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 Fallacies Keep Us Fearful and Avoiding the Dentist

by Andrea L. Algar

Let's face it, dental fears go back to the days when dentistry was pretty barbaric and yet, they are still prevalent even in today's era of modern dentistry and outstanding technologies that make dental procedures easier than ever before. So what are we hearing that keeps us stuck with unrealistic dental fears?

Credit: mimiandeunice.com

I've done some research into the matter, and what I've found is that information that is passed from person to person is sometimes based on absolute falsehoods.

Some of the information I uncovered is blatantly out there on the Internet, spoken as if gospel. Others are from stories that people have passed on to me first-hand. Like the story which was presented as "fact" by the young man who insisted that it was FAR better to go without brushing your teeth or having a cleaning at the dentist because once you disrupted the natural state of things in your mouth, you were BOUND to get a cavity!!!  (Hmmm....wonder how many he has by now without his dental visit!) He was actually convinced that going to a dentist would make him get a cavity.

Here, I've compiled a list of what "facts" (actually false) that I saw the most. See which ones you've heard, then follow with the facts:

1) Root canals hurt like hell.
2) Pregnant women should not have dental care during pregnancy.
3) Fluoride in our drinking water is dangerous.
4) You shouldn't use toothpaste with fluoride because it's already in our water.
5) If you lose a tooth, it's okay to just leave it alone.
6) Smoking doesn't affect your teeth.
7) Tooth extraction is necessary when you crack your tooth.
8) Wisdom teeth always need to be removed.
9) It's okay to delay dental treatment if you're not in severe pain.
10) If it doesn't hurt, it's okay.
11) Nutrition isn't important to teeth.
12) If I haven't been to regular visits, my dentist may take it out on me.

Here's the facts:

1) Root canals don't have to hurt. Modern dentistry has blessed us with many options to reduce and/or eliminate pain during procedures. Modern equipment is better than ever. Even the dreaded dentist's drill is far less scary than forty or fifty years ago. The plain truth is that the root canal procedure is designed to help save your tooth/teeth.

2) There is no evidence that dental procedures cause harm to mother or baby. In fact, the opposite may be true. Women who maintain their dental health during pregnancy have less risk of passing infection to their unborn baby.

3) Despite some scrutiny on the use of fluoride in public drinking water, the Centers for Disease Control and American Dental Association stand by the practice. Facts seem to back them up.

• Since 1960, total tooth loss in adults has dropped 60%. 
• Cavities among adolescents has decreased from 90% to 60% 
• The number of teeth with cavities dropped from 6.2 to 2.6 
• When factoring in all age groups, the cavity rate drops to just 40%.

4) The amounts of fluoride used in drinking water and toothpaste combined are not considered dangerous levels.

5) If you lose a tooth due to decay, gum disease or an injury, it's important to see the dentist to have some type of replacement made. The options generally are denture, implant or bridge. The primary reason is to prevent jaw problems, pressure on other teeth, change in your bite, help with speech and chewing, as well as aesthetic reasons.

6) We've heard of the dangers of smoking for decades, but there is now far more evidence on the extent. Smoking can affect your teeth, gums, tongue, mouth and throat as well as other parts of your body. In addition to causing smoker's breath, it can cause oral ulcers and cancers. Luckily, twice-yearly dental exams can help identify these early when treatments are more effective.

7) This may have been commonplace fifty or a hundred years ago, but today, a cracked tooth can be fitted with a crown to restore the tooth to full function. Modern equipment is now available that delivers same-day crowns in a single visit.

8) Wisdom teeth don't always need to be removed. If there is sufficient space in your mouth, and they are not problematic (such as impaction) they can stay forever. Many people do need to have wisdom teeth removed, however, and can be helped greatly with sedation options if they are nervous or fearful of the procedure.

9) Some patients delay visits because they can't afford treatment right now, are fearful, or feel they don't have the time. Whatever the reason, it's usually not a good idea as delaying can only make your existing problem worse, cause more pain, and may even end up costing you more money.

10) Even though pain is sometimes a good indicator that there is a problem that needs attention, not all dental problems cause pain. People have different pain tolerances. Different dental problems cause different amounts of pain. And, pain can be intermittent. If something has changed in your mouth, you'll want to discuss it with your dentist just to be sure.

11) There is overwhelming evidence that nutrition is very important to oral health. And it's not just milk that creates strong teeth! In addition to what you eat, there is now some evidence that shows it may be equally important how you eat! (We'll take a look at this in more detail in a future article.)

12) I actually had a friend who believed this! Yet, I have never encountered a dentist who didn't realize that going to a dentist can be difficult for many people. Don't let it prevent you from starting a new routine and instead of avoidance, you ask your dentist for help in forming new healthy habits!

What I've concluded from my unscientific research into this is that fearful people generally like information that gives them the excuse not to have to go to the dentist. Unfortunately, there is a lot of bad information that is abundant on the Internet and is often passed along from person to person unchecked for fact. If in doubt, check out the facts by visiting websites that are reputable. The American Dental Society and WebMD. have sites which are based on fact.

There are more dental fallacies, I'm sure. Stories I didn't uncover, or haven't heard before. I hope it does get you to take a look at the information being given and to do your own research into it if something sounds suspect. Of course, what makes a lot of sense is to get a visit with your favorite dentist and ask him or her! I find that a good dentist loves to give the right information.

Got a story you'd like to share?

RESOURCES:
ADA - American Dental Association
WebMD - WebMD

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

Fact or Fiction: Number 1 Infectious Disease In Children Is Tooth Decay

by Andrea L. Algar

An recent article on OregonLive.com made the bold headline that the "No 1 infectious disease among kids is tooth decay; early dentist visit matters," sparking more than a few comments about how true this claim may be, or whether it was "propaganda". I was a bit surprised by the skepticism so I decided to do some research.

Early Dental Care
Essential To Good Health

Common sense would seem to suggest that, sure, the earlier a child is introduced to the dentist, the greater the chances are that he/she will not develop any unrealistic fears, receive good oral health training, and perhaps do a better job of brushing and flossing.  And, research does seem to back up the claims that the earlier we involve our children in dental care, the better. The ultimate goal, of course, would be to have our children develop such good dental care habits that they do not develop any cavities and end up with a mouth full of beautiful, healthy teeth.

But even in today' advanced society, there is controversy. And it certainly exists when it comes to dental advice. The American Academy of Pediatric Dentistry's (AAPD) published report on the state of oral health of children in the United States seemed to strike a nerve for some. The report concluded, "Tooth decay has become epidemic among our youngest children." It went on to express fears that the Affordable Care Act (ACA) may actually worsen the trend, and concluded, "What is most frustrating for our organization, the American Academy of Pediatric Dentistry (AAPD), is most tooth decay is preventable."

The AAPD hopes that by launching their new educational campaign, more people will learn the importance of teaching our children good oral hygiene early on. They say that children should be learning these skills as early as one year of age. Does the AAPD have an "agenda"? Well, yes! I think they hope to spread the message that early intervention is key in preventing a lot of common dental problems that, if left untreated, can become serious health issues.

The actual report (see link below) contains 149 reference citations supporting their claims. And, their findings seem to be backed up by the Centers for Disease Control (CDC) and the American Dental Association (ADA). The AAPD research demonstrated the importance of good oral health and how something as "simple" as a cavity can have long-term consequences such as:

• dental pain
• ear, sinus and brain infections
• chewing difficulty
• loss of teeth
• greater risk of tooth impaction
• gum disease
• poor speech
• interrupted sleep
• self-esteem issues
• poor school performance
• health issues such as asthma

Long term, chronic tooth disease can lead to:

• obesity
• diabetes
• heart disease
• death

I thought the paper was well done. I hope it helps to get the message out to parents.

Not all dentists treat children, but even those who treat adults only know that proper introduction to dental services is essential in helping children develop good dental hygiene habits that can last a lifetime. Preventive care has always played a significant role in avoiding common problems such as cavities as children grow into adulthood. For those who did not have the best dental habits as a child, the message seems clear. Seek out good dental care so problems can be addressed and more serious consequences avoided.

RESOURCES FOR MORE INFORMATION:
AAPD - The State of Little Teeth
ADA - Disease Prevention
CDC - Children's Oral Health

Kardashians Giggle Over Dental Visit

by Andrea L. Algar

The Kardashians seem to make news in just about every aspect of their daily life. Whether they're in the headlines for what they wear or who they are being seen with, the press just can't seem to get enough. Today's buzz is all about Kourtney Kardashian's recent visit to the dentist.

Kourtney Kardashian
Photocredit: Instagram 01-30-14

All across the internet we're seeing photos of Kourtney Kardashian's lopsided grin as anesthetic kept her mouth partially numb. Reports are that sister Khloe couldn't help but make fun, and the media went wild.

Most of us have experienced what its like to have a numb mouth or lips following some dental procedures. It's not that it is uncomfortable or painful, it just makes it a bit more difficult to eat, drink and even smile. Effects are temporary, and usually do not last long. And, we're usually able to avoid having anyone notice, in fact, it is usually only noticed if we say something.

So don't fear. Thankfully, most of us will never need to fear the embarrassment of being caught in the spotlight as Kourtney Kardashian did. With a little planning, no one need know you've even been to the dentist.

If you have concerns about numbing injections or any procedures used in dental offices, talk to your dentist. He/she can explain the use, affect, and potential side effects, and can sometimes offer alternatives to help put you at ease. With modern dental equipment and techniques you no longer need to worry. Just look how much fun the Kardashian's had!

RESOURCES:
eonline.com - Kourtney Kardashian's Mouth Is Numb...
globalgrind.com - Awkward! A Dentist Trip Leaves Kourtney Kardashian's Mouth...
nydailynews.com - Khloe Kardashian Shares Funny Video...

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.