John Gamba was 9 years old when a dentist failed to anesthetize a back molar properly and hit a nerve dead-on. The result was a lifelong fear of dentists that reached a peak in his 20s, when he stopped going to the dentist entirely. "I couldn't even drive by a dentist's office without getting stressed out," he tells WebMD.
Gamba was 38 when a chipped back molar began to decay, eventually causing him constant pain. "I was paralyzed. I couldn't even consider going [to the dentist's office]," says Gamba, an Internet entrepreneur from Naples, Fla. "It was much easier to accept the pain, sick as that sounds."
Few people look forward to a spell in the dentist's chair. But serious anxiety prevents millions of Americans from seeking proper preventative care. The consequences of this problem may go far beyond dental pain or lost teeth. Gum disease is a serious infection that can affect other parts of the body. Studies now link it to illnesses including heart disease, stroke, and diabetes.
Fortunately, many dentists are specially trained in handling fearful patients; a variety of methods and treatments are available to reduce pain and alleviate fear in the dentist's chair.
The 'Root' Causes
Between 5% and 8% of Americans avoid dentists out of fear, estimates Peter Milgrom, DDS, director of the Dental Fears Research Clinic at the University of Washington in Seattle and author of Treating Fearful Dental Patients. A higher percentage, perhaps 20%, experiences enough anxiety that they will go to the dentist only when absolutely necessary, Milgrom tells WebMD.
Milgrom's dental practice specializes in fearful patients. About two-thirds of them relate their fear to a bad experience in the dentist's office, Milgrom says. Another third have other issues for which fear of dentists can be an unpleasant side effect, such as various mood or anxiety disorders, substance abuse, or posttraumatic stress experienced by war veterans, victims of domestic violence, and victims of childhood sexual abuse.
Fear of dentists stems not so much from the experience of pain as from the lack of control that patients experience in the dentist's chair, says Ellen Rodino, PhD, a psychologist in Santa Monica, Calif., who has studied dental fear. "You're lying prone, a dentist is hovering above you, and he's putting you in a situation where you can hardly talk or respond. That creates a lot of anxiety for some people because they don't feel in control."
Still, many dentists create unnecessary anxiety in patients because they assume that all patients have similar pain thresholds and will handle dental procedures in the same way, Milgrom says. "If all dentists were a lot more careful about pain control, took the time to be sure patients were comfortable, and didn't go ahead if they weren't [comfortable], then we would create fewer phobics."
Fearful patients need to be more assertive about their needs, Milgrom says. Patients should say to their dentists, "I want to talk about what can be done to make me more comfortable. I don't want someone to tell me something doesn't hurt me."
Treating Fear of Dentists
Some dentists who specialize in treating fearful patients go out of their way to create a nonthreatening environment. The place where Jack Bynes, DMD, works in Coventry, Conn., is barely recognizable as a dentist's office. It's housed in a renovated historic gristmill, with a treatment room that overlooks a waterfall. The waiting room contains a fireplace and soothing photography; it's free of posters depicting the horrors of gum disease. Bynes himself fancies bow ties rather than scrubs. Many "people have a fight-or-flight reaction" to the sights, sounds, and smells of a dental office, and taking away these cues has a calming effect, Bynes explains. And Bynes should know. He specializes in fearful patients today because he himself had to overcome his own medical phobias as he trained to become a dentist.
Bynes first talks with patients in his office, rather than in the dental chair. "I tell them they can leave anytime they want," he says. "Only one has done it in 40 years. It's so they know they have control."
The best dentists use simple methods to enhance that feeling of control, Milgrom says:
- They gently explain what the patient will soon feel, and for about how long.
- They frequently ask the patient for permission to continue.
- They give the patient the opportunity to stop the procedure at any time the patient feels uncomfortable. ("I give them a cue," Bynes says. "If for any reason they need to stop, raise your left hand.")
- They make time for breaks as requested.
Many dentists lack the patience to treat fearful patients with the care they deserve, Bynes says. Even those who advertise that they "cater to cowards" may not do a good job of it. If you're looking for a new dentist, Bynes suggests being honest about your fears from the first call. Ask to speak to the dentist about your fears before you come in. If the receptionist seems dismissive, or the dentist never returns your call, don't go, he says. "That's not the right office for you."
Chances are, visiting a dentist won't be nearly as painful as you expect. Surveys of patients before and after the most dreaded procedures -- such as a root canal or wisdom tooth extraction -- have found that they anticipated much more discomfort than they actually experienced, Milgrom says.
The root canal in particular gets a "bad rap" because it is typically preceded by painful toothaches, Milgrom says. The procedure itself relieves this pain, often in just a single visit. Wisdom tooth extractions get a bad name because of occasional jaw pain experienced several days afterwards, which can be treated with pills.
Still, even if your mind tells you you'll be just fine, your body may still fear that dentist's chair. Here are a few tips that may help you overcome your fear of the dentist:
- Go to that first visit with someone you trust, such as a close relative who has no fear of dentists, Bynes suggests. Bynes even encourages friends and relatives to sit with the patient during treatment.
- Seek distraction while in the dentist's chair. Listen to your own music on headphones --"a new CD, not one you've heard a lot, so you'll be a little more interested in it," Milgrom suggests. Or find a dentist with a TV or other distractions available in the treatment room.
- Try relaxation techniques. Milgrom suggests controlled breathing -- taking a big breath, holding it, and letting it out very slowly, like you are a leaky tire. This will slow your heartbeat and relax your muscles. Another technique is progressive muscle relaxation, which involves tensing and relaxing different muscle groups in turn.
- Review with your dentist which sedatives are available or appropriate. Options include local anesthetic, nitrous oxide ("laughing gas"), oral sedatives, and intravenous sedation. While oversedation can be dangerous, too many dentists are uncomfortable using any oral sedation, Milgrom says. And only some dentists are qualified to perform IV sedation.
- If you can't bring yourself to go to any dentist, you might want to try seeing a psychologist first, says Ronald Kleinknecht, PhD, a clinical psychologist at Western Washington University and co-author of Treating Fearful Dental Patients. The most "tried and true approach" to treating dental phobia (and other phobias) is what Kleinknecht calls "direct therapeutic exposure." It involves introducing the patient to feared items -- say, a needle -- in a gradual and controlled manner.
As the pain from Gamba's back molar intensified, he found support online through a forum for people with dental fear. He also found a dentist, Fred Eck, DDS, of Bonita Springs, Fla., who advertises his skill with fearful patients. Before going, Gamba says, "I convinced myself that I wasn't going to have any procedure, that I was just going to talk with the dentist." But Eck put him so at ease that he agreed to the extraction of the back molar on the first visit. And it was painless, he says.
Comfortable with his new dentist, Gamba finally got some much-needed dental work done. He spoke to WebMD just an hour before an appointment to get his final wisdom tooth removed. "It's been miraculous," he says. "I've gained such strength, hope, and courage by getting through these experiences."