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Nervous Patients


Am I the only person who is nervous about going to the dentist?

No, you are not alone: there are many millions of people who suffer from dental phobia, leading to anxiety, panic attacks, nausea and fainting. Many people are so fearful or anxious about visiting the dentist that they let their oral health suffer as a result. They feel nervous and embarrassed, especially if their teeth are in poor condition. They also find it difficult to talk to anyone about it and worry that their dentist will not take their fears seriously or will think less of them because they have allowed their dental health to deteriorate.


What is dental phobia?

Dental phobia is generally defined as a fear of dentists and dental work, however in reality it may be a complex condition involving one or more of a wide range of fears that centre around the dental experience. These may range from the negative associations of the sights, smells and sounds of the dental surgery with childhood experiences, to specific fears such as


  • Fear of dentists: for many people, dentists represent authoritarian figures that are there to check how well we’ve looked after our teeth. This kind of perception often stems from childhood visits to the dentist.
  • Fear of needles: fear of needles is a common phobia which is all the more difficult to cope with in dental situations. 
  • Fear of pain: the avoidance of pain is a natural instinct. Many patients who experienced pain at the dentist as a child find it very difficult to go back.
  • Fear of numbness: many people are unable to visit their dentist because they are afraid of being unable to call for help or control the level of pain they receive. They feel that, if they are under local anaesthetic, for example, they may find it difficult to communicate with their dentist.
  • Fear of choking: fear of choking is another common phobia which makes everyday life difficult. One area where is becomes particularly acute is at the dentist.
  • Fear of anaesthetic: most people do not fear anaesthetic but the thought of what could happen. They are phobic about feeling the pain, of not responding to the anaesthetic, or of being allergic to anaesthetic. 
  • Fear of the dental drill: the drill is an iconic symbol of dentistry for many people, and sums up everything they fear about dentistry. The distinctive sound is often enough to stimulate an anxiety attack amongst phobic patients. 
  • Fear of being embarrassed: many phobic dental patients will go to great lengths to avoid a visit to the dentist. This creates its own problems as the worse their teeth and oral health becomes, the more anxious they become about visiting the dentist. 
  • Fear of diagnosis: finally, fear of diagnosis is the fear of a simple check-up turning into an expensive, long procedure that runs out of the patient’s control. For phobic patients, therefore, the ‘solution’ is usually to avoid the check-up. 


Will my dentist understand my fears?

Yes. Many dental phobics do not realise just how common their phobia is. 

In recent years, great strides have been made by the dental profession in recognising that many patients need more support, more advice and more dedicated care from their dentists. Dental practices are now much more friendly and welcoming places; modern dentistry has many techniques, products and treatments to help you overcome your fears.


Far from them being the unsympathetic and authoritarian figure you may imagine, you are far more likely to discover that a standard part of your dentist’s training focussed on how to treat dental phobic patients.

He or she may even be certified as a dentist who provides dedicated treatment for dental phobics; use the search facility on this page to find your nearest Gentle Dentist.


How can my fears be addressed?

The first step you can make in overcoming this fear is to recognise it and know that something can be done about it. 


Choose a dentist who is experienced in treating patients with dental phobias; they will understand your fears and have a variety of techniques and treatments to help you. 


Arrange an initial consultation simply to talk about your fears to the dentist – no dental work at this stage. Once your dentist has a better understanding of your fears then you can both agree on the best way for your dentist to treat you. It is important that you can talk about your fears and concerns with your dentist openly and comfortably. If you find that the dentist or the staff are not sympathetic towards your concerns, you should seek a dental practice that is.


Try to be open and honest with your dentist if you feel embarrassed about the condition of your teeth or your lack of previous dental care. Most dentists will probably have seen teeth that are in a much worse state than yours. The important thing is that you're taking a step in the right direction to address your fears.


What treatment options are available for dental phobics?

You may find that something as simple as your dentist explaining (in non-technical and easy to understand language) how a procedure will be carried out, and giving you the opportunity to ask questions, will relieve your fears. 


Agreeing with your dentist a signal that you want them to immediately stop what they are doing will help you feel in control of the process. Simple relaxation techniques such as aromatherapy and massage may also help; your dentist may offer DVD goggles to take your mind off the treatment, headphones with music to mask sounds and scented candles to mask smells.


Where specific fears are involved, modern dentistry has several approaches:

Pain free dentistry

While dental procedures can be made pain-free by the use of local anaesthetics, for those patients with fear of pain the anaesthetic injection itself may be a source of dread. Your dentist can apply a numbing gel to the gums and ensure that the injection is given slowly and with the anaesthetic at room temperature; these precautions should make the process pain free.  Giving the anaesthetic time to take effect before starting treatment is also important, as the time taken varies from patient to patient. During treatment if you feel any pain at all your dentist can “top up” the anaesthetic to ensure that you remain comfortable. 


The Wand

The most common cause of pain during injection of local anaesthetic is, in fact, due to the anaesthetic being injected into the gums too quickly. The Wand delivers the local anaesthetic slowly via a computerised system and has the advantage that it doesn’t look like a syringe – the handpiece containing the tiny needle looks like a pen and is light and easy for the dentist to use and manoeuvre into the correct position in the mouth. The precise control of the anaesthetic flow rate and pressure reliably produces a comfortable injection and The Wand makes patients much less anxious than a conventional needle. It is becoming an increasingly popular technique and many more dentists are investing in the equipment to provide this service.

Drill free dentistry

For patients who are phobic about needles or drilling, there are alternative techniques available which may be suitable in certain cases:

Healozone:

ozone gas occurs naturally and is a very efficient natural disinfectant.  The Healozone system generates ozone from the oxygen in the air and channels it through a tightly fitting cup placed over the affected tooth. The tooth is bathed in the ozone for 20-60 seconds and during this time the bacteria which cause tooth decay are killed (along with any viruses or fungi present). A remineralisation solution is then applied to the tooth to encourage the natural rebuilding of the tooth structure.


The system is effective in the prevention of tooth decay and treatment of early, small cavities. It may also be used in conjunction with conventional drilling or the techniques below to open up larger cavities for disinfection.


Micro air abrasion:

this technology is most commonly used to prepare various types of cavities to be restored with composites, or "white fillings". An air abrasion instrument blows a powerful air stream of tiny, fine particles out of its tip onto the tooth, gently removing decayed areas. The procedure is painless and very quiet; it can leave your mouth with a gritty accumulation of harmless particles so the dentist or dental nurse may use a water spray or vacuum hose while the procedure is carried out.


Air abrasion cannot be used as an alternative in every procedure. There are some treatments, like crown and bridge preparation, or the removal of an existing filling, that still require the use of a dental drill.


Dental laser technology:

a laser-energised air and water spray can be used in some cases to remove tooth decay and prepare cavities; it does not generate heat, vibration or pressure – all causes of pain in conventional dental drilling – and allows precise cutting and shaping.

Sedation dentistry

Sedation uses medication to put the patient in a very relaxed, dreamlike state whilst having treatment carried out; you are conscious and can follow instructions that your dentist may give; but you do not feel the stress and anxiety that you might otherwise feel. There are advantages for the dentist too: sedation means that treatment is easier to perform, and that more can be achieved in one session, reducing the number of sessions needed to carry out a course of treatment.


Sedatives may be taken in three forms:

  • tablets prescribed for you to take the night before and/or the morning before your appointment; you will need someone to take you to and from the appointment. 
  • inhalation sedation, also known as nitrous oxide or more commonly, as ‘laughing gas’. This pleasant smelling gas has the effect of eliminating pain, and bringing on a warm and comfortable feeling. Dentists prefer nitrous oxide because of its extremely fast effect – just 5 minutes after you inhale it - and also because of how quickly a patient recovers from the gas. 
  • intravenous sedation: the sedation drug is administered into a vein using a very thin needle that is encased in a soft plastic tube. When the needle is removed from the vein, it leaves the plastic tube behind, and this tube is used to administer the drug. The sedative takes effect very quickly, and your dentist can adjust the dosage to bring about the level of sedation that is required. IV sedatives can lead to deeper levels of sedation than other sedation methods but are not suitable for use on all patients; neither is this method suitable for needle-phobic patients.

 

Not everybody is suited to sedation; those who are already taking some sort of medication must alert their dentist before accepting oral sedatives, as well as those who have a history of allergic reactions to medication. Your dentist will be able to advise on your particular case.


 
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