New Techniques Put Your Dental Phobias To Bed

Dental Phobia is one of the most frequent fears in the adult population, ranking fourth among common fears, and ninth among intense fears.  It's prevalence varies from study to study; recent surveys indicate between 16 and 30 percent of respondents admitted being somewhat anxious or terrified of dental procedures.  Regardless of how one measures it, dental phobia is an enormous obstacle to oral health, and for many sufferers, sedation is the only solution.  

Approaches to sedation vary from dentist to dentist, depending on the nature of the fear or phobia (i.e. the needle, the drill, gagging, cleaning, loss of control, etc.) the intensity of the fear of the phobia, and the treatment required.  Dr. Peter Copp, a Toronto GP with a specialty in Anesthesia, explained some of his sedation techniques as they relate to fear and/or treatment issues: "I have a patient who gagged just when I walked in the room - such was the psychological fear.  The idea of getting into his mouth, to examine his teeth, was impossible.  So it was necessary to render him unconscious to obtain X-rays."

Procedures as basic as cleaning can also involve anesthesia.  "I have some patients who I put to sleep for a few minutes," said Dr. Copp, "so I can give them freezing - to their entire mouth - in order to carry on with the cleaning.  Ultimately, it was the needle - not the cleaning - they needed to be asleep for, but they needed the freezing for the cleaning.  I have other patients who require anesthesia for not only cleaning - but for the entire procedure because they have a terrible phobia of allowing anyone in their mouth."

Dr. Bruce Glazer, a Toronto prosthodontist with a specialty in anesthesia, describes his sedation techniques as based "on what the patient is able to tolerate and his or her ability to cooperate.  I personally like to use drug combinations which boast the lowest possible risk and allow me to work without interruptions, ad when needed, the patient can help me accomplish certain procedures.  The IV route allows me total control of the dental situation and the patient.  But in terms of safety, I would place nitrous oxide as one of the safest sdation techniques available."

The question of safety in dental sedation is a crucial one.  According to a recent study, the mortality rate for dental anesthesia in Ontario is 1.4 per million cases in deep sedations and general anesthesia. Conscious sedation techniques, of course, run less risk; but even deep sedation proves to be safer than highway driving or commercial flying.

Another patient group that may eventually present to sedation dentists are "avoiders" - patients who won't go to dentists, usually for reasons of fear. Studies indicate that dental avoidance ranges from 2 to 20 percent of the population. "Many of the patients I see," said Dr. Copp, "haven't been to a dentist in 10 or 20 years.  Offering patients anesthesia gets many people back to the dentist, but often they need pain to drive them to it."

The origins of dental fear are multi-factoral and complex.  "The reasons that my patient cohort became dental phobics," said Dr. Glazer, "include trauma in a dental situation, choking, drowning and sexual abuse.  These memories are very difficult to overcome."  In a 1990 study of dental phobics, 89 percent reported having had traumatic dental experiences, 70 percent of which occurred in childhood." Childhood experiences appear to be major sources of dental phobia, and in some cases they need not even be dental in origin. 

Drs. Copp and Glazer all emphasized the importance of treating patients with understanding and respect. "You've got to be nice and empathetic and listen - you can't be judgmental about people's phobias, because to them, it's real. You have to accept that for some people it's a major accomplishment to have made it into the office." For some patients, the empathy and kindness of the dentist makes all the difference in the world. There is no longer any need to feel uncomfortable, or afraid. When the dentist understands, it makes you feel much better.  What also helps is the dentist's mannerisms - they're quiet and gentle and confident in their work.  You trust them.  It's about gaining your trust.