Case Example B:

Case example B: “Terrified”
This 37-year-old Caucasian woman came to a private dental practice of PED with a toothache. She had avoided the dentist for years and was apprehensive and fearful. Her appearance was not unusual. She was employed full-time in a responsible business position and her initial history was unremarkable except that she had dental fear.

It was not until her six-month recall visit that it was learned she had suffered from trichotillomania—noticeable hair loss from the recurrent pulling out of one’s hair—since age 14. It is an impulse control disorder that affects 2 to 4 million people in the United States. The most common complication is damage to self-image that can lead to depression. She had tried at least eight different types of treatment, including medications, biofeedback, psychiatry, meditation, and support groups. As a result, she had excellent insight into her illness. In her early appointments, she used nitrous oxide, but over time, it was no longer necessary. The status of her trichotillomania has not changed, but her oral health problems were treated successfully, and she has maintained regular recall for more than 10 years.

Notes
This case can serve as an alert that even people who appear perfectly health can have underlying emotional or psychiatric problems that affect oral health treatment. This patient had been terrified that the dentist would notice her lack of eyelashes and hair. By discussing her illness in an accepting manner, the staff was able to normalize her experience and relieve much of her fear. Treatment for trichotillomania is effective for some patients, but in more than 33 years, this woman has not found a cure. The patient is in a support group, maintains her job and other responsibilities, and manages her illness well.