|Year : 2013 | Volume
| Issue : 3 | Page : 73-74
Helping our patients overcome their fear of the dentist
James K Bahcall
American Board of Endodontics, Midwestern University College of Dental Medicine, Downers Grove, Illinois, USA
|Date of Web Publication||25-Sep-2013|
James K Bahcall
American Board of Endodontics, Midwestern University College of Dental Medicine, Downers Grove, Illinois
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bahcall JK. Helping our patients overcome their fear of the dentist. J Res Dent 2013;1:73-4
Just for one moment, try to picture yourself in the dental chair awaiting treatment without any prior knowledge of dentistry. I bet your heart rate just increased and a bead of sweat has formed on your eye-brow! This type of reaction is common in the estimated 30 to 40 million Americans who still have fear, anxiety or phobia when it comes to visiting a dentist.  Today, it has never been more important for dentists to address the topic of a patient's fear of dentistry.
As dentists, it is very easy to get caught up in the everyday practice of dentistry, worrying more about our crown margins and root canal obturations than what our patients are thinking or feeling during these dental procedures. With all of the periodicals published each year, there is very little that is written about how dentistry can change its poor public perception in terms of a patient's fear and anxiety of oral healthcare.
It still amazes me how some patients can go through a major medical procedure like cardiac bypass surgery or childbirth, but the anticipation of a trip to the dentist raises fear that does not compare with any of these medical treatment experiences. Bare  study showed that 66% of the people surveyed attributed their anxiety of going to the dentist due to fear of anticipated pain.
Although dentists today are very well trained healthcare professionals, one of the common previous bad experiences of dental patients is the dental injection. It has been reported that one in four adults have a significant fear of dental injections that lead many of these individuals to avoid dental care.  Easing a person's dental anesthesia anxiety through education can be one of the best therapies you can provide. It is important to explain that the local anesthesia used in dentistry today is significantly better than the Novocain type anesthesia that these patients have been exposed to in the past. Secondly, that a dentist uses topical anesthesia on the gingival tissue prior to any injection. Thirdly, local anesthesia is slowly placed into the injection site, which will cause minimal patient discomfort. Also, instructing a patient to eat a light meal before a dental appointment in which local anesthesia will be given will help prevent their chances of feeling light-headed or passing out in the dental office. Lastly, we need to explain that there are other types of anesthesia (i.e., nitrous oxide, oral sedation, etc.) that can be offered to patients in conjunction with local anesthesia to help an individual feel more comfortable with experiencing dental treatment.
A study by Brenson  reported that patients, who experience dental anxiety but did seek dental care, were significantly better at developing coping strategies than dental phobics that avoided seeking dental care. Therefore, it is especially important when a apprehensive individual does become a patient in your office or clinic that you extra spend time with this person to discuss oral health prior to any dental treatment. This discussion on changing your patient's perception of oral healthcare can include:
- Help a patient overcome their fear of the dentist by empowering them with proper knowledge on how advanced the practice of dentistry is today. Living in the internet era provides the patients with unlimited access to healthcare information. Unfortunately, not all of the information that the patients receive is correct. This misinformation on oral health can continue to fuel their fear and phobia of dental treatment
- Review a new patient's medical history and provide a thorough oral examination before proceeding with any dental treatment. Although oral and esophageal cancers account for less than 3% of all the cancers detected in the US each year, it is the eighth most common cancer in males and fifteenth most common in females. Oral cancer is the eleventh most common cancer worldwide.  Early detection and treatment can save a patient's life. Take a patient's blood pressure. A patient with high blood pressure can go undetected because they tend to avoid regular check-ups with the medical physician too.
These comprehensive oral examinations can help a phobic dental patient understand that dentists are not just "tooth mechanics", but rather oral physicians. The patient will also learn to appreciate the need for regular dental examinations and be less fearful of the dentist knowing that each time they visit the dentist that major dental treatment will not be needed to be performed.
- When a new phobic patient comes in to your office or clinic in pain, it is paramount that you listen carefully to their chief complaint. Proper diagnosis of a non-odontogenic or odontogenic problem must be completed before any type of dental treatment is rendered.
In certain cases, a patient may present with what they describe as a toothache when actually the pain is being referred to the teeth or tooth from another source.
For example, in 10% of heart attacks, pain can radiate to the lower jaw (primarily the left side) rather than down the typical left armpathway.  Also, maxillary sinus infections can cause the entire quadrant of the teeth to be sensitive to temperature and mastication. A patient's fear and anxiety will be greatly reduced when you are able to accurately diagnosis odontogenic and non-odontogenic pain etiologies, especially when you may be detecting a major health condition. Providing treatment for a patient's odontogenic pain will also help reduce their dental phobia.
- Although dentists do a wonderful job educating their own patients, organized dentistry must commit also to properly educating the general public who avoid oral healthcare due to fear and anxiety.We must inform these individuals that 21 st century dentistry is light years away from what it was even 15 years ago and that optimal oral health can be achieved without any of the fear and anxiety.
In the book The Tipping Point, author Malcolm Gladwell  writes about how certain small events (termed as tipping points) can cause a larger epidemic-type change within a population. He wrote, "Look at the world around you. It may seem like an immovable, implacable place. It is not. With the slightest push, in just the right place, it can be tipped."
Perhaps our continued message to the public can help "tip" the way dentistry is viewed by those who have anxiety and fear of dentists and oral healthcare. I certainly hope that our profession will cause a significant change in the way people think and feel about their oral healthcare. After all, it is the "word of mouth" from our patients about their positive dental experiences that will ultimately ease their dental phobia and the public's perception of dentistry.
| References|| |
|1.||Bahcall J. Smile for Life. 1 st ed. Cleveland, Ohio: Greenleaf Book Group; 2004. |
|2.||Bare LC, Dundes L. Strategies for combating dental anxiety. J Dent Educ 2004:68:1172-7. |
|3.||Heaton LJ, Leroux BG, Ruff PA, Coldwell SE. Computerized dental injection fear treatment: A randomized clinical trial. J Dent Res 2013;92:S37-47. |
|4.||Bernson JM, Elfstrom ML, Hakeberg M. Dental coping strategies, general anxiety, and depression among adult patients with dental anxiety but with different dental-attendance patterns. Eur J Oral Sci 2013;121:270-6. |
|5.||Neville B, Damm D, Allen C, Bouquot J. Oral and Maxillofacial Pathology. 3 rd ed. St. Louis, Missouri: Saunders Elsevier; 2009. |
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|7.||Gladwell M. The Tipping Point. 1 st ed. New York, New York: Little Brown; 2000. |
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