Fear of the dentist, revisited
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MOST people I know do not like going to the dentist. In fact, some even approach their dentist by stating, ‘I hate dentists.’ Actually, they do not hate dentists; they are fearful of the treatment their dentists render to them. And trust me, it is generally traditional. A person who is a true dental phobic may carry their fear to extremes by taking extra-long routes to and from work, just to avoid driving by the dentist’s office.

A landmark study published recently has reported that up to 80 per cent of any population experience some degree of dental fear; and that extreme dental fear is a problem for every one in four patients.
I know of many true dental phobics whose fears may be so extreme that they will seek dental treatment only when they have severe pain and major problems.
Anxious dental patients many times repeatedly cancel their appointment; arrive late, knowing they will have to be rescheduled; or just do not show at all. This results in a progressive deterioration of their dental health. When treatment is rendered, these patients many times are not in control of their emotions; are not cooperative; and certainly are stoical about pain. These patients usually do not stop to realise that their behaviour makes the dentist, his staff, and any other patients in the office very anxious. The result may be substandard treatment.
Research indicates that fear of the unknown, loss of control, bodily injury, and helplessness and dependency are the four elements common to fears and phobias. Anxious patients report that dental injections and drilling are the two most feared procedures that occur in the dental office.
Try to identify your specific fears and concerns. Many times, patients’ fears have been traced to parents who preconditioned them as children to be afraid. Preconditioning usually happens subtly, though sometimes it may be all too obvious. For example, a mother might say, ‘Johnny, if you are not good, I am going to take you to the dentist so he can take out all of your teeth.’
Stories (real or not) that we all hear about the horrors that have occurred at the hands of some dentists also have a great influence. Many times, the person relating the story has actually gone through a frightening experience that has left a lifelong mark. It is important to understand that our dental fears are not unique and, most important, that there are ways to control these feelings.
If you experience dental anxiety, it is important for you to recognize your anxiety; accept that it is a common reaction to an uncertain situation; and learn to master it. This will help you be more comfortable about dental visits, which, in turn, will boost your confidence and oral health.
Dental fears are usually managed by either pharmacological or behavioural methods. Hypnotic or anti- anxiety drugs can either be administered orally, intravenously, or by way of inhaling a mixture of nitrous oxide/oxygen.
Pain is controlled primarily by topical anesthetic gels (or solutions) and injectable anesthetic solutions. Hypnotic or anti- anxiety drugs administered orally or intravenously may also block pain responses.
Patients can be tranquilized with medications such as Valium, and the pain is controlled with topical and local anesthesia, conscious sedation (nitrous oxide/oxygen, ‘laughing gas’), and general anesthesia. Even though these methods are used to control pain, there is always the risk of side effects, not to mention the danger of fostering dependence on the medications.
Pain relief through the use of behavioural management eliminates the risk of dependence. Some of these methods include biofeedback, hypnosis, and progressive relaxation techniques. Anxiety relief through the use of behavioural management eliminates the risk of drug dependence.
The logical approach to eliminating fear is to treat the cause, not just the symptoms; but efforts in this regard are just beginning in dentistry. Psychotherapists use desensitization techniques to help patients with all types of fears and anxieties, and that includes dental fears, too.
The most successful method involves the patient developing a list of all the most frightening aspects of treatment. He or she then organizes the list starting with the least frightening and progressing to the most frightening. Patients are asked to try to associate each situation in their minds with a pleasant experience and to think for several minutes about each pairing. When one situation no longer brings on feelings on anxiety, the patient moves on to the next item until all have been dealt with. This process is best done under the supervision of a trained therapist.
Another method involves distracting oneself from the procedures by, for example, listening to a relaxing tape or going over shopping lists. In my clinic the patient can watch television while sitting in the dental chair. Yet in another technique, apprehensive patients are trained to concentrate on breathing at the rate of eight breaths per minute. This relaxation exercise keeps the patient’s attention focused on something other than the dental treatment. Another common relaxation technique involves systematically tightening and then relaxing the major muscle groups in your leg, arms, hands, neck and shoulders.
Using visualization is an excellent way to feel more relaxed and comfortable before and after a dental visit. For instance, before your visit you can visualize yourself sitting calmly in the dentist’s chair while he is examining your mouth or restoring your tooth. You can also focus on a relaxing scene from your favorite vacation spot or activity and hold it before your ‘mind’s eye’ during treatment. Fortunately, many patients’ fears and anxiety will not exist if they know from experience and recommendation that their dentist is competent.

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