Dental Phobias

In practice, I often encounter (or don’t encounter) patients with dental phobias.  A phobia is defined as an “irrational fear.” It is easy to label this behavior as irrational, but to the patient it is very rational and is usually the result of a childhood trauma at the hands of a dentist who was rough or due to the days before Novocain, when there was no numbing involved.
The dentist would just go to town on the tooth with a hand piece.  Chances were that the hand piece was a slow relic and the burs not as sharp as the industrial diamonds we have today.  It was similar to cutting steak with a butter knife.

Through the years, I have only had 3 patients who preferred not to be numb, and I think there was something different about their wiring. One of them would just laugh as I drilled, the other felt like they were getting a “high” off of the drilling.  One patient, who had been in the military, did not allow himself to feel any pain.

Then there are other patients who are simply terrified and have never been to the dentist.  Perhaps it is fear of the unknown and someone sticking things in their mouth in a clinical setting.  I have had people with piercings and tattoos who said they could deal with pain anywhere but not in the mouth.  Mothers have told me that visiting the dentist hurt more than childbirth.  In one famous film, a person is tortured by drilling into his teeth without anesthetic.  No wonder people have a fear of the dentist!

The problem is that the fear is keeping some people from getting the dental care that they desperately need.  And by the time they do come to the office, in pain, the years of damage and neglect can end up being quite involved and very expensive.

Having said all this, how has dentistry changed to address dental phobias?  First of all, Novocain has evolved over the years.  Some of the new anesthetics are stronger and longer lasting.  A lot of the patients that come in saying “they couldn’t numb me” have been able to get numb.  Sometimes the previous doctor just doesn’t get the right landmarks in the mouth. There are at least three to four different anesthetics that we have to choose from with different strengths and durations.  Topical anesthetics can be left in place to numb the tissue before an injection.

The subject of anesthesia can extend to breathable gases such as nitrous oxide, oral conscious sedation, and IV sedation.  With nitrous oxide, patients breathe in a mixture of oxygen and nitrous which has a relaxing effect.  It can be quite effective with patients and children and is considered safe, with no lasting effects.  The patients leave the office fully conscious as the nitrous is flushed out of the patients system completely before they leave the office.

Oral conscious sedation had become more popular in recent years, where the patient is given a crushed pill placed under the tongue.  The patient’s vital signs are monitored continuously, making the procedure quite safe.  The dentist practicing oral conscious sedation must have adequate training and the administration of the drugs monitored by the proper authorities.

IV sedation usually falls in the realm of dental anesthesiologists.  These are dentists who usually study at least two years after receiving their dental degree or are dental specialists such as oral surgeons.  The idea is that when you wake up, you won’t remember the experience you just had, such as the pulling out of wisdom teeth.  It is also helpful when a patient needs a lot of work and doesn’t want to have to keep coming back.

Hopefully, I have shed some light on the advances and options a person has that may help to alleviate some dental phobia.  Of course, a dentist’s chair side manner is a good place to start in making the patients’ experience more bearable.