Overcoming Dental Fears Now And In The Future

by Andrea L. Algar

Dentists have been struggling for years to help patients conquer fears of coming in for much needed dental services. For some men and women, as little as the sound of a dental drill brings feelings of anxiety and even panic. Racing heart, sweaty palms, body shakes, irregular heartbeat and hot or cold flashes are just some of the symptoms that can happen in an instant when a panic attack happens.

MRI

In a previous article, we looked at research presented at the Society for Neuroscience that suggests that they may now be closer to understanding dental fears thanks to MRI's that allow them to "see" anxiety. Researchers revealed the findings after studying two groups of people: those who had dental anxiety in one group, and those who had no history of dental anxiety in the other.

MRI (magnetic resonance imaging) brain scans were taken while the researchers played a variety of dental sounds of dental drills and suction instruments. They found that there was marked differences in brain responses between the two groups.

Some say that this finding suggests that with the use of MRI's, dentists may soon be able to uncover specific calming methods for their anxious patients. With the high costs of MRI, and the difficulty in getting anxious people to come to a dental office in the first place, it begs the question of whether this will ever be an effective way to diagnose exact triggers and calming methods for those who have moderate to extreme dental anxieties.

It is estimated that about 10 percent of the general population suffer from severe anxiety about going to the dentist. Many of these men and women put off visits to the dentist until they have a full-blown problem that needs immediate attention. Even then, a good number still avoid going. Dental anxieties can cause overwhelming fears that lead to dental avoidance altogether. This can have devastating consequences, as there is clear evidence that dental problems that are not treated appropriately can lead to a number of serious medical conditions.

Many think that anxiety is caused from a fear of pain, and this may be one of the common fears, although fear of the unknown (i.e. what's going to happen next, what instrument will the dentist use, what if I gag or choke, etc.) is probably just as provoking as "how much will it hurt". The "what-if's" are an anxious person's worst enemy.

Contrary to what many anxious patients believe, pain is actually quite rare in dental surgeries and in many dental procedures. A recent survey by Tickle confirmed this, reporting that, "451 adults visiting dentists in the north-west of England and found that 75% of patients reported no pain at all during their visits. Those having the most invasive procedures, such as tooth extractions and root canal treatment reported some of the higher pain scores, but even many of these claimed to experience no pain at all." While this news should be encouraging to most people, the report concluded, "The strongest predictor of pain during dental procedures was dental anxiety. Anxious patients were four times more likely to experience pain than non-anxious patients."

Dental fears are very real for those who suffer with them. While we have a number of dentists who are sympathetic to dental fears and offer services under the names "gentle" and "calming", it often does not address the anticipatory anxiety that can overwhelm a patient and prevent them from going to any dentist, even one who caters to nervous patients. For anxious patients, the anticipation is often worse than the actual experience, and for these men and women, it needs to be addressed by professionals who know how to help.

The good news is that there are extremely effective methods available right now. The field of anxiety treatment has been much improved with the wider use of cognitive-behavioral methods by qualified mental health experts trained in handling anxiety and phobias. These methods work well with dental anxiety and dental phobias.

Richard C. Raynard, Ph.D., a Licensed Psychologist who has specialized in anxiety and phobias for over 35 years, explains, "Anxious patients are much more likely to perceive pain, even at times when non-painful procedures or simple events such as rinsing the mouth with water occur, because they are already in an anxious state. Their body may be reacting in ways that makes them feel like they are about to die or have no control. It is easy for their anxiety levels to escalate quickly. However, these types of anxieties are very treatable."  Even more severely affected phobic individuals can be helped with these methods and go on to successfully, and comfortably, visit their dentists for needed services.

RELATED ARTICLES:

Dr. Bowen - Dental Fallacies Keep Us Fearful And Avoiding The Dentist
Dr. Bowen - Dental Fears "Seen" By Scientists

ABOUT THE AUTHOR:
Andrea L. Algar is a writer and business consultant in San Antonio, Texas. She has worked with healthcare, beauty, automotive, music and other professionals for over 35 years.

Dental Fears "Seen" By Scientists; Therapists May Hold Key to Overcoming Them

by Andrea L. Algar

Sound of the dentist's drill can create anxiety for some, unleashing a variety of symptoms such as rapid heartbeat, sweating and nausea. For others, studying why this happens is a compelling mystery.

Dental Fears

The Society for Neuroscience reported at a recent meeting in San Diego that researchers now believe they are closer to understanding why some have anxiety and others do not. Scientists in Japan have discovered that some patients display different brain activity which could be the key to effectively handling dental fears for those more predisposed to it. The goal, of course, would be to ease anxiety symptoms and perhaps eventually eliminate fears at the dental office.

The study was conducted scientifically, of course. With the help of psychiatrists, two control groups were created after assessing how much patients feared a trip to the dentist. Researchers then divided the research subjects into two groups; low fear and high fear. 

While playing sounds usually found in a dental office such as suction instruments and drills, responses were measured in the brain for both groups by scanning subjects in an isolated MRI where brain activity results would not be influenced by visible or audible responses. The sounds were mixed with a variety of different sounds deemed "neutral" so that reactions to the dental sounds could be measured reliably. The MRI images gave researchers results they could actually "see". 

What researchers discovered was that those in the low fear group displayed more activity in the brain when responding to the dental sounds than when they heard the neutral sounds. The activity occurred in the auditory areas of the brain. In the group of high fear subjects, however, they found more intense levels of activity in the part of the brain called the left caudate nucleus, thought to play a role in learning.

This research supports the findings of behavioral psychologists who have learned that cognitive-behavioral methods can be extremely effective in treating a variety anxiety disorders, including dental fears and phobias. Richard C. Raynard, Ph.D., Clinical Psychologist and anxiety disorder specialist, explains, "Many people have small amounts of dental anxiety, which is normal. It is quite common for people to experience brief episodes of anticipatory anxiety, primarily from a fear of the unknown (i.e. what will be needed, how much will it cost, will it hurt, will other people notice)." 

Dr. Raynard elaborates, "For about 10% of adults, however, levels of anxiety can be quite severe. Some even develop full-blown phobias. For these people, fears can bring on symptoms such as heart palpitations, sweaty palms, dry mouth, nausea, dizziness, and a host of other body symptoms. The pattern of anxiety, physical symptoms, then worry actually reinforces the anxiety and can lead to episodes of panic and avoidance.  Over time, patients may avoid all dental visits, including dental emergencies." 

The news is good, however, even for those with dental phobias. "Dental fears are highly treatable with a form of behavioral therapy which includes desensitization. Visits to a psychologist with this specialized training and experience can help reduce or eliminate dental fears and allow for needed dental work to be done without the grip of anxiety or panic," states Dr. Raynard. 

Dentists who are sensitive to patients with anxiety is important. Dr. Gregory R. Bowen, a San Antonio dentist with over 30 years experience, believes that there are a number of reasons why people can develop dental anxiety. Early dental experiences, not being informed before a procedure, and even listening to someone else's story about a dental visit can affect one's views of the dentist and create unneeded and unwanted anxiety. "Dental fears can be learned. Dental anxieties are more common in children with parents or caregivers who have dental fears. In my experience, those with anxiety are also far more likely to report pain during a dental visit, where the vast majority of patients do not experience pain. In fact, many patients report a reduction in pain following a dental visit. Dental fears can be addressed in a variety of ways once your dentist is aware that you're anxious," explains Dr. Bowen. "It's important so that we can help our patients feel comfortable and trust that we will do everything we can to minimize their anxiety."

Dental research will continue to explore how to integrate the use of cognitive-behavioral methods along with dentistry that is sympathetic to those who have anxiety. Some dentists already have an understanding of this relationship and, like Dr. Bowen, have taken steps to make trips to the dentist more relaxing for anxious patients.

REFERENCES:

Official Website: Society for Neuroscience

OASIS: 2013 SfN Conference Abstracts

Richard C. Raynard, Ph.D.: Panic Update, Panic Doctor Website

Dr. Bowen: Website for Dr. Gregory R. Bowen, DDS

How to Find The Right Dentist - Your Step-By-Step Guide

by Andrea L. Algar

Sooner or later, we're all faced with the task of needing to see the dentist for a visit. While many have regular preventive visits, others avoid not only regular cleanings, but needed services such as handling a cavity, chipped tooth or even toothache or abscess. Some avoid the dentist because they have real anxiety and dental fears. Many times they have not even looked for a dentist until they reach a crisis point . . . then they need to find a good dentist fast.

For many people it can be unsettling when trying to find a new dentist. Where do you begin? How do you find something who is honest, trustworthy, skilled and just plain nice? The list of concerns  can grow, anxiety rises, and it can sometimes feel overwhelming.

Most dentists try to set their practices apart from others in their area by offering unique services, focusing on their experience or skills, or by offering competitive prices, all while claiming to provide top care. Most all have the common goal of wanting to maintain a strong and comfortable doctor-patient relationship. So how do you narrow down the field of dentists and find one that feels like a good fit for you?

First, look at some of the reasons why you need to see a dentist:

• toothache
• jaw pain
• cavity
• loose tooth
• chipped or broken tooth
• missing teeth
• broken or lost filling
• broken or lost crown, cap or bridge
• sports injury to mouth, teeth, jaw or tongue
• auto injury to mouth, teeth, jaw or tongue
• infection or abscess in mouth
• loose dentures
• crooked teeth
• chronic bad breath

Then, look at what you look for in a good dentist:

• trustworthy
• fair prices
• honest appraisals of what you need
• honest recommendations of what is the best treatment
• respectful of your time
• convenient location
• convenient hours
• friendly staff
• accepts your insurance
• is sensitive to your anxiety / dental fears
• experienced
• utilizes modern technology and equipment
• stays current in training, education and new techniques
• is skilled
• respected by his peers

It is always better to have found a great dentist before you need them for a dental emergency. But how do you find a dentist that meets all your top wishes in the competitive and sometimes confusing world of dentistry? Here are some suggestions:

1)  Ask friends, relatives or co-workers for recommendations. People will freely recommend a good dentist.

2)  Do an online search and visit different dental websites for dentists in your area. If there is a specific need you have, such as gum disease, see who offers that specific service and take a look at what they say on their website. You should get an immediate "feel" for who they are.

3)  Then take a look at how they rate with the factors which are most important to you. Don't be afraid to be specific:

     - How much experience do they have?
     - How long have they been practicing in your area?
     - Is it a private practice or a large group practice? (this may or may not be important to you)
     - Have they invested in new technologies that can provide a better experience?
     - Do they offer non-invasive techniques that are usually less painful and shorter recovery times?
     - Do they accept your insurance and/or offer payment options for cash pay?
     - Do they offer patient financing for larger procedures?
     - Do they offer convenient hours or have options for emergencies?

4)  What do their patients say about their experiences with your top choices? This can reveal a lot about the dentist and his/her practice. Some say that review sites encourage complainers, others show that they encourage those who are happy to share with others. In truth, it's probably a bit of both. Do the reviews you see seem genuine? Good reviews typically reveal small details about their visits that let you know they're real. When you get several patients with similar experiences, it is usually a good indication that this is "normal" for that dentist.

4)  How does the office respond to you when you call their office or send an e-mail for more information? Do they listen to your needs or do they push you for an appointment before you're convinced they're the right fit? Do they offer a consultation with the dentist or do they require that you see a hygienist or other staff person for an evaluation?

5)  Once you schedule a consultation visit, assess how well the dentist explains his findings and recommendations. Do you feel they listened to your wishes and needs? Did they have your best interest in mind? Do you feel they addressed any concerns that you had, and that you were given options? Were you given time to make a decision or did you feel rushed or pushed into making a decision on the spot?

Remember, you do not need to feel obligated to have a treatment if you're not convinced you've found the right dental office. Sometimes you need to think things over following your initial consultation, and you should feel okay with that. A good dentist will understand that it is not always easy to look for a dentist, and that many factors go into selecting one.

Once you do find the "right" dentist, you'll feel relief knowing that you can turn to your new dentist for any dental need that may come up. A great dentist will make sure you understand treatment recommendations and options, will instill trust, and may even relieve your fears of going to the dentist!

ABOUT THE AUTHOR:
Andrea Algar is a writer who is a regular contributor to Dr. Gregory R. Bowen's blog. Over the last 30 years she has published articles on a variety of topics, authored two books, and writes for several blogs.