Can You Trust a Smiling Dentist? : San Diego Practitioner Uses Behavioral Techniques to Help Patients Overcome Their Dental Phobias

After 20 years of having his mouth poked and pried by a succession of Navy dentists, Ray Fluta didn’t exactly look forward to annual checkups.

“I developed a general dislike of going to the dentist as a child. I’d go in for a checkup and always hope I didn’t have any cavities so I wouldn’t need any drill work. I guess I don’t like people putting their fingers in my mouth,” he said.

While Fluta suffered through mouth-probing sessions, San Diego dentist Carl Jepsen pondered his own patients’ sufferings. In the past, he had used hypnosis to ease their anxiety, but he wondered whether he could do more to make visits a pleasure instead of a pain.

Jepsen decided therapeutic techniques that foster trust, caring and friendship between patient and doctor might help him desensitize his patients’ fears.

In 1970, he enrolled in the doctoral program in behavioral sciences at United States International University, earning his Ph.D. in 1983. What he learned dramatically altered his ideas about the doctor-patient relationship. He began looking at it as a partnership between two people, rather than a situation where the doctor takes total control.

Growing Trend

Jepsen’s use of therapy to relax patients has launched a rapidly growing trend in dentistry. The Hillcrest-based practitioner gets several calls a week to teach seminars across the nation on positive communications and behavioral techniques.

“When I first started lecturing 14 years ago, we were hard-pressed to put a class together,” said Jepsen, 47, who will present his first international seminar at a dental conference in Switzerland this fall. “Now, my classes of 400 for a three-hour lecture are standing room only.”

About 43% of dentists never ask patients about their dental anxiety, according to behavioral scientists at Northwestern University. Even if they are aware of a patient’s discomfort, dentists tend to ignore outward signs of tenseness as long as the patient cooperates.

Repeatedly abrupt treatment often causes people to delay or skip appointments. The dentist is anxious about the patient, the patient is anxious about the dentist, and in the end both are exhausted by what might have been a simple procedure under more relaxed circumstances.

Jepsen found that talking with patients about their fears for 20 to 40 minutes before examining them creates a bond of trust. The session works as well, if not better, than Novocaine, laughing gas or general anesthetic.

“We deal with high-stress situations constantly, and effective communications are essential in these areas,” explained one Jepsen admirer, Dr. E. Lynne Miller of Columbia, Mo.

Miller employs many of the same techniques the San Diego dentist uses. Like Jepsen and others on the profession’s cutting edge, Miller sees a move toward patient-oriented dental practices.

If Ray Fluta’s reactions are any indication, Jepsen’s work is succeeding. Since the retired lieutenant commander began seeing Jepsen last summer, he said he no longer dreads dental appointments and takes better care of his teeth. In fact, he looks forward to appointments and visiting Jepsen as well as his office staff.

“It’s sort of like a miniature family,” said Fluta, who plans to have his wife and children go to Jepsen as well.

Realizing that many people feel anxious or tense the moment they walk into a dentist’s office, Jepsen tries to create an atmosphere of relaxation based on trust. If patients feel their doctor is working with them, rather than on them, they are more likely to feel a sense of control. That in itself lowers anxiety.

For Elaine Krueger, a little control made a mouthful of difference. A self-described dental phobic, Krueger was so fearful of dentists she tried to avoid them socially as well as professionally in her work as a property manager. Her firm rented to two dentists and, though she knew her feelings were irrational, she disliked working on their accounts.

Extreme dentophobes will resort to having their teeth pulled and replaced with dentures so they can avoid the dentist forever, she said.

Krueger, 60, dreaded dental care like a child dreads a shot. Before and during her former dental appointments, she would suffer full-blown panic attacks, sweating and hyper-ventilating. Her dentists “recognized the symptoms, but what could they do about it? They’d just say, ‘Come on relax, relax.’ A lot of good that did!”

Finally, a dentist referred the Bonita resident to Jepsen.

“What he emphasized is that we would work on this together,” Krueger said. “That was the key for me. It made me feel like I had some control over the situation.”

Like Fluta, Krueger said she takes better care of her teeth since she began seeing Jepsen six months ago.

“The fear, anxiety and stress that used to accompany my trips to the dentist have been, if not completely removed, at least alleviated,” she said.

Unlike physicians who take classes in bedside manner during medical school, dentists aren’t schooled in making patients feel comfortable. To fill the educational void, the dental school at USC may add a class in “chair-side manner” to its curriculum, Jepsen said.

Lack of Training

The lack of training is ironic because dentists need good communications skills even more than doctors because patients often see them as inflicting pain rather than healing it. But it is the dentist who can stop pain more quickly, said Jepsen, while illness of the body often takes longer to diagnose and correct.

“Most dental schools don’t have time to talk about this in their curriculum,” he said. “It’s something dentists pick up on their own after school. And frankly, the dental practices that use this type of philosophy are the most successful.”

Since he began using behavioral techniques five years ago, Dr. Sheldon Greenspan said he is much happier with his practice in Orange, N.J. Before taking classes from Jepsen, Greenspan said, he “felt like a journalist running from assignment to assignment with no time to think.”

Greenspan said he wanted to work more closely with his patients, on a more intimate basis.

“People like Carl are trying to help the dental profession by saying that if you truly care about a person, the treatment will go much better,” he said. “I won’t patch people up anymore. It used to be that I was plugging people up, fixing people up. Now, I want to treat the whole person.”

Jepsen explains his partnership philosophy to patients, making sure they feel comfortable with his open attitudes. Some people would rather work with a doctor who takes all the responsibility and makes all the decisions about a patient’s treatment, he said.

“I want them to choose to be here; I don’t want them to be here by default,” he said.

Jepsen’s style isn’t for everyone, but that doesn’t trouble him. He sent one woman to another dentist after she nixed Jepsen’s partnership plan. Still, the move was a success.

“She wrote me a thank-you note saying I’d found the perfect dentist for her,” he said.

Jepsen said his relationships with his patients are like friendships. Not only does he encourage patients to confide in him, he is honest with them as well. When he received word recently that his son had broken his arm, Jepsen explained the situation to his patient so she wouldn’t wonder why he was distracted.

Had he not explained, the woman would have picked up his concerns on a subconscious level, he said, wondering whether something awful was wrong with her mouth, or whether the dentist was angry with her. By being honest, he alleviated her anxiety, Jepsen said.

“Instead of getting upset, she asked me if I would be all right,” he said.

When a new patient arrives, Jepsen greets them with a handshake and takes them to his upstairs offices. There is no dental equipment, just oak office furniture and two comfortable chairs. Academic degrees hang on the walls. They discuss the patient’s fears about the dentist and why he or she feels scared or distrustful.

If the patient feels comfortable, Jepsen takes him downstairs for a check-up to determine what kind of work they need.

Jepsen doesn’t charge for his initial therapy session. He’s learned that if a patient is relaxed when he comes in, his time has been well spent. The National Institute of Dental Research says dentists can save 20% of their time if the patient is not afraid.

Fluta, who had been referred to Jepsen by friends, said he was slightly skeptical when Jepsen took him upstairs in his homey, peach-painted building on Park Boulevard, figuring that, “I’d be seeing a head shrink upstairs.” But his skepticism vanished soon after they began talking, and he said he felt comfortable enough to tell Jepsen he was afraid to have his teeth capped. To rid Fluta of his fears, Jepsen used a desensitization technique called “anchoring.”

Asking Fluta to imagine his worst dental fear, the doctor lightly touched the man’s wrist to “anchor” the anxious feeling. Then he told Fluta to imagine something pleasant, a situation in which he was confident and in control. He touched Fluta’s hand to anchor that feeling.

While Fluta remained fixed on the negative thought, Jepsen simultaneously touched both places. The patient’s fears are neutralized by merging the fear with the sense of confidence.

Fluta swears by the technique.

“It was just really holding my hand and two gentle touches. I could just feel all my old fears of going to the dentist go away. I wish more dentists would use the technique. Otherwise, people will just go in and gut it out when there’s no reason to.”

Perhaps just as important in allaying his fears, Fluta, 42, liked the idea of building rapport with a doctor after 20 years of seeing one Navy dentist after another.

Krueger likened her visits to relaxing in a home rather than an going to an office appointment.

“It’s a treatment for both the mind and the body,” Krueger said. “Instead of a laying on of instruments, it’s a laying on of hands. It is a healing experience.”