Overcoming Dental Phobia
How to Restore Your Teeth, Youth, and Confidence
Both practicing at Smile in the City Dental Group in New York City, NY
“Sometimes your joy is the source of your smile, but sometimes your smile can be the source of your joy.” – Nhat Hanh
Afraid to Smile
“Let us always meet each other with smile, for the smile is the beginning of love.”
– Mother Teresa
All the stories in this book are true—real experiences of patients treated at the authors’ dental practice in New York City. The names have been changed to protect the privacy of patients.
The End of Dental Fear
“A smile is a curve that sets everything straight.” – Phyllis Diller
There is a clear ultimate solution for those needing extensive treatments and suffering from extreme dental fears, but before looking at that solution, it’s important to consider the different ways dentists typically manage and mask the impact of treatments to the body as they are being performed. This is not a book on therapies.
Typical Treatments for Dental Phobia
As common as phobias are, it’s no surprise that there have been many treatment methods created to assist people in dealing with them. This book is not a book on therapies for treating dental fear. While there is definitely a place for therapies, in that they can address the roots of psychological fear, this book is more about keys for dealing with dental fear in the most painless, comfortable way possible.
With dental phobias in particular, it’s important for people to find a way to manage their fears. In a recent study of over 6,000 patients in Australia, 29.2% of people with fear had delayed treatment, whereas just 11.6% without fear had done so. This demonstrates an important reality: without a way to successfully treat that anxiety, it’s very likely that a dental patient will delay treatment and exacerbate their oral problems.
Nitrous Oxide or Laughing Gas
Most commonly, dentists use nitrous oxide or laughing gas. Stemming from as far back as the 1800s, laughing gas provides light sedation during treatment, making the process more bearable.
On the plus side, it alleviates patient discomfort and exits the body quickly, leaving no lingering side effects. But unfortunately, this treatment also has some major negative attributes: for one thing, it’s not very powerful, so it doesn’t really do much for most dental patients. For patients who, on their first visit, won’t even let a dentist look in their mouth, more substantial help is needed. Laughing gas can help the slightly phobic patients, but for those with severe fears, the nitrous oxide does very little to help. These patients are at a whole different level, one that nitrous oxide cannot touch.
Plus, research has shown some concern over the substance. One study in Sweden, which evaluated the effectiveness of nitrous oxide over the last 200 years, led the anesthesiology department at the University Erlangen-Nürnberg to discontinue its traditional use completely. The major concern with nitrous oxide is overdosing. Too high a percentage of nitrous will deprive the brain of oxygen potentially leading to serious life-threatening consequences. Dental offices that utilize nitrous oxide are not required by law to monitor a patient’s oxygen levels, which can lead to serious complications. Nausea, intestinal and ear pain have also been reported with nitrous oxide use. Nitrous oxide should not be given to pregnant women as it has been shown to lead to birth defects and premature labor.
Overall, if used correctly in healthy patients, nitrous oxide can be used to ease mild forms of anxiety.
Oral Sedatives or Sleeping Pills
Oral sedatives or sleeping pills are often used to treat patients with dental phobias. The way it works is the patient receives a pill to take one to two hours before treatment; this pill makes some patients groggy and actually puts others to sleep. For patients with needle phobia, for example, oral premedication with benzodiazepines or other antianxiety agents can help patients avoid hypotension, unconsciousness, convulsions, and other demonstrations of fear.
At the same time though, oral sedatives have their limits. One of the biggest issues is they can’t be titrated (i.e., customized in measurements to suit a patient’s specific situation and needs). Since the right dosage isn’t only based on a patient’s height or weight, it’s hard to know how much is necessary to effectively cover them through treatment. An extremely anxious individual may need a higher dose to produce relaxation. However, too much of a dosage will put a patient dangerously deep in sedation. If a patient gets too deep, respiratory function can diminish and protective reflexes will be gone. This can be very dangerous, especially in light of the fact that oral medication cannot be reversed quickly if needed. If too low of a dosage is given, adequate sedation may not be achieved and the patient will need to take more pills, wait additional hours for the medication to sink in, and try again.
Research has shown that acupuncture prior to dental treatment can have a beneficial effect on patient anxiety. In one study observing eight dentists and 20 very anxious patients, there was a significant reduction in fear after undergoing acupuncture treatment: where only six could handle treatment without it, all 20 were able to undergo dental work with it. Additionally, acupuncture has been shown to help patients manage the gagging reflex, a response commonly associated with putting foreign bodies in the mouth. According to one study, a large number of gagging patients can undergo dental work after stimulation of the P-6 Neikuan acupuncture point, located on the wrist.
Virtual Reality Therapy
A behavioral therapy sometimes used to treat phobias, virtual reality therapy has been shown to be effective at generating stimuli to help desensitize patients to their fears. Specifically, it has been used to treat self-reported anxiety regarding public speaking, social situations, and agoraphobia.
Relaxation training, also known as progressive muscle relaxation, systematic muscle relaxation, or Jacobsen relaxation, is a therapy designed to reduce anxiety and fear through certain techniques that relax muscles. A patient goes into a quiet room and tenses a group of muscles, then relaxes those muscles, and after that does the same with another group of muscles. Throughout the process, he or she focuses on the difference between tense and relaxed muscles. This treatment may also involve meditation, breathing exercises, or yoga. One study reviewing ten years of relaxation training showed consistent, significant improvement of patient anxiety through this treatment.
The long history of hypnosis attests to its power in behavior modification, particularly in the realm of fear. Research on using hypnosis to treat dental fear shows that it can be helpful when combined with other techniques like systematic desensitization, but it is highly dependent on the individual.
With all these treatment options, however, it’s still hard to guarantee success. Estimations on the risk of failure are as high as 60% — with a variety of different factors to blame, including insufficient motivation, fear bigger than the treatment, accidents during treatment, and others. What today’s dental patients need is a stronger treatment option, one that can address all levels of fear.
How to Overcome Dental Fear and Anxiety: The Ultimate Solution for Dental Phobic Patients
Patients who won’t even let dentists look in their mouths have severe dental phobias. Therapy can be a way to treat this condition. And while this approach can give some results, it does take time. Unfortunately, a majority of dental phobic patients have immediate dental needs, active infection, multiple missing teeth, and other problems. This is when these patients seek the care of dentists that offer IV sedation, which is a highly specialized treatment option custom designed for this type of patient.
IV sedation is common in oral surgery offices. Many times, unfortunately, patients find themselves in an oral surgeon’s office when their situation is beyond restorability. At that point, an oral surgeon will address the chief complaint and, more often than not, remove teeth using IV sedation. Although this approach will likely alleviate a patient’s pain, it is not the ideal approach. The correct approach to this situation would be to have a comprehensive plan of restoration of teeth before extraction in a comfortable setting. This type of plan can be achieved with a group of dental specialists combined with IV sedation. Many phobic patients are not aware that this type of service exists.
Comfortable dental treatment for phobic patients consists of both IV sedation and a specialists’ approach to treating complex dental problems. It is fast, painless, and seems to go by quickly with no memory of your procedures. Past negative dental incidents are replaced with positive experiences, giving you hope for a fearless and healthy dental future.
The beauty of IV sedation is that it is administered directly through an IV, so when the patient wakes up, everything is all done. They don’t have to be aware of the treatment or feel the possible pain they’re so afraid of. Instead, patients wake up and say, “Wow, what time is it?” And they can’t believe their treatment is already completed. They say, “You did all that already?”
As an example of how this works, there is Sharon—a patient who came from a very upper middle-class family and had been given just about everything while she was growing up. As she had aged, she’d started getting into designer prescription drug abuse, and eventually, she was a full-on drug addict, having to go through rehabilitation. By the time she found her way to seeking dental care, she was at a halfway house.
At Sharon’s first dental visit, she was crying hysterically. She couldn’t face the dentist; her smile was in very bad shape from the drug abuse, and she was extremely embarrassed, with very low self-esteem from all she’d been through.
Extreme dental pain forced Sharon to seek treatment, but she was still afraid. Her family lived out of town, so the social worker from the halfway house escorted her to the appointment.
Right away, it was obvious that treating Sharon’s problems would not be easy. Even getting her in the chair was difficult. She was very afraid and reluctant; yet, she also knew she needed the treatment. The dentists got the sedation started, and while she rested, they did a lot of work without causing her the slightest discomfort. She had a number of root canal treatments, several extractions, implants placed, some fillings—and she did great. After just that first visit, her smile was already looking good. She woke up, amazed at what had been accomplished, and she was thankful to look better so quickly. Anyone could see that her self-esteem was rising.
After that initial visit, Sharon did need to return for more dental care, but every time got a little easier. On her second visit, she wasn’t crying, but was still a little nervous. With each successive visit, she grew less afraid and more pleased with the results of looking and feeling so much better. It was the IV sedation that allowed her to be able to undergo all of the treatment.
Fast-forward until she was totally done with all her treatments, and Sharon was a completely different woman. She walked into the office on her own and said, “You know, I don’t even need sedation anymore.” Talk about a transformation!
Sharon’s story is one of the biggest success stories regarding IV sedation. Through the comfort level it was able to provide, she got totally transformed and conquered her dental fears. Now, she looks fantastic and her self-confidence is high. She started out feeling so low, but now anyone can see that she is well on the path to a successful and constructive life.
For Sharon and many other patients, transforming their smiles played a major role in transforming their lives. The IV sedation made it possible: it nearly cured these nervous patients of their previous dental fears and anxieties. Now, Sharon is all set to maintain her new smile with regular visits to the dentist. She’s so pleased with the results that she’s even been referring friends.