Dentists Learn to Treat the Anxiety, as Well as the Decay

Many people suffer from dental anxiety. Just the thought of going to the dentist fills them with terror. As a result, they postpone needed care until dental disease forces them to seek treatment. But why are people so fearful?

“Many people are afraid of going to the dentist because past experiences have been very poor,” says Harvey Passes, D.D.S., Director of Dental Anxiety Control at Jamaica Hospital’s Department of Dentistry in Jamaica, N.Y.

Parents often unwittingly add to their children’s fear by threatening to take them to the dentist if the children aren’t good. Hearing another person’s less-than-pleasant experience at the dentist adds to dental anxiety, as do TV and movie portrayals of dentists.

But thanks to modern techniques, today’s dental visit can be practically painless. Laughing gas (nitrous oxide) and hypnosis help patients relax. Solutions dissolve decay so it can be scooped away with little drilling. And high-speed drills cut down drilling time.

Many dentists also gear their practices to helping anxious patients relax. Patients can bring in their favorite audio cassettes and have the music piped into their room during the visit. To block out the sound of the drill, some dentists let patients wear stereo headphones. Others provide video games or small television sets mounted near the ceiling as distractions.

For some patients, though, these distractions aren’t enough.

“Until recently, the only way to treat dental anxiety patients was by general anesthesia or intravenous sedation. In other words, patients had to be medicated with tranquilizers before, during and sometimes after dental treatment,” Passes says. “These are good ways to help the anxious patient complete dental care. The disadvantage is that the anxiety is still present when the patient awakens.”

Passes wanted a way to treat the anxiety as well. He says the anticipation of a painful dental visit creates anxiety, which intensifies the patient’s perception of pain. As a result, the discomfort of even the simplest dental procedure is magnified. To end this vicious cycle, Passes developed the Dental Anxiety Control Program.

The program is a three-step strategy usually involving four visits. During the first visit, the patient simply meets the dentist so that the two can get to know one another. This also allows the dentist to figure out who the patient is, where the anxiety comes from and the severity of the anxiety.

If the patient is a candidate for the program, he or she is taught a technique called progressive relaxation: a way to relax quickly and easily. The dentist records the session on an audio cassette, and the patient takes the cassette home and practices progressive relaxation several times a day for a week.

During the second visit, the dentist teaches the patient how to deepen the relaxation. Using a biofeedback device, the patient learns to relax all the voluntary muscles of the body and to know what the body feels like when the muscles are relaxed. The patient then practices at home with the biofeedback device a few times a day for a week.

“After the patient knows how to relax himself and after he uses biofeedback, we still have the problem that the patient may, for example, be afraid of the syringe,” Passes says. “So the next step is to have the patient undergo a period of desensitization.”

During the desensitization process, the patient practices progressive relaxation with the biofeedback device. Then, while the patient is relaxed, the dentist has the patient slowly assemble a syringe.

“You can’t be relaxed and tense at the same time,” Passes says. “Having the patient bring on muscle relaxation will in turn bring on mental relaxation in the face of a threatening stimulus.”

Once the patient is able to assemble the syringe while remaining relaxed, the dentist shows the patient how he or she can have a painless injection.

“When the patient has an injection while they are undergoing relaxation and they do not feel the injection, the patient starts to develop confidence. They learn that they do have control of themselves over the dental experience,” Passes says.

The Dental Anxiety Control Program has been so successful that Passes now teaches the program to dentists. “We’re hoping that this program will become a uniform procedure throughout the country,” Passes says. “The only way to do this is to teach other dentists so that more and more practitioners can have these feelings of consideration for the patient and also have the skills necessary to manage these dental cripples.”

Does fear of the dentist keep you from getting regular care? If so, there are ways to cope with your anxieties. Passes says fighting the fear starts with communication.

“If the patient does not let his feelings be known, there’s no way for the dentist to know the kind of person he’s dealing with,” Passes says.

Ask the dentist if your dental work can be done without your feeling anything and if there is a way you can be more relaxed while in the office. If your dentist is not sensitive to your questions, seek out someone who is more considerate. Your local dental society can supply the names of dentists in your area who gear their practices to anxious patients. Also, ask your friends and neighbors about the dentists they visit.

Caring for teeth at home is important for both children. “Brush, floss and avoid sugary treats” may sound like a broken record, but preventive care is the key to a painless dental visit.

For more information on the Dental Anxiety Control Program, contact Passes at (516) 365-3131.