Lessons from a Second Opinion, Part II
I went to a new dentist a few of months ago. Admittedly I hadn’t been to the dentist in a little over a year.
They took all the X-rays, did a full cleaning and added a fluoride treatment at the end. I told the hygienist that I typically don’t use fluoride and she gave me a regretful look and a mild lecture. The dentist came in to chat with me. He was a younger guy, around my age, and he sat down comfortably and relaxed. He explained that I had upwards of 5 cavities that needed to be taken care of as well as a wisdom tooth extraction. I was stunned. I floss and brush my teeth the way I’m told and even the hygienist commented on how good my teeth and gums looked. I know I hadn’t been to the dentist in a year but could that much have progressed in a year’s time? I’ve also repeatedly been told that as long as the wisdom tooth was kept clean, I didn’t need to worry about it. I told him this and he said extracting it makes the most sense to prevent future issues.
He asked me about my fluoride use, which resulted in me receiving my second regretful look of the hour, and told me cavities were due to the fact that I wasn’t using fluoride in my toothpaste. He insinuated that I was in the category of “all the twenty somethings that come to New York and get into organic stuff and stop using fluoride and then develop cavities.” I didn’t care for that remark or its delivery. He suggested I schedule the fillings within the next month. After I hesitated by asking about how much this would cost and if I had to do it all at once, he dropped the plan of action down to 4 fillings and an extraction, which I could split up between 3 visits. So that fifth cavity was optional?
I left with a quote in hand for a few thousand dollars, confusion about my disuse of fluoride and what to trust, skepticism about how all of this had developed within a year, and fear of having that much dental work done (I’m a wuss when it comes to invasive procedures).
I decided to get a second opinion. Dentist #2 came in and patiently chatted with me for about 15 minutes, and by the time I walked out of his office, I was completely at ease. Contrary to what you might be thinking, he did NOT tell me that my mouth was perfect and needed no dental work. He actually gave me the same treatment plan as dentist #1. He suggested I extract the wisdom tooth and he said I do have four areas in my teeth that needed fillings or filling replacements. But he was so relaxed about it. He said, “yeah you’ve got some stuff going on, but you know, you’re 38, you have some tooth decay and that’s totally normal. You don’t have a cavity prone mouth, you have great looking teeth.” His delivery was also void of urgency which made me feel more in control of my situation. He suggested I just start with the one that’s clearly bothering me and the others we could keep an eye on till the next visit. He also said the wisdom extraction wasn’t urgent but I would want to consider it sometime within the year.
Finally, I told him I don’t use fluoride and that dentist #1 told me that was the culprit. He took a big sigh and said, “Look. I use it, my wife and kids use it, I tell my patients to use it. But I also have seen native New Yorkers who’ve been drinking fluoridated water their whole lives come in with a mouth full of cavities. I’m not convinced it prevents cavities.” He basically flat out told me, “I don’t know,” and there is something wildly valuable about such an honest response coming from an authority on a subject. It usually reveals humility, up to date knowledge, and room for options in protocol.
Dentist #2, essentially gave me the same “diagnoses” as dentist #1 did. But everything about the way I felt was different — I wasn’t afraid. There was no “fluoride shaming,” or a sense of emergency that led me to catastrophic. He helped normalize my situation which reduced my fear and he wasn’t pushy for me to make appointments, so I felt I had time.
No one needs to teach us to want to feel this way. We seek out and repeat interactions that feel safe and comfortable and assuring, whether it’s with a restaurant server or a surgeon. There are long terms effects of even this simple dentist story. A comforting relationship with my dentist will encourage me to visit regularly and take care of the dental work I need done. It will reduce my fear of the needles and invasive extractions and promote faster healing.
But understanding how this can impact our pain physiology might be less understood. The relationship of trust and feelings of safety have an enormous impact on our pain physiology. Our feelings about a healthcare professional can impact the outcome of the treatments or procedures provided by such professionals (source source)
Movement and pain works in exactly the same way. Whether you’re in pain, have fear of a particular movement, or are resistant to exercise, achieving a sense of safety is a pivotal component for reducing pain sensitivity and increasing confidence. At any given moment, your brain is assessing the safety of your situations. It’s processing billions of bits of data to determine this, most of which is happening subconsciously. Think of your safety level as a dial. All the way to the right is total danger (someone breaking into your house) and all the way to the left is total safety (laying on the beach at a resort). The dial is influenced by A LOT of factors, always. Things like the state of your biological tissues, hormone fluctuations, sounds, colors, memories and associations from past experiences, temperature, the comfort of what you’re wearing, a conversation you might have just had, current stress levels about work, etc, are all factors in how your dial is reading at any given moment.
Let’s say folding forward causes you back pain. It isn’t the folding forward itself only. It’s ALL of the factors that are taking place at that given moment creating your needle on the dial to be closer to the danger feeling than the safe feeling. Your body doesn’t feel safe bending over. This is where that trusted relationship with a professional can be so influential. A relationship of trust can move that needle on the dial toward safety, so that when you forward fold with the guidance of that trusted relationship, you may may experience less sensitivity in your back. You now have a new experience for your brain to take in and register, which means you’re on the path to creating new brain associations with bending over. That trusted relationship is just ONE of many factors influencing that moment, but it’s a big one, and one that is the cornerstone of my work as a coach.
All of this to say that when working with a professional, use these questions to guide you on whether or not you may be developing a relationship of trust, because the relationship with your professional can have a large impact on your physical experience.
Does the gravity of the treatment option seem comparable to how you’re feeling about your injury?
Are you more scared and nervous leaving the doctor’s office than you are comforted?
Are you more nervous about the outcome of the treatment than the injury itself?
Were you given options?
Were you educated about your situation in a way that reduced your fear and elevated your confidence rather than the reverse?
keep moving.