Drilling out the fear factor




This is an article from the Irish Times by a patient of ours about dental anxiety

About 10 per cent of people worldwide are phobic about dentistry. Liz Kelleherfinds out why we are so nervous about the dentist’s chair and reveals a few tips on getting through that annual check-up
If thoughts of the dentist set your teeth on edge, take comfort from the fact you’re not alone. “Fear and anxiety about dental care is very common,” according to Dr Eddie Cotter of the Irish Dental Association (IDA) – and it’s not just an Irish phenomenon.

Dr Marylin Poynter, an Irish-born dentist who helped found the British Dental Anxiety and Phobia Association (DAPA), qualified as a clinical hypnotherapist and developed workshops to help dental phobics to overcome their fears. Her research indicates that about 10 per cent of people worldwide are phobic about dentistry.
The IDA estimates that more than 80 per cent of the population are entitled to a free annual oral examination and polish. But surveys consistently show that Irish people are reluctant to go.

Psychologists rank people’s concerns about dental visits into four categories ranging from nervousness to phobia. For dental phobics, fear prevents them attending a dentist even when in great pain. They resort to painkillers to manage pain, rather than seek professional help.

Dublin dentist Colin Lynam has witnessed this first hand: “People who are very anxious will self medicate until they’re unable to handle the pain and will attend the dentist only as a last resort. I’ve had people who’ve come in only when they became worried they’d overdose on paracetamol, the pain was so bad.”

Cotter says: “The anxiety is very understandable in light of the vulnerable situation in which a dental patient finds themselves.”
Lying back with your mouth open with a bright light shining in your eyes, while a stranger pokes at your teeth with sharp instruments is bound to induce a sense of powerlessness in even the most self-possessed patient. But there’s more to dental anxiety than physical insecurity; it can also stem from early childhood experiences.
“The first life experiences for a newborn are through the mouth in terms of breastfeeding, and as infants explore the world, they do so by putting everything in their mouth,” explains Cotter.
“The eruption of baby teeth can signal an end to breastfeeding and this may be traumatic for the child, who may subconsciously link the mouth with a sense of upset. The loss of baby teeth can also be traumatic for young children, as they may not understand that new teeth will appear.”

In most cases it’s a bad experience in the dental chair that causes the fear. Dubliner Lisa Curtis (27) attended the dentist regularly and fearlessly until a painful extraction 10 years ago.
“I can’t go to the dentist now,” she says, “because I just associate it with pain. I had a needle a few years ago and the pain was excruciating. Memories of childbirth compare well to thoughts of the dentist.”
There is evidence to suggest that parents can unwittingly pass their dental anxiety onto their children. Lisa agrees.
“Your fears do rub off onto your children. My dad was terrified. He’s six foot two but he’d faint going to the dentist. As children, he’d bring us to the clinic and wait outside. I think after my own bad experience, I absorbed some of his fear.”
Does she worry that she could pass her fears to her son?
“Yes, but we’ve been careful. My partner likes going to the dentist so he brings him.”
The wealth of horror stories and jokes involving dentists can also instil fear in patients.
“People say all sorts of horrific things to patients and there’s a huge psychological impact,” says Lynam.
But avoiding the dentist can only ever be a short-term strategy. This writer had clocked up a personal best of 15 years when an abscess finally drove me to confront my dental demons. Fortunately, a lot had changed in the 15 years since my last visit. Having recently undergone four extractions and eight fillings, I experienced the remarkable advances made in the crucial area of pain control.
My gums were numbed before the needle was inserted and music hummed in the background to drown out the sound of the drill. The mild sedative prescribed before the first visit helped reduce my anxiety to normal levels. I didn’t need a sedative for the second visit and now feel no anxiety at the prospect of future visits.

The good news is that dental anxiety can be cured.
“All dentists in Ireland will have been trained in identifying the concerns of patients, and will have developed many different methods to help them,” says Cotter. “Communication is central to achieving a positive outcome.”

Lynam agrees: “Communication is very important. You need to talk to the patient and identify the source of their anxiety and deal with it. Then you have to get rid of the pain.
“You’ll always try to do something that’s not invasive but that will ease the pain. Basically, you’re building up the patient’s trust. Once the pain has been eliminated, it’s important to work out a treatment plan and talk the patient through it,” he says.
“You explain what treatment options are open to them and the potential consequences of leaving the problem untreated.
“It’s basically a process of informed consent.”