Sitting in the dentist’s office this morning, shifting in my chair from right to left and back again, I pondered how the other people in the room felt. I wondered if their stomachs were turning somersaults or their hearts beating out of their chests. I mused whether or not they too would bolt for the door at the first open opportunity.
Picturing the dentist in my mind, I saw a huge hulking figure with strong arms and bulging muscles that could prevent any chance of escape. I saw a stern, opposing face that glared with condescension and disdain. I mentally pictured all of the equipment with arms that seemed to loom above and around in a menacing manner. I considered the sharp, probing tools all laid out in a row ready to puncture and cut and scrape with unstoppable pain.
That, my friends, is one of the most common phobias known to man: Dental phobia. A lot of people suffer from the common fear of dentists. Irrational as it might be, it certainly doesn’t feel irrational to the person caught in the clutches of the fear. To them, it is very real and very frightening.
Sometimes dental fear arises as the result of an unpleasant experience. Such is the case of my dental phobia. I am terrified of dentists and always have been to some extent but nothing like I am today. My phobia is the result of one of the worst experiences of my life.
Back a few years ago I was lucky enough to finally have dental insurance, so my husband and decided to get some serious work done on our aging teeth. I knew that I needed a couple of cavities filled and that I had a tooth that might need a root canal. So I made my appointment to the only dentist accepted in my health care network and off I went.
As suspected, the offending tooth required a root canal. It wasn’t a pleasant experience to go through, but it also wasn’t inordinately bad so I was happy once it was finished. I went home thinking I’d finally accomplished a major task and feeling rather good about it; that is, until the novocaine wore off. I knew instantly, as the numbness began to subside, that I was in trouble. The pain ripping through my lower jaw was unbearable.
I picked up the phone and called the dentist’s office and explained the situation. The receptionist laughed and said it wasn’t common to feel some minor discomfort after an invasive procedure. I tried to explain that I was not experiencing minor discomfort; I was in agony. I demanded to speak to the dentist. She refused the request. She told me to take some aspirin, and “grow up.”
After throwing the phone across the room and breaking into an uncontrollable fit of tears, I gave into what appeared to be my inevitable fate. After a sleepless night, I reported to work as usual. My partner remarked immediately about the excessive swelling of my jaw and neck and made an appointment for me with his dentist.
To make a long story short, I ended up in the hospital having IV antibiotics pumped into my body for a solid week; all the while in agonizing pain whenever the medication wore off.
Such experiences, while not common, per se, unfortunately do happen and consequently feed dental phobia. It certainly fed mine, keeping me far away from dentists for nearly three years.
The Diagnostic and Statistical Manual of Mental Disorders goes so far as to describe dental phobia as a “marked and persistent fear that is excessive or unreasonable.” I take exception to that fact. I know that my phobia stemmed from an experience and not any kind of “mental disorder.” Additionally, the fact is that there isn’t a single type of dental phobia. There are many reasons for this fear, including:
Fear of the Dentist,
Fear of Medical Settings,
Loss of Control,
Numbness or Lack Thereof,
Unnecessary or Excess Treatment, and
A few people experience allergies to the typical anesthetics used for dental work. This makes treatment for them much more difficult. Some dentists ascribe only to the class of anesthetics known as the “caines.” Oddly enough, however, novocaine – – the one with which most people are familiar – – is no longer one of them.
Many people are allergic to novocaine, an ester based drug, which is why it has been replaced by amide drugs instead. These typically include lidocaine, mepavacaine, prilocaine, articaine, and bupivacaine. Dentists now use these newer alternatives since there are much fewer reported allergy cases among them. Even then, if a person is allergic to lidocaine, it doesn’t necessarily mean that he or she is also allergic to articaine; thereby giving the dentist alternative choices.
Patients who have an allergy to novocaine that has prevented them from seeking dental assistance in the past, should check with local dentists to determine what alternative anesthetics are available that actually might work for them.
Although efforts are being made to change this, the fact remains that the majority of Americans do not have access to dental insurance. Without it, the cost of dental work can be cost prohibitive for the average everyday working Joe or Jane.
Although most dentists do accept major credit cards, the ever rising interest rates attached to those credit options cause most people to think twice before pulling out the plastic. Unfortunately, each year fewer dentists accept in-house credit payments; closing the door on the final option available for those who do not have any remaining disposable income.
On the flip side, however, more and more communities are attempting to fund free dental clinics in an effort to provide adequate dental care for those who might not otherwise be able to afford it. Those interested in determining if their city or county provides such services should contact their local department of human services.
A lot of people who have a fear of dentists are embarrassed about the condition of their teeth. Many, like my family, don’t have dental insurance or excess money to use for dental work. Unfortunately, a lot of dentists take a very negative and condescending stance when people try to explain their situation. Since most of us don’t like to be looked down upon, it weighs heavily in our minds and translates itself into dental phobia.
While this obviously leads to a vicious circle in that the essential phobia being – – embarrassment – – leads to avoidance, which in turn means the person is unlikely to make a trip to the dentist. Without proper dental care, the teeth further disintegrate which continues feeding the initial embarrassment; leading to a no win experience all the way around.
It is important to keep in mind that chances are the dentist has already seen the worst of things. It is unlikely that he or she will be shocked by much of anything. Plus, with continuous dental care, it alleviates the need for embarrassment, thus blocking the cycle and solving the issue.
Fear of the Dentist
This fear is very common and generally results from an unpleasant dental experience such as the one I experienced. The dentist I saw was very condescending in the first place, berating my supposed unwillingness to take care of my teeth. He failed to understand that without dental insurance, most dentists – – himself included – – demanded immediate cash payment. At the time, while paying over $800 a month for my mother’s medications, there was no disposable cash for such treatments. Then, of course, there was the result of the work he did which left an indelible negative impression in my brain probably forever.
This assumption that we, as human beings, often attribute to a group of people who have something in common (in this case, dentists) is called a construct. Although it should not be, it oftentimes is based on a very small number of observations.
This fear may be the most difficult to overcome. It will take time and trust; things that won’t happen over night but that can be overcome.
Fear of Medical Settings
Many people have a fear of anything medically related. While the fear may not actually stem from a fear of dentists, it is nonetheless crippling since those individuals are frightened of the sterile environment, the sights or sounds of a medical facility, and/or the equipment or tools used.
Like the fear of dentists, this is a difficult phobia to overcome. However, dentists are well aware of the problem and many are making slight environmental adjustments aimed at making their patients more comfortable. With research, it may be possible to find a dentist who is sensitive to this issue.
A fear of gagging sometimes relates to a fear of vomiting. Some conditions that cause that fear include not being able to breathe properly through the nose, sinusitis, upper respiratory issues, gastrointestinal disease, dry mouth, and medications that cause nausea.
The good news is that over the years most dentists have developed a variety of ways to help their patients with gag reflex issues. Some even find that nitrous oxide (laughing gas) can be helpful in this situation. Patients with this problem should do some research to determine if their dentist could help with this issue.
Lack of Numbness
There are four primary causes for local anesthetic not working:
Anatomical variation. There are, of course, physical variations between people but about 99 percent of are well handled through the standard injection technique. When this technique doesn’t work, dentists have alternative methods that almost always work. However, patients must inform their dentists when such situations arise so that alternative means of anesthetizing the area can be explored.
Bad technique. Unfortunately, there are a few dentists who are simply bad at their anesthetic technique. Some of them don’t care to admit to the problem while a few more just don’t care at all. In this situation, the best course of action is to find another dentist or to request another form of treatment (if available).
Anxiety. Sometimes when people are highly stressed or anxious, local anesthetic may not work effectively. The hormones related to anxiety can prevent some anesthetics from doing their job. In these situations, dentists may prescribe a sedative to prevent the onset of anxiety, thereby hopefully eliminating the issue.
Local infection. An abscessed tooth can prevent local anaesthetic from working properly. In such instances, the dentist may prescribe antibiotics to help ward off the infection in order to allow the tissue to respond appropriate to the anaesthetic. This may, however, take some time and delay the dental treatment.
Loss of Control
Some people fear losing control in any situation. Therefore, being basically pinned down on their back in the dental chair, surrounded by equipment, causes them major panic. Sometimes this type of fear can result from past negative experiences whereby a dentist continued to do work even while the patient was in obvious distress or discomfort. However, generally these kinds of deep seeded fears result from something more long term in nature such as a history of abuse or exposure to situations where the individual was forced to surrender control.
About 8 percent of dental phobic individuals have a fear of needles. The level of phobia varies from person to person, ranging from mild fear to outright panic. Some people are simply fearful regarding dental injections, while others will do absolutely anything to avoid any kind of injection.
Dentists today have a variety of tricks up their sleeves to avoid dental injection pain. Patients who experience this type of fear should inform their dentist prior to treatment so that he or she can determine the best form of treatment option.
Some people have high pain tolerance while others have little or none at all. With the variety of anesthetics available to dentists today, most of the time they can ensure clients relatively pain free dental treatment. The exception to this rule – – along with possible solutions – – has already been covered above (e.g., abscessed tooth, improper inoculation, etc.).
Dentists are familiar with this problem and most have developed a multitude of possible solutions to help their clients get through just about any dental procedure. Generally, such attacks are precipitated by one of the other problems listed above. Solve the problem; solve the attack.
Unnecessary or Excess Treatment
The high cost of dental work often attributes to this issue. Most people, however, are more frightened about what the dentist will find. Therefore, this fear is often fed by one or more of the above-related fears.
The most important step toward over-coming any dental phobia is to find a good dentist; one that:
is highly competent;
endeavors to make each meeting pain free ;
genuinely cares about you; and
has the ability to nurture you through past traumas.
A dentist should never be chosen at random from the phone book. Instead, those seeking a dentist should ask family members and friends. If a single name keeps coming up time after time again, chances are good that the dentist is a winner. But even if that is not the case, as long as the family member or friend believes in and trusts the individual, he or she might be worth a try.
In any case, it is important to schedule an initial visit to set up records and get an overall evaluation. This also allows the potential patient to check out the dentist, ask questions, and make themselves comfortable about their decision.
A good dentist will approach dental care from a partnership prospective; allowing the patient to have input and control over his or her dental care. If the dentist visited takes a different approach, then it is possible he or she isn’t the right one. No one is forced to go to the same dentist forever. Patients, who are not happy with their visit, should move on. They are, after all, the customers. The dentist is the service provider.
Prior to any procedures, patients should make certain that their dentists provide them with sufficient information on what they should expect. This helps to alleviate fear and calm anxiety. If the dentist does not take this proactive role, then patients should take the lead. Either way, it is important that the patient have a clear picture regarding their dental work – – at every step.
The best counteractive agent for dental phobia is trust. Patients that are unable to develop a genuine trust in their dentist are very likely going to the wrong dentist and should move on until they locate one with which they are comfortable.
While it is very likely impossible to alleviate all dental fear, sometimes calming the fear is sufficient to allow the patient a level of comfort with which they can deal. For me, today, the phobia dispersed as soon as I spoke to the gentle, smiling, caring individual who is my new dentist. He answered my questions, did not admonish me for past events, and promised to work “with” me to make me feel better. Best of all, he did not try to force treatments that I didn’t need and he was respectful of my budget limitations.
My dental phobia may not be totally gone, but it is definitely on vacation. With a little luck, and a good dentist, perhaps I can keep it there forever.