Twenty-Two Years Without a Dentist, and an Abscess That Ended It

Quick answer: Sedation makes dental treatment possible for people who genuinely cannot manage it awake. It is not general anaesthesia — you stay conscious and breathing on your own, but relaxed and usually remembering little. For severe phobia it is the difference between treatment and no treatment.

The call

Tamar, 41, from Mishkafayim, phoned rather than booking online because she wanted to explain first. She had not seen a dentist in twenty-two years. She could not sit in a dental chair without her heart racing and her hands shaking. Twice she had made appointments and turned around in the car park.

An abscess had made the decision for her.

What we found

The first appointment involved no treatment at all, which was the point. She sat in a chair in the consultation room, not the surgery, and we talked for half an hour.

Two things emerged. Her phobia traced to a specific childhood experience — being held down for an extraction at eleven. And her particular trigger was not pain or needles but loss of control: not being able to stop, not being able to speak, not knowing what was happening.

That distinction matters, because the management is different depending on the trigger. Needle phobia is managed one way; loss of control is managed by giving control back.

When she agreed to a brief look, we found a broken-down lower molar with a chronic abscess, and a great deal of other work needed.

What we did

Options, laid out honestly. Not everyone needs sedation, and it is worth trying without it first if there is any chance of managing.

• Behavioural techniques alone — stop signals, control over the pace, appointments at quiet times, topical anaesthetic, nothing done without warning. Enough for many nervous patients, including the patient in one of our other stories.
• Oral sedation — a tablet before the appointment. Mild, unpredictable in effect, and you need someone to bring you and take you home.
• Inhalation sedation (nitrous oxide) — breathed through a nose mask, works within minutes, wears off within minutes, you drive yourself home. Excellent for moderate anxiety.
• Intravenous sedation — a sedative given through a cannula. Deeply relaxing, you remain conscious and able to respond but usually remember almost nothing. Requires an escort, monitoring throughout, and a properly trained and equipped team.
• General anaesthesia — genuinely unconscious, in a hospital setting. Reserved for cases where nothing else is possible.

She tried the extraction with behavioural techniques alone and could not proceed. She was not able to keep her mouth open long enough for the anaesthetic to be given.

So we did it under intravenous sedation, with a sedationist present, full monitoring, and a written plan she had read in advance including exactly how she could signal to stop.

Afterwards — and this is the part that matters more than the extraction — we used the sedation appointment as a starting point rather than an endpoint. Her next visit was a simple filling with inhalation sedation. The one after that was a hygienist appointment with no sedation at all.

The outcome

Three years on she attends every six months, with no sedation, for routine care. She still dislikes it and says so. She comes anyway, which is the entire goal.

What to do if this happens to you

1. Phone and say you are phobic before booking. It changes everything about how the appointment is arranged.
2. Ask for a consultation with no treatment first.
3. Work out what specifically frightens you — needles, sounds, gagging, loss of control, being judged. Different fears need different approaches.
4. Ask what sedation options are available and what each involves.
5. Agree a stop signal and expect it to be honoured immediately, every time.
6. Treat sedation as a bridge, not a permanent solution, if you can. Many people work back to routine care.

Too frightened to book? Phone Ramat Beit Shemesh Urgent Dental Care and say so — that is the whole first step. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.