PreEmptive Healing » Dental Phobia

Dental Phobia Caused by Fear of Pain

Dr. Anthony J. DeMarco — Mon, 05 Apr 2010 16:42:07 +0000

Dental phobia or dentophobia is defined as the fear of dentists and of dental procedures in general. It is a very common fear that often involves other fears that are more defined, specific, and individual. One of these fears is the fear of pain.

Sufferers from this phobia, in terms of their dental health, are unable to visit their dentists because of a prior painful memory when they were young. They remember the visit as a particularly painful one. This memory manifests later in life as an unconscious desire not to visit the dentist resulting in dental appointments being constantly delayed or missed entirely.

Most people prefer not to suffer pain. For dental phobics, however, just the mere idea of pain is far worse than the actual pain itself. Ironically, because they are unable to regularly visit their dentists, they suffer almost constant pain from their neglected teeth.

It is important to note that the fear of pain from visits to the dentist is often from memories of long ago. These memories tend to become warped over time. Modern dental practices have reduced the pain involved in dental procedures from what they were even as recently as a decade ago.

People afflicted with this type of phobia often do not receive suitable levels of dental care. By not having any sense of relationship with their dentist, they are unable to articulate their fears or get any kind of professional reassurance. By staying away from their dentist, they further increase their fears since nobody is able to provide information that will counterbalance their imaginations. They are stuck with a mental picture of the dentist based on painful childhood memories.

These phobics also miss out on the benefits from the advice, new ideas, and preventative care that dental practitioners offer.

Pain phobics will exhibit symptoms such as shortness of breath, breathing difficulties, and anxiety at the mere thought of visiting the dentist. What happens is the patient’s brain warns the rest of the body that pain is approaching. However, the problem is that the body’s response to the warning becomes disproportionate to the perceived threat.

Fortunately for these individuals, dentistry has progressed so that efforts are being done to address dental phobia in all its aspects. Improved treatment modalities are now readily accessible and understandable for most people. Dental professionals are going out of their way to put their patients at ease and make sure that they realize just how valuable customers they are.

With this kind of phobia, which concerns the fear of pain as well as the pain itself, it is vital that patients understand the treatment and care that they can reasonably expect. The solution can be as simple as finding a dental environment where they can relax and be comfortable as much as possible. A well-run dental practice will provide an atmosphere that is calming. The waiting times will be short, and the reception will be most welcoming.

Other techniques available to these patients include sedation and distraction techniques, which are also used to help people exhibiting more acute phobias.

A number of psychological approaches and techniques have also helped other people cope. These include hypnosis, systematic desensitization, deep breathing, visualization and guided imagery, positive affirmations, and reward systems. There are some therapists specializing in phobias and anxiety disorders who work in tandem with phobic-friendly dentists.

Let Us Help You

Mobile Anesthesia Service Concepts, LLC (MASC) is an anesthesia service that specializes in office-based anesthesia. We can be found on the World Wide Web at www.masccares.com.

MASC combines outstanding anesthesia practices with techniques that are designed to free the patient’s mind of their fear.

Conditioning the Mind before a Dental Procedure

Dental Phobia – A Guided Meditation for Dental Fear and Anxiety is an audio download designed to help reduce anxiety and fear both consciously and unconsciously through the conditioning of the mind. Instead of having the patient accept fear and anxiety, we are empowering his mind to destroy that fear and anxiety. This results in a reduction of narcotics as well as a decrease in complications postoperatively.

This audio download can help condition your mind for your upcoming dental visit and procedure. If you follow the guidelines as directed by Dr. DeMarco, you will be better prepared, more relaxed and you will be surprised at how well you recover when you take fear and anxiety out of the procedure.

You don’t have to be scared to visit the dentist. Visit our website, read our blog articles about Fear and Anxiety and sample our wonderful audio product, “Dental Phobia – A Guided Meditation for dental fear and anxiety.”

Whatever the individual patient’s situation, there is no reason to avoid visiting the dentist. Whatever course of treatment the patient eventually chooses, bear in mind that the most important thing is to have a dentist who understands and who can help them handle their fears.

The Fear of Being Powerless during a Dental Procedure

Dr. Anthony J. DeMarco — Wed, 31 Mar 2010 10:42:11 +0000

Dental phobia or dentophobia is defined as a general fear of dentists and of dental procedures. It is actually a very common fear that often involves fears that are more defined, specific, and individual. One very specific fear is the fear of being powerless while in the dentist chair.

The phobia effects those people whose personality traits do not permit them to place themselves totally in control of other people, in this case, the dentist. Individuals who are used to controlling their own environments and deciding on their own can often become very difficult patients. The dentist treating these patients has to communicate clearly and react quickly to these patients requests.

For these patients, a controlling personality is just a part of the problem. They are actually nervous and are covering their fears by making outrageous demands on their dentists.

This situation often results in personality clashes between dentists and patients. It is exacerbated when the treating dentist fails to understand that the behavior is because of a phobia. With the breakdown of the patient-dentist relationship, the patient often refuses to continue with the treatment, a condition that is ultimately detrimental to the patient’s health.

Unfortunately, the longer the dental treatment is postponed, the more urgent it becomes. This actually heightens the fear, makes the symptoms more visible, and puts additional strain on an already tenuous relationship.

People with this type of phobia have a tendency to be more argumentative, more demanding, and more challenging than regular patients. This is why some are often tagged as difficult or controlling when, in fact, it is really a coping mechanism. These patients don’t exhibit the classic symptoms of fear, but combined with increased heart palpitations, shortness of breath, and tension, they become increasingly agitated.
In this day and age, it is very fortunate that dentistry has progressed so that efforts are being done to address the problem of this kind of patients. One of the most important approaches being implemented has nothing to do with the patient but with the dentist. Dentists, nowadays, are being trained to have the skills, assurance, and empathy to be able to treat these patients. Dental schools have begun offering courses in behavioral sciences and have put a much greater emphasis on chair-side manner. For a lot of patients, the solution to their fears is simply finding a dentist with the right skills, personality, and technique.
A well-run dental practice will provide an atmosphere that is calming. The waiting times will be short, and the reception will be most welcoming.

Sedation is another option that is viable in some cases. There are two types. One in which the patient is completely unaware of what is happening and another where the patient is sedated just enough so that they can relax and allow the procedure to be completed. A number of psychological approaches and techniques have also helped other people cope. These include hypnosis, systematic desensitization, deep breathing, visualization and guided imagery, positive affirmations, and reward systems. There are some therapists specializing in phobias and anxiety disorders who work in tandem with phobic-friendly dentists.

Eliminate the fear of being powerless during a Dental Procedure.

Dental Phobia – A Guided Meditation for Dental Fear and Anxiety is an audio download that can help you reduce and even overcome your fear of needles and dentistry. This audio download can help condition your mind for your upcoming dental visit and procedure. If you follow the guidelines as directed by Dr. DeMarco, you will be better prepared, more relaxed and you will be surprised at how well you recover when you take fear and anxiety out of the procedure.

Is Your Fear of Needles Preventing You from Visiting Your Dentist?

Dr. Anthony J. DeMarco — Mon, 29 Mar 2010 18:39:03 +0000

Dental phobia or dentophobia is generally defined as a fear of dentists and of dental procedures. It is actually a very common fear that often involves fears that are more defined, specific, and individual. One of these is the fear of needles, one of the most common phobias known to man. This is especially true in the field of dentistry since it is nearly impossible for the patient to look away because the needle is injected in the gum or cheek.

The 1988 Adult Dental Health Survey in the UK reports that 8% of respondents have an existing fear of injections (Todd & Lader 1991). Other studies suggest that nearly 5% of the population may be afraid of needles in general.

The level of fear is different among various individuals. While some people are phobic of dental injections in particular, others are afraid of almost any kind of needle. Some people will even go to extremes to avoid injections.

Most needle phobics have had a particularly bad past experience with a dental injection. There are a number of reasons why this came to be:

The dentist lacked empathy. While dental students are taught compassion at dental school, not all dentists are created equal. Some will have more empathy with their patients than others.
Lack of using topical anesthetics or numbing gels. While it is possible to give painless injections without it, numbing gel should always be applied.
Using a dull needle. This has become quite rare because of disposable needles, but it was a common cause of painful injections. This can occur today with multiple injections. In practice, a single needle should be changed after three or four uses on the same person. Under no circumstances should needles ever be shared between patients.
Technique for administering anesthetics. Some tissues need to be stretched to make the injection comfortable. Applying pressure on some areas can block out feelings of pain. This is true is areas such as the palate where painless injections are very difficult to do.
Rapid administration of the anesthetic. The most common cause of injection pain is that some dentists administer the anesthetic too quickly. These rapid injections can tear the tissue, resulting in immediate pain, which then results in soreness.

While it is impossible to guarantee that each and every injection will be painless, the level of pain can be reduced by making sure that the topical anesthetic is left on for long enough for it to work properly, by injecting the anesthetic very slowly, and by applying pressure for certain types of injections.

The best way to find a dentist who gives comfortable injections is by asking for recommendations. It’s also a good idea to ask your potential dentist outright if he or she is capable of giving painless injections and if they apply numbing gel.

Some dental office also uses a device called the Wand which guarantees painless injections, because the speed of the delivery of the anesthetic is computer-controlled. The device, which doesn’t look like a syringe, has been touted to work wonders with needle phobics.

For some needle phobics, there is the option of intravenous sedation where nitrous oxide is used to relax the patient enough to tolerate the venflon. The area where the venflon is put is first numbed with EMLA cream or Ametop.

Remember, there is no reason for you to avoid going to the dentist. There are many ways that you can deal with your dental phobia. Most importantly, find a dentist who understands your fear and knows how to handle patients who are scared of dental procedures.

Reduce or overcome your fear of needles

New PreEmptive Healing Product – Dental Phobia!

Dr. Anthony J. DeMarco — Mon, 29 Mar 2010 17:14:48 +0000

Understanding The Fear Behind Dental Phobia

Dr. Anthony J. DeMarco — Mon, 22 Feb 2010 05:09:51 +0000

Dental phobia or dentophobia is generally defined as a fear of dentists and of dental procedures. It is actually a very common fear. It is estimated that as much as 50% of Americans do not regularly see their dentists because of anxiety and that about 9 to 15% of the population avoid dental treatment altogether due to severe fear. Dental phobics will avoid visiting their dentists at the cost of needless pain, tooth decay, or the loss of their teeth.

Many instances of dentophobia often involve fears that are more defined, specific and individual. Here are some examples:

The fear of dentists: Dentists represent authoritarian figures that check how well we’ve taken care of our teeth. This fear is the effect of traumatic childhood visits to the dentist.

The fear of needles: One of the most common phobia since it is nearly impossible to look away since the needle is injected in your gum or cheek.

The fear of anesthetics: This includes the fear of waking up and feeling the pain, not responding to the anesthetic or being allergic to it.

The fear of the dental drill: The iconic symbol of dentistry. The distinct sound alone often triggers anxiety attacks in patients.

The fear of pain: Patients who experienced pain when they visited the dentist as a child often find it difficult to visit again.

The fear of numbness: The fear of being unable to call for help or control the level of pain they are able to receive once they are under anesthesia.

The fear of choking: Another common phobia particularly since the dentist needs to work in the mouth area.

The fear of being embarrassed: A fear that feeds on itself since the more you avoid going to the dentist, the worse your oral health becomes.

The fear of diagnosis: The fear of a simple check-up becoming an expensive and long procedure.

For some people, just passing a sign or an advertisement for dental services can set off panic attacks or some severe symptom of anxiety.

Fortunately for such people, help is now readily available. Many dentists are now advertising specific techniques designed to deal with such patients.

Fast acting sedative medications are now available that are able to relax the patient enough so that they can undergo dental treatments without any fear.

Other dentists use relaxation and desensitization techniques to help patients overcome their fears gradually. In these techniques, the patient remains fully conscious without the need for sedatives.

Mobile Anesthesia Service Concepts, LLC (MASC) is an anesthesia service that specializes in office-based anesthesia. We can be found at www.masccares.com.

MASC combines outstanding anesthesia practices with techniques that are designed to free the patient’s mind of their fear.

Reduce or eliminate Dental Phobia

How Do You Deal With A Patient Who Is Terrified Of A Dental Procedure?

Dr. Anthony J. DeMarco — Tue, 05 Jan 2010 00:15:58 +0000

How many times have you dealt with an individual who is deathly afraid of having a dental procedure? It is estimated that about 5 to 15 percent of people living in Western countries avoid going to the dentist because of fear. Logically, the person knows that he needs to take care of his teeth. If he does not do so, his teeth will develop decay and, ultimately, lose them all. It makes sense to brush your teeth, floss, and go for regular dental checkups; right? However, this reasoning does not hold true for this type of individual. A reasonable person will conclude that he will spend less money, have better dental health and, generally, whiter teeth if he just go see his dentist. For this individual, however, there is something stopping him. What can it be? It can be due to a bad experience when he was young. So young that his communication skills and ability to reason are not quite developed yet which, in turn, caused the perceived trauma to go undiscovered and, eventually, became a permanent one that is now unconsciously imprinted on his brain. As he grew up, unaware of this experience, he outwardly manifests fear when he visits the dentist, a fear that becomes greater and greater on every visit. Do you happen to have this type of patient? You can’t miss him. He is the patient with a high sympathetic outflow that presents itself as the classic “fight or flight” phenomena. He walks into your office, white as a ghost, sweating profusely, with an increased heart rate, an elevated blood pressure and, my favorite feature, the look of “a deer caught in the headlights.”

Here he is. The patient has mustered as much courage as he possibly can. He has correctly rationalized that it is very important to take care of his teeth. He has already overcome a major obstacle just by being in that chair. Now, what are you going to do for him? Do you have the courage to face a patient like this, a patient who is truly afraid of you for no logical reason? Do you have the patience, compassion, and understanding to care for this type of patient, a dental phobic?

Unless you have a phobia of your own, it is very hard to understand what this person is experiencing. As human beings, we try to empathize with others but, unless you have similar fears, it is very difficult to understand what this person is actually experiencing. Even so, we still are compelled, as healthcare professionals, to do whatever we can for this patient. How can we help this type of patient deal with this crippling fear?

As an anesthesiologist, I have tried to come up with a system that will help the dental practitioner deal with this difficult situation. Why, as a board certified anesthesiologist, would I want to be involved with anyone that has a dental phobia? Because I believe I have an innovative solution to a very difficult and recurring problem. In my specialty, I always deal with patient fears and anxieties. Why? Because medical and surgical procedures evoke some level of fear and anxiety in every individual. Just imagine yourself needing to undergo a certain procedure. The date is set. If this is set for the next day, that’s great! The patient has no time to think about what could potentially go wrong! However, the reality is that these type of procedures are usually scheduled one to two weeks out and, sometimes, even further in advance. This situation gives the patient all the time in the world to think about what could or could not happen. That is anxiety!

Over the past 15 years, I have developed a great system for making patients feel calm and comfortable during their pre-anesthetic visit. This visit normally occurs one to two weeks prior to the actual procedure. What happens during this interview? First, I obtain a history from the patient. I look for any anesthetic problems which might have existed in the past with either the patient or his immediate family. Second, we go over medications, allergies, and any past and present medical problems. This interview helps me to determine whether the patient is medically optimized for the procedure. What does medically optimized mean? Even though the patient might have a medical systemic disease, i.e., hypertension, is he in the best health he can possibly be in for the procedure? I cannot cure him of high blood pressure, but I can make sure that it is under control and has not damaged vital organs, such as his heart or his kidneys.

If I feel that the patient requires further tests, I will ask for those to be performed, such as a consultation with his cardiologist. I will obtain an ECG within the last six months, as well as any further blood studies. Our goal, as the medical team, is to make sure that the patient is safe during the upcoming procedure.

Once the anesthetic history is obtained, I then go through what the patient should expect to happen on the day of the procedure. Does this help reduce anxiety and fear? Yes. By how much? I do not know. But it is a process that definitely helps. When a patient does not have any idea of what will happen on the day of the procedure, anxiety and fear goes up by about 50%. This pre-anesthetic interview lasts for 10 to 30 minutes and is usually done one to two weeks prior to the procedure. What does the patient do from the time I have the talk with him until the time of the procedure? I believe this period of time is when fear and anxiety becomes manifest. I also believe that, as a medical community, we should investigate how we can help these patients. We need to help patients empower themselves, through their thoughts and actions, to reduce such anxieties and fears. The medical community should be aware of the trauma caused by not addressing these issues. Remember that fear and anxiety cause significant increases in sympathetic outflow. An increase in sympathetic outflow can cause an increase in heart rate and an elevated blood pressure. What is the effect of an increased heart rate? An increase in heart rate increases the amount of oxygen that the heart requires to function. What does this do? Due to the increased oxygenation demand, there is a need to increase the supply of oxygen to the heart. When the heart is not supplied with enough oxygen, the heart starts to fail. This failure of the heart is called an ischemia, which is the lack of oxygen to the heart’s tissues. Ischemia can occur with the person unaware that it is already happening. An increased heart rate can actually cause ischemia. Will the patient feel the cause of the ischemia? No, not always. Thus, the patient can have an undetected problem due to fear and anxiety.

An increase in sympathetic outflow can increase blood pressure. How does this happen? The nervous system can actually constrict all the blood vessels in the body. A constricted blood flow does not help in the healing process. By constricting blood flow, the nervous system is inadvertently causing the pooling of blood in certain areas of the body. Unfortunately, these are not the blood rich groups that aid in the healing process. What are these? Blood rich groups are composed of organs with enriched blood flow, such as the heart, lungs, liver, kidney, and brain. In short, these are the organs that promote the healing process. Are we then, in effect, slowing down the healing process when we increase anxiety and fear? Yes! If we are able to decrease anxiety and fear prior to the procedure, can we then improve the healing process? Yes! How do we do that? We can help do so by simply listening to a CD that I have created.

This CD is called PreEmptive Healing. Have the patient listen to the CD twice daily: once in the morning upon waking up and once at night prior to falling asleep. PreEmptive Healing is designed to be used from the time a dental procedure is scheduled to the date of the dental procedure. I also suggest that patients be allowed to listen to the CD during the actual procedure.

During the testing of PreEmptive Healing, I noticed a decrease in the degree of anxiety and fear by 30-50%. There is also less use of narcotics as well as a decrease in complications postoperatively. The CD is designed to help reduce anxiety and fear both consciously and unconsciously. How does it work? The mind must be approached at all levels of consciousness in order to consistently and persistently lower fear and anxiety. Simply stated, this is done through the conditioning of the mind. Conditioning, by definition, is repeatedly going over something in order to have the thought imprinted. In practice, instead of having the patient accept fear and anxiety, we are empowering his mind to destroy that fear and anxiety. Conditioning is the only way to consistently and persistently free someone’s mind of the fear and anxiety in having dental work performed.

We have now taken care of the first part of the fear and anxiety a dental phobic has to deal with while waiting prior to the procedure. How do we then take care of the fear and anxiety on the day of the procedure and during the procedure itself?

While on the way to the dentist, I suggest that the patient repetitively listen to the PreEmptive Healing CD in the car up to the time of the procedure. Again, if allowed, it would be an excellent idea to listen to the CD while actually having the dental procedure.

How is the actual dental procedure done? The actual procedure is done by giving the patient anesthesia. What kind? I recommend heavy sedation. Who are we? Our company is called Mobile Anesthesia Service Concepts, LLC (MASC). MASC is an anesthesia service that specializes in office-based anesthesia. We can be found on the World Wide Web at www.masccares.com.

MASC provides outstanding anesthesia practices. Our service is designed to provide increased efficiency, safety, and patient satisfaction. MASC comes to the office prior to the case to make sure that we are able to provide safe and effective anesthesia. Does the office need to provide any of the equipment? No, we take care of those. The only equipment not provided is oxygen. Because oxygen is flammable, MASC does not carry oxygen in our vehicles. The dental office is therefore required to provide it.

In the case of a dental phobic, heavy sedation works great. What is heavy sedation? Heavy sedation is an anesthetic technique using propofol, Versed, and local anesthesia. The technique is called a total intravenous anesthetic or TIVA. The procedure is as follows. MASC will bring the patient in the room. All consent forms are signed. The patient arrives in sweat pants and sweatshirt to reduce the risk of being cold. Why is this required? Being cold under anesthesia increases oxygen consumption by the heart by up to 300%. It also delays awakening after the procedure. Once in the room, the patient is seated and a tourniquet is placed on the arm where the IV is going to be placed. All the monitoring equipment are then put in place: ECG, supplemental oxygen in the form of a nasal canula, noninvasive blood pressure cuff and pulse oxymetry, which measures the oxygen saturation of the body. All the monitoring equipment has the same standard of care used in most operating rooms. Once the monitoring devices are in place, the IV is placed and secured. MASC is now ready to sedate the patient.

The four areas of anesthesia which must be employed to have a complete anesthetic are hypnosis, amnesia, analgesia, and surgical anesthesia. MASC provides all four levels of anesthesia with heavy sedation. We begin with 2-4 liters/minute of oxygen delivered via the nasal canula. Then 2-4 mg of Versed to calm and cause amnesia. Then a propofol drip is started to place the patient into a sleep state. Once the patient is asleep and not moving, i.e., surgical anesthesia, the dentist then places a block with local anesthesia to provide analgesia intraoperatively and postoperatively. Once all four levels of anesthesia are achieved, the procedure can begin. The dental phobic patient is now asleep and will not remember anything regarding the procedure. The dentist, on the other hand, has a calm and comfortable patient, thus making the procedure go quickly and smoothly.

Once the procedure is completed, the propofol drip is stopped. In 10 to 15 minutes, the patient will awaken. Following emergence from the sleep state, the patient will be monitored for 30-45 minutes. This monitoring period is done in order to give time for the patient to recover from the anesthesia. After the recovery period, the patient is walked to the car and sent home. The patient will be advised not to make any major decisions or drive in the first 24 hours because it takes that much time for the propofol and Midazolam to be fully metabolized. At home, the patient can relax and recover further from the anesthesia. As far as meals after the procedure, from an anesthetic point of view, the patient will be able to eat anything. Since no narcotics are used during the procedure, patients are less likely to have nausea and vomiting postoperatively. Propofol also decreases the risk of nausea and vomiting. Patients have been observed to do well with this anesthetic technique. They recover rapidly with very few or no side effects.

I believe that this system is a win for the patient. He has no recall of the procedure, which gives him a positive dental procedure experience. This, in turn, starts to break down his fears and anxieties about going to the dentist. The dental phobic can now take care of his teeth and have better oral hygiene in the future. This system is also a win for the dental practitioner because, now, he has a solution for these type of patients.