was small but appeared very modern and well-equipped. Richard offered credible assurances regarding pain control, anxiety control and the fact that he would not be using a probe during check-up (something which had caused some pain in the past).

Extraction of cracked tooth shortly after Christmas

After discussing the options, we agreed that the cracked tooth should be removed. We agreed that this would be completed using Midazolam intravenous sedation after nitrous oxide was used to calm me for about ten minutes.

I was absolutely terrified as this was my first extraction and this had always been my ultimate dental nightmare. I had virtually no memory of anything once I had received the injection. The site healed well despite being a smoker. This experience reinforced Richard and Chris’s competence and improved my trust further as in my mind this was “real surgery”. As an aside – for an anxious patient, dissolvable stitches are a VERY good idea.


Followed up by check-up completed under nitrous oxide and two treatment sessions one of three hours and one of just over two hours, both using nitrous oxide.

Nitrous oxide experience

Downsides:

· Like so many things in life, the first time can seem a little strange!
· Mask and pipes can feel a little claustrophobic.
· The equipment can make the occasional strange noise – it can be difficult to talk without a “windy noise”.
· Strange metallic taste in mouth – can be quite strong.
· Mind seems to focus on one thought and this can feel quite serious.
· Some other slightly strange sensations – tingling in hands, perceived temperature changes etc.
· Cost implication.

Upsides:

· It works!
· It allows me to feel that I am in control, unlike Midazolam which is frightening in that whilst  you don’t remember what has happened, you are technically conscious, so I was worried that I could have had a really bad time and just not know about it afterwards.
· Some of the “focussed thoughts” mentioned above can seem incredibly amusing at the time.
· It makes time fly by – so a two-hour session seems more like 20 minutes to me.
· It puts me in a position where I can communicate any discomfort to Richard, but I am not in constant anticipation of pain.
· It allows me to tolerate treatments that otherwise I could not contemplate, Eg – use of a dental dam which I would normally find extremely claustrophobic.
· It probably helps Richard and Chris as I am not such a pain in the bum as a patient, so they can probably focus more.
· In theory I can drive to and from the surgery without someone to look after me (so far I haven’t as I prefer the support).
· Unlike with Midazolam, I don’t have to spend the rest of the day woozy and sleeping.
· Most importantly it allows me to face dental treatment without the usual anxiety beforehand as well as during the session itself.

Other comments

I still take 5mg Diazapam an hour before treatment as this helps. I would like to see nitrous oxide used in every dental practice, as many people I know have at least some level of dental anxiety. As a businessman I would have thought that this represents a good revenue opportunity for most dental practices as well as a great marketing opportunity to attract more anxious patients. Overall, the combination of nitrous oxide and the professional and kind treatment of Richard and Chris has gone a long way to restoring my faith in the dental profession.