It has been my long held belief that for many, if not most patients suffering from Dental Phobia or Dental Fear that treatment under sedation should be kept in reserve as the solution of last resort. My view is based on our experiences helping people with dental fear and phobia in our dental practice in Edinburgh over the last 20 years. The concern I have with sedation is simply that when you are sedated you will remember nothing of the process. Now on the face of it sounds good, however the downside is that your subconscious never has the opportunity to learn from the experience so you remain dependent on sedation to have treatment carried out. If you then ever are in a situation where you require dental care and sedation is not available then you will have to face your fears with no priorpreparation, which is not in my view a great plan.
A study published in this months British Dental Journal has provided me with some evidence that we are thinking along the right lines in this regard. The study looked at a group of patients who underwent Cognitive Behavioural Therapy (CBT) to help with dental phobia around 10 years ago. The results were fascinating, of the patients who underwent the CBT 95.2% were able to undergo dental treatment without sedation after treatment with CBT. What was even more amazing to me is that after 10 years 100% of these patients continued to be able to receive dental care without sedation.
While one would hesitate to call this a “cure” for dental fear, this study certainly suggests that it comes very close. To return to my original point interestingly less than 5% of all patients needed sedation after receiving some professional help with their dental anxiety.
Many people are resistant to theidea of any knd of “therapy” in the UK however this is a concept that is becoming out dated. Just as logging on to an online forum to share experiences with others in a similar situation can help, CBT should be seen as just one of the many tools that you can be used to help overcome your dental fears.
Let me know what you think?
Have a great week
Over the last few weeks I have been chatting to a lot of my patients at our dental practice in Edinburgh about, the “hurdles” that they had to overcome in beating their dental fear. There are clearly a number of road blocks to be passed and it is interesting that many people tell me that overcoming the first roadblock of simply making contact is often the hardest part. However the next major hurdle can be the first visit to the practice so here is a little video where I chat about a typical new patient consultation.
This video comes with Dental Fear “U” rating……suitable for all! there are no dentists or team members in dental outfits and no dental equipment shown. Just me talking to myself and feeling a bit self conscious in our hallway! Just click the image below to see it on You Tube
Reports hit the press this week reporting on some research that is being done on dental anaesthetics to make them more comfortable. At present some of the more commonly used anaesthetics are acidic, which can mean at point of first contact you can feel a little discomfort. The acidity is caused by some of the preservatives used to keep anaesthetic effective while it is waiting to be used.
The new development involves a special cartridge that will mix 2 parts of the anaesthetic together just before use thus doing away with the need for a preservative. Sadly researchers think it will be a few years before this makes its way out of the laboratory and into our hands in practice.
In the mean time here are the things that we already know can help to make injection pain a thing of the past.
1. Using lots of surface anaesthetic gel…..my favourite is bubble gum flavour!
2. Warming the anaesthetic to body temperature – makes for a more comfortable injection
3. Injecting very very slowly… this way the anaesthetic soaks in- believe me the first time someone gives you a really slow injection you will know the difference immediately.
4. Using techniques that allow us to avoid the most sensitive areas- there are many ways of numbing a tooth up so if you are someone who normally feels it a lot, tell your dentist and they can try an alternative approach.
Finally we know that in a heightened state of anxiety we often experience pain vividly more than we do when we are relaxed…… so a great self help tool is to start working on self relaxation techniques well before your visit. This way when you are with the dentist you can use some of these techniques to reduce and control your anxiety levels. If you need any suggestions or ideas just get in touch.
Just a final quick invitation to our Dental Fear Open Night
Beating dental fear is all about taking the first step and we are committed to helping as many people as possible do just that. So if you or someone you caer about suffers from dental fear why not join us tomorrow evening from 7:00pm
Enjoy a glass of wine or a soft drink and have an informal chat with one of our team. We are happy to talk teeth or not if you would prefer. No one here will find your fears unusual or funny. On all matters dental you are welcome to speak to our dentists or one of our experienced nurses if you would prefer.
More information on http://www.craigentinny.co.uk/Open
We chat to our new patients in some detail about the origin of their fears. Among our team we meet regularly to share our ideas and learning too. It was one such meeting with John Booth the other partner at my dental practice in Edinburgh that led to this posting
Many patients at have told us that they felt that their fears and even any pain that they were experiencing were being dismissed by their dentist in the past.
The subtext of the conversation being something like “ I have given you 2 injections and yet you are still saying it is sore, you must be numb, please stop acting up and let me get on with your treatment”
Now very often these are NOT the actual words that have been spoken to a patient but it is the message that they have perceived from their dentist or dental team indirectly. Any exchange like this can leave you feeling as though you are being judged as lacking in moral fibre or are making a fuss about nothing. What’s more it may even encourage you to be quiet and try to tough it out………….. this is the wrong thing to do.
It strikes me when I meet someone with dental fear who reports this sort of history that quite possibly the reverse is true of what my dental colleagues in the past have perceived or inadvertently conveyed. It is not a lack of moral fibre or the desire to make a fuss that leads to someone experiencing pain. There can actually be very good reasons why someone is difficult to get numb and rather than expressing frustration, it is our job to work out what that reason is and so something about it.
For example. some people may simply be far less sensitive to the usual local anaesthetic that we use, and so is much more likely to feel pain when dental work is being carried out. Others take much longer for the anaesthetic to take effect or simply need a different anaesthetic to the one we normally use. There are always solutions to these problems.
Persistently painful visits will destroy your dental confidence so it is critical that your dental team work to finding a strategy that allows you to enjoy pain free dentistry.If every dental visit results in pain then, it is little wonder that you become increasingly (and understandably) anxious before each visit and ultimately want to avoid the dentist until a problem occurs. This is human nature in action, we all avoid stuff we don’t like.
If you suffer from dental fear, I genuinely believe that the single most important thing that a dentist can do is help you develop a great prevention routine. With this in place the volume and frequency of dental treatment that you need will reduce in the long term.
If problems do occur we have to make each individual patient feel as comfortable as possible. Generally I find that once we work out how to make dentistry pain free, then the “recipe” can be applied at all future visits.
Good local anaesthetics, careful techniques and lots of open two way communication all help to make treatment visits as comfortable as possible. Comfortable and dare I say relaxed visits are the best way to help overcome dental anxiety and fear in the long term.
There are still situations where it can be difficult to get someone as numb as they need to be, but in my view modern dentistry should be pain free. If for whatever reason your treatment cannot be made painless on a given day then there are very few situations that I can think of where pressing on regardless is a good idea.
Dentists as a profession need to overcome our biggest hurdle: preconceptions about our patients and what they experience during visits to see us. When we can do this, listen, observe and generally be attuned to what our patients are experiencing then I think we begin to have a chance at understanding how big a deal dental fear is for many of our ”anxious” patients.
-As a final add on to tonights posting I hope you will forgive a shameless plug for our
Beat Your Dental Fear Open Night on 27th April
Details are in my last blog posting
The event is entirely free and we would love to meet you in person. register here to attend
Have a great week
The view on the right is taken in a mirror and illustrates the crowding of the front teeth rather well. We discussed all of the available treatment options which included traditional cosmetic dentistry, Inman Aligners, fixed train track style braces, Invisalign or similar Clear Braces. Each system has its own advantages and disadvantages and I believe it is really important to consider every option before starting treatment. After careful consideration and a good discussion about all of the options our patient opted to have the Inman Aligner treatment.
I regularly write about taking small steps towards your goal of beating your dental fear. Here is just another way where we could help you take a small step toward success. The open night is a great chance to pop along and meet the team on a non dental visit when you know that nothing else will be happening. The evening is entirely free.
- Discover new ways to beat the 7 most common dental fears
- Enjoy a glass of wine or soft drink and chat informally with our team ( it does not even have to be about teeth!)
- Get direct help and tips to beat your dental fear direct from our expert team
- Get answers to any nagging worries our doubts that you have
- A free goody bag for everyone who attends
Some of our most experienced team members will be on hand to chat and answer your questions. Whether it is a question about your dental health, the nervous patient programme or just a fear that you really seem to be stuck on we would be delighted to see you. The team love getting to know new people and will be very happy to talk to you on any subject you wish, dental or otherwise. The evening is held in our reception hall and waiting room so there will be absolutely no dental equipment on show and you won’t even need to go anywhere near a dental surgery unless you want to. You are also most welcome to bring along a friend, family member or significant other for moral support.
It still surprises me when someone new comes to see me for an examination or consultation at my Edinburgh Dental Practice how often they start our conversation by apologising for the “state” of their teeth or for not having attended a dentist within the last 6 months, year or even longer. What’s even more surprising is that people who are anxious or scared are often the most apologetic. The tone of these chats also makes me believe past experience, the advice of friends or something else has led these people to believe that they are somehow going to be “judged” by the dentist when they do attend. Or reprimanded for the condition of their mouth and teeth.
If I had a bad experience and was as a result scared of the dentist it would make me want to avoid repeating the process. It is a natural instinct and genuinely nothing that you should feel the need to apologise for. Humans have finely tuned mechanisms to deal with stress or past unpleasant experiences. And one of the foremost mechanisms is learning to avoid situations that have not gone well in the past. For example, how many times did you as a child touch something that you were told was hot and would burn your fingers? ….not more than once or twice I bet…… Exactly, this is classic self preservation / learning in action.
So I can understand why people feel this way about their dental anxiety. Often their friends or family are able to attend for dental care. So the anxious or phobic person can often feel that somehow their fear is something they should just be able to “get over”. When they struggle to do so they feel ashamed and often assume that as time goes by their teeth have to be deteriorating. (An Interesting side note here is that in my experience many anxious patients look after their teeth extremely well to “compensate” for not attending the dentist and often have very healthy mouths.)
I’d suggest instead that anyone who has managed to overcome their dental fear and make that all important first contact with a dental practice deserves congratulations for overcoming their “natural” resistance to do so. What’s more at that first visit, maybe it’s the dentist who should be apologising to you on behalf of our profession for making you scared or anxious in the first place!
Just a thought
Have a great week
Happy New Year! May 2011 bring you plenty of smiles and only pleasant dental experiences.
Whether this is the effect of so called “austerity” Britain or just a realisation that on planet earth we need to conserve our resources, it seems that many people are looking to achieve more with fewer resources in all areas of their lives and dentistry appears to be no exception.
In the heyday of full on cosmetics as typified by extreme type makeover programmes, we saw porcelain veneers and crowns being fitted like they were going out of fashion. If the teeth were not in the right position, then porcelain (from which these items are usually made) could sort the proble
m out. The only down side is that whenever you prepare a tooth for a crown or prepare it heavily for a veneer then you run a risk of killing the nerve inside the tooth. Depending on whose research you believe between 5 and 15% of all teeth prepared this way will eventually die. So it is little wonder that more and more patients and dentists have been asking what the alternatives to crowns or porcelain veneers are.
In situations where teeth are a long way out of position more patients are tending to align the teeth first to improve their overall position before they have the final veneers or bonds placed. This in turn reduces how much tooth needs to be removed. Though it may add 12-18 weeks to treatment time, is this really an issue when you are looking fro results to last for years and years?
As 2010 draws to a very cold and snowy close I have been reflecting on the last 12 months and realised that there many, many things to be thankful for. I am indebted to my supportive family and great kids who make every day a joy, without doubt they are responsible for a lot of the high points and were invariably supportive and understanding when I experienced the odd low point too. I am grateful to the many patients who have taken the leap of faith and entrusted their dental care to our dental practice in Edinburgh. It has been my privilege to watch most of my new patients transition from terrified newcomers to become confident and happy people who enjoy coming to see us. Without doubt the team of committed and talented professionals that I work with should take the majority of the credit for this.
So how will you remember 2010 and can I help you to make 2011 the year where you finally beat your dental fear?
I set up this blog to help encourage people who currently are too scared of the dentist to reach out and take the first step towards beating their dental fear. To some extent it has worked and we have many success stories already but I would love to do more. So I have a Christmas favour to ask?
Please let me know how we can be more helpful in 2011 ?
What could this blog do to help you move forwards and beat your dental fear?
And finally if you have taken our 7 Day Beat Your Fear e-course please let me know what worked and what didn’t. Good or bad I really would love to know.
So until next year I wish you a Peaceful and Happy Christmas
With all good wishes