Extreme fear and dont know what option to choose

[Ellery]

Hello everyone. I’m new here and had some questions.

I hadn’t gone to a dentist in over 10 years since I’m very afraid. I also have Obsessive-Compulsive Disorder (OCD), pretty severe anxiety and suffer from panic attacks, and struggle with agoraphobia and don’t like to leave my house.

Anyway, my tooth broke in October of 2021 and I let it go until I started to feel some pain around February. I still feel some pain but it’s not too much. I eventually did go to a consultation with a dentist at the end of March and did not like him. I went to a few others and have not found a dentist I like as no one seems compassionate or understanding to my concerns and worries but I have set an appointment with one for June 16th. I will be doing oral sedation which is my first time experiencing that and I’m kind of nervous about how it will go.

The other thing I’m nervous about is that he says he will do a pulpotomy to help with the pain and then I have to eventually have a root canal if I want to save the tooth, which I do. However, I also really don’t want a crown though and I’m having trouble with the idea of that. I would like to do an onlay after the root canal which I’ve read is possible but everyone is just pushing the crown. I think it might be because of my OCD but the idea of a permanent change like losing my tooth forever and having a fake tooth put over it is incredibly upsetting to me. I feel like the onlay wouldn’t upset me as much because I’d still be able to see some of my tooth and it won’t have to be shaved down like it would for a crown.

I was wondering if it really is possible to do the onlay after the root canal and also if anyone had any experience or thoughts about the pulpotomy. I have read they can last for a long time sometimes and wonder if I could just do the pulpotomy and leave it like that for years?

If not, I’m just wondering if the pulpotomy would ruin the tooth structure at all and make it less likely I can have the onlay after. Would it be better to not do anything with the tooth and look around more for someone who could possibly do an onlay?

I’m very nervous and would greatly appreciate any help as I really don’t know what to do.

Thank you.

P.S. I attached x-rays I just had done last month as well as photos of the broken tooth (sorry the quality isn’t the best).

 

[MattKW]

After the Root Canal Therapy (RCT), nearly all teeth require either an onlay (more conservative) or a crown (less conservative). Your tooth has a large hole at the back (distal) that will require a crown; an onlay won't suffice. Oral sedation can be fine, but you need someone to come with you and drive you home - don't use public transport. The shortest-acting oral sedative is triazolam; just ideal for typical dental appts. A better choice may be nitrous oxide (inhalation, "Laughing Gas") because it is quickly reversible, and more easily adjusted during the appointment. With really nervous pts I would use triazolam PLUS nitrous.
My preferred use of triazolam is a dose the night before (get a good night's sleep), and then an early dental appt the next day. The triazolam should be given in the reception area about 45 mins beforehand so we can see if you have an adverse reaction (very rare paradoxical reaction with no harm) - I've only ever seen one in 40 years of practice.
I look at your Xrays and see significant erosion of your lower teeth, that is seen in people who have many acidic drinks (usually sodas or fruit juices). Start drinking plain (non-sparkling) tap water or an RCT will be the least of your worries. Erosion is very difficult to treat beyond a certain point, which you are very close to achieving.
Lastly, if you get thru the RCT OK, talk to your dentist about removing upper and "lower wisdom teeth" on your right side.

 

[Hopefulgirl]

Hi did you ever get an onlay done if so how do you like it? I wanted your opinion on the onlay in particular, thanks