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| Visualization is a great way of reducing stress... |
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| ... it helps you to relax ; ) ! |
There are many different techniques which can help people overcome their dental phobia or fears.
They are sometimes referred to as "behaviour management". Should you come across this terminology, relax - it doesn't mean
you'll be handcuffed to the chair. Not if you behave... *grin*
In any event, there are some pretty comfy dental chairs around, believe it or not... some of the American chairs are really
well padded because they're designed for, err, what's the euphemistic expression for "big-boned" again? Never mind,
some of the KaVo chairs are also really good but because they're German, if you aren't in the surgery by 6.30 am there's a
beach towel over it and you can't use it ;-P. But I'm digressing... let's have a look at what psychological methods for overcoming
dental phobia are on offer!
The Comfort Zone
The basic premise underlying behavioural and psychological methods of overcoming dental phobia is that of the "comfort
zone". Unless you're a masochist who enjoys "flooding" (i. e. immersing yourself in the things you fear. If
you really fancy that method, "Marathon Man" might be a good place to start...).
So let's take our cue from methods which were originally developed in the context of children's dentistry instead. These
methods allow you to "relearn" the emotional tags which go with the seemingly threatening stimuli pertaining to
dentists/dentistry/anything dental-related.
A common approach is to schedule a show-and-tell type of appointment (often referred to as a "Happy Visit").
The aim of such an appointment is not to do a complete exam but to proceed at a pace within the child's comfort zone. For
example, during the happy visit nothing more might occur than the child sitting in the dental chair and holding a mouth mirror.
If the child feels comfortable, it often proceeds well beyond that, for example allowing a complete exam. The important thing
is that regardless of how much has been "achieved" at the end of the visit, any outcome is considered successful.
The same concept can easily be applied to the adult phobic patient, though it's less likely that you'll find a dentist
who automatically adopts this method. However, being an adult you have the advantage of being able to speak your own mind
(or if you're too scared to speak up, to write down the things you're not ready for and give this list to your dentist). At
the end of the day, you're the customer, and if you don't feel like sitting in "the chair" or being told "the
diagnosis" straight away, all you have to do is let your dentist know. And if you prefer not to see any or all of the
"tools", just say so!
To cut a long story short: proceed at your own speed and try and stay within your comfort zone!
You're in Control
Well, not really. That's why you should find a dentist who puts you in control! The use of pre-agreed stop signals, going
slow, and being "talked through" procedures are all simple yet effective methods for reducing anxiety.
Many people fear losing all control while in the dental chair, and get panicky as a result. If that's the case, you may
want to find a dentist who will talk to you throughout the procedure, tell you what s/he's doing and what sensations to expect,
and explain each and every step. This will actually help you feel in control, by understanding what's going on.
Secondly, DON'T let your dentist continue if you feel pain. There's no reason for it! Make sure you ask your dentist for
a pre-agreed stop signal which you can use whenever you want to take a break or in case you feel pain. In the latter case,
you can always get more anaesthetic - or if, for some reason, that's not possible, you can schedule a new appointment.
The most common stop signal is raising a hand, but there are other stop signals around (e. g. raising both arms slowly).
If you feel you won't be able to give a stop signal (for example, because you're prone to dissociative states, become "frozen
with fear", or experience flashbacks), discuss this with your dentist and see how else s/he'll recognize that you're
in pain or need a break (e. g. by observing your breathing, eyes, stopping very frequently to check with you, or similar).
Or you can "practice" giving the stop signal first (see the "Tips & Tricks" section of this website).
If a dentist offered a stop signal in the past but then didn't stop, you may want to mention this, too. A sense of trust
lies at the heart of all psychological methods of anxiety control, and you will have to learn to trust your dentist - or maybe
you will feel instinctively comfortable with them.
Positive Reinforcement
That's "praise" in English... Ample positive reinforcement on your dentist's behalf can go a long way in helping
overcome certain dental fears. Luckily, dentists are more aware of this nowadays. But obviously, it's not something you've
got any control over... still, I thought I'd mention it!
Distraction and the Environment
One of the first "practical" bits of advice you'll come across when you surf the internet looking for tips on how to overcome
dental phobia is the suggestion to take a CD-player along, so that you won't hear the noises associated with various dental
instruments. You may even have read about Virtual Reality glasses which are now offered by some dental offices.
However, there's far more to distraction than blending out noises with music or avoiding the sight of dental instruments by
watching a movie. Distraction can encompass the whole environment - all of our senses - and quite literally create a new reality.
To find out more, I asked one of the experts in the field of distraction techniques, Lloyd Jerome BDS, to give us the lowdown
on The Art and Science of Distraction. Happy reading!
It goes without saying that people feel more relaxed in a warm, cheerful environment. Thankfully, more and more dental practices
pride themselves on their relaxed and happy atmosphere. As a dentist, you may not always have the luxury of working in such
an environment, which means that you'll have to work quite a bit harder on the interpersonal relationship level. Still, with
a bit of ingenuity, it should be possible to introduce or adapt some of the suggested distraction techniques. For many people,
little things such as being able to address their dentist by their first/Christian name and their dentist not wearing a white
coat or very formal attire makes a huge difference.
Desensitization and Tell-Show-Do
Desensitisation is when anxiety is reduced by a gradual acclimatisation to the object which causes fear. Basically, you're
exposed to things or situations which resemble the feared things or situations, and in a series of steps are guided towards
"the real thing". This "gradual approximation" works really well for lots of people!
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Your dentist might want to start you off with something like this...
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... rather than head straight for the real tools (only joking, this isn't a dental handpiece!)
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Tell/Show/Do (TSD) was initially designed for children's dentistry, but can be adapted for use with any age group. The TELL
phase involves an explanation of the procedure including descriptions of any instruments which may be used and for what reason.
The SHOW phase is used to demonstrate a procedure up to the point where the instrument is actually used. The DO phase is then
initiated with the client's consent and the treatment is performed. Might sound elaborate, but should only take a few minutes.
"Tell" and "show" can often be done simultaneously (or the "show" bit may precede the "tell"), but it's best to leave the
"do" till last =).
TSD and desensitization go hand-in-hand ("desensitization" must be distinguished from "systematic desensitization", which
is a more structured and less rapid technique than TSD), as you'll see on our Desensitization and Tell-Show-Do page.
However, this technique is not for everyone. If you prefer to see as little as possible, please let your dentist know! They
can then ensure that they don't take instruments out while you're looking. Modern standards of cross-infection control (at
least in the UK) mean that instruments are no longer laid out in plain view, and you can either keep your eyes closed or bring
a sleeping mask to wear during any treatment. For more ideas, see Lloyd's article on the use of distraction in dentistry.
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Systematic Desensitization
While there can be some overlap between TSD and systematic desensitization (especially during more complex tell-show-do's,
for example in the needle desensitization protocol described in the Tell-Show-Do section), systematic desensitization is a
separate technique.
For this technique, you'll either need to work with a psychologist or dentist who has experience with it. It's more elaborate
and less rapid than the desensitization that accompanies TSD.
Basically, a hierarchy of fear-producing stimuli is constructed, and the client is exposed to them in an ordered manner
- starting with the least threatening stimulus. One of the key differences to TSD is that you receive relaxation training.
Once the desired state of relaxation is attained, you're exposed to each stimulus in the hierarchy in turn, only progressing
to the more threatening stimulus when you're relaxed and feel able to do so. Here's an example from a recent (2004) research
project in Norway (Kvale et al, not yet published):
Relaxation, Hypnosis, Self-Hypnosis and NLP
In contrast to distraction, relaxation techniques and hypnotic phenomena require attention to be directed to the inside, rather
than the outside, if that makes any sense. Of course, there is considerable overlap... anyway, I didn't want to write lots
of separate pages, so I decided to throw the whole lot into one pot, give it a stir, and let you pick out what you reckon
might work for you! Click this link to find out about Dental Hypnosis, Relaxation and NLP!
Modelling and Support
A potentially great idea is to sit in while the dentist treats another patient so that you can become accustomed to the environment.
Finding a friend or family member who'll allow you to do that can be tricky - but if they really recommend their dentist,
they may have absolutely no problem with it (I wouldn't have any qualms about it if someone asked me). Some dentists won't
allow this (personally, I'd take that as a bad sign - JMO).
Some people find that taking a friend or close family member along (either to meet the dentist for the first time, or
during treatment to hold their hand, or both) very helpful. A word of caution: bringing someone else along can, on occasion,
backfire. Reason being that the other person interacts with the dentist on your behalf, which could make it harder for you
to strike up rapport with your dentist (and vice versa!).
Others find bringing someone along simply embarrassing (bad enough to make a fool of yourself in front of a dentist and
nurse without the added humiliation of letting someone else witness it ;)). You may still want to bring someone along to keep
you company in the waiting room (always a good idea). As always, it's your call!
The Use of Language
Nowadays, most dentists are aware of the need to avoid "threatening" words, such as pain, hurt, drill, or extract.
In dental lingo, this is referred to as "euphemistic language". With a nervous patient, it's particularly important
to avoid threatening language. For example:
* handpiece (not drill)
* numb / freeze (not give a needle, shot, or injection)
* treatment room (not operatory)
* discomfort (not pain or hurt)
* hole (not cavity or caries)
* take out / remove (not extract)
* remove tissue
* clean the soft decayed part of the tooth away (not "drill the tooth")
* "I don't expect you to feel this" (not "This won't hurt" - all the person hears is "hurt")
* "If there's any discomfort just raise your hand and I'll stop immediately" (not "You'll probably feel
some pain" - all the person hears is "pain")
Why are words so powerful in shaping our thinking? A lot of this has to do with learning by association. "Clinical-sounding"
words will trigger existing associations with being treated in a clinical, impersonal, and depersonalizing way. Many (if not
most) people have come to associate the word "drill" with "pain". And whenever cells in the brain fire
together, they wire together (see "The Aftermath - and the Neuropsychology of Fear"). Conversely, when cells fire
apart they wire apart, allowing for a fresh interpretation of the situation. By using non-threatening words and coupling these
with a positive situation, the "threatening" situation can be relearned and coexist with, and act as an alternative
to, negative associations or bad experiences ("the handpiece doesn't cause pain - it's safe <> "the drill
that causes pain". Note that it's perfectly obvious to the "thinker" that handpiece and drill are the same
thing - on the conscious level).
The use of "euphemistic" language can also be applied in self-talk while overcoming your dental phobia or fear.
Once you've had a positive dental encounter, you can start adopting unthreatening-sounding words when thinking about dental
scenarios. This can help to reinforce learning by association. Lloyd Jerome's article on the art and science of distraction
touched upon much of this.
Different dentists will use different methods when working with people who are fearful, according to both their personalities
and their training. Not every dentist will know how to use the techniques described below. In fact, very few dentists will
have had special training in how to deal with people who are terrified of dentists. Most dentists develop their own ways of
handling nervous patients, depending on what works for them.
Over the last decade or so, more and more dental schools have started offering courses in behavioural sciences, and there
is a much greater emphasis on chairside manner. However, this differs from dental school to dental school.
Should you see anything within these pages that you particularly like and that you think would be really helpful to you,
you could describe it to your dentist and ask if he or she could do it that way. Apart from hypnosis, most of these techniques
don't really require special training. A lot of the methods, apart from distraction, are about replacing distrust with trust,
reducing "fear of the unknown", and building up your confidence.
Some of the stuff above may strike you as too elaborate or complicated, or useless for your particular fears. The more
elaborate techniques are rarely needed for most fearful patients - the single most important way for a dentist to help a patient
overcome their fears is to be sensitive to their needs and adjust communication and treatment accordingly. Once trust is established,
oftentimes fear virtually disappears. These are only ideas from which to pick and choose. Different methods will work for
different individuals and different types of phobia. As a rule of thumb, the simplest solution is usually the best solution.
Read more...
Overcoming Your Dental Fears by Dr. Michael Krochak
Conquer Your Fear of the Dentist by Dr Eric Spieler
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