Recently I decided to do some Google searches for terms such as: gentle dentist, gentle dental, and we cater to cowards. My screen was inundated with innumerable listings of dental practices proclaiming “painless dentistry” as their mantra. Conducting an even deeper search uncovered a plethora of chat rooms and online forums in which scores of patients recounted their tales of dental woes and commiserate with each other about how going to the dentist is scary and dreadful. It’s no wonder that so many dentists use the “concept of compassionate care “ in their marketing; there are thousands, if not tens of thousands, of would-be/could-be dental patients who aren’t patients at all because they are just too afraid to make an appointment (let alone, keep it!).
Going to the dentist is not on most people’s list of favorite things to do, and for the anxious, fearful, and certainly the phobic patient, the mere idea of going to a new dentist is like pulling teeth (sorry, I couldn’t resist!). Notwithstanding dentistry itself with all the accompanying sounds, tastes, smells and sensations; a visit to the dentist, especially one for the first time, can engender unsettling feelings of anticipation and vulnerability.
What is it about going to the dentist that evokes such unease?
I have some thoughts about this that I’d like to share with you; thoughts based on insights gained from more than 30 years of private practice and a lifetime of observation.
We each have a comfort zone and an individual sense of personal space that greatly influences our daily interactions with people. Say, for purposes of illustration, you go to a party and meet someone for the first time. Discounting an encounter with a “close talker” you may begin your conversation at an arm’s length distance. As the evening progresses and if you develop rapport, your proximity to each other closes to within a foot or two. If you really hit it off with your new acquaintance perhaps by night’s end your mutual perception of personal space and its boundaries has eased to where you are actually sharing some space; maybe to the point of a hand brush or tap on the back. So, over the course of several hours you have adjusted your comfort zone with someone and have tacitly “invited” your new friend closer into your personal space.
Now fast forward to the next day. You have an appointment with a new dentist. Within minutes of meeting him, the dentist is not only in your personal space, he’s literally in your face, in your mouth, and above your head “coming at you” with sharp objects that shimmer in the light. So much for comfort zones!
A truly caring and effective dentist must recognize and understand the behavioral and emotional dynamics at play between himself and his patient if mutual trust and comfort is to be achieved. This is especially true when anxiety and fear are part of the equation.
What I Have Learned About Dental Fear
A quick and easy rapport is essential to breaking the ice. Light banter and a sincere smile go along way to putting a new patient, especially an anxious one, at ease. I never approach a patient clinically without first having made direct eye contact and sharing at least a few moments of conversation. By the time I don my gloves, the patient has relaxed enough to be ready for an examination. In essence, I await permission to enter his or her personal space. This initial exchange is very important for the anxious or fearful patient because it gives a sense of control that the truly vulnerable don’t possess.
Another aspect of Dental Fear is the feeling of having something done to you. For the record, I never do anything to my patients, but I always do my best for them. Semantics? Absolutely not. It’s my philosphy and approach to people that epitomizes compassionate care and minimizes patient stress. If someone truly feels cared for there’s less angst about the treatment rendered.
One final comment: I don’t treat teeth; I treat people with teeth. Knowing that my staff and I and I are here for them, gives my patients both an implicit and explicit sense of reassurance.
Saying “I’m Sorry”
“I’m Sorry” is probably of the most oft spoken words I use with my patients during any given day. While I pride myself in delivering virtually painless injections (good technique and lots of topical anesthetic), I almost reflexively say, “I’m sorry” while administering “a shot.” I’m not so much offering up an apology, as I am acknowledging the unpleasantry of getting an injection in the mouth. One of my wonderful assistants Carmen has joined me in my mea culpa, so our “sorrys” are delivered in harmony. It’s just our way of letting the patient know that we are here with, and for them. “I’m not giving a shot to you; I am giving anesthetic for your comfort.)
Along with the “I’m Sorry” comes the all-important handhold or reassuring hand squeeze. Kim and Carmen are great at “manual reassurance” and our patients almost universally appreciate the gentle reminder that we care. Vulnerability and fear dissipates in the company of comforting hands and words of kindness.
Case Study: A Patient with Dental Phobia
A new patient, Rachel C. recently came to my office. She had previously been the recipient of quite a bit of dental care and needed Root Canal therapy on a front tooth. Going through our ritual of getting her numb, I sensed uneasiness after I completed the injection. I asked if she was alright. Rachel told us the “shot” was great but she had never had her hand held in a dental office and was a bit surprised. I then inquired if she was uncomfortable by it, to which she quickly replied, “Oh no…. I kind of liked it. I just didn’t expect it! You can hold my hand any time.” We all laughed and a tense situation (injection and forthcoming Root Canal) was lightened with levity. In this day and age of high tech dentistry and medicine which can be quite intimidating, the importance of high touch – reaching out to connect with your patient on a personal level – is that much more important.
Pain Control in Dentistry
Pain control is paramount to managing dental anxiety and fear. If you’ve ever had a bad experience in the dental chair involving pain, the memory can last a lifetime. Erasing the experience from the conscious or unconscious mind can be a Herculean, if not impossible, task. But making sure that my patient does not feel pain during treatment is my first priority. I have had many dental procedures performed in my own mouth including fillings, crowns and Root Canals. I have sensitive teeth I know the feeling when a not quite numb tooth is drilled on and I know that dreadful feeling of anticipation; the waiting to feel that pain again; even if it never comes. Once you feel the pain, you never stop waiting to feel it again.
Ensuring that my patients are physically comfortable provides an emotional and psychological feeling of well-being. And it’s not enough to just give a sufficient dose of anesthetic, I make sure to wait long enough for it to take effect. Some people just take longer for their mouths to get numb and I will often ask those patients to arrive for their appointment a bit early, just to give the anesthetic more time to take effect.
More Ways to Lessen Dental Fear
There are additional ways and techniques available to make patient care more comfortable. Nitrous Oxide is a wonderful analgesic that not only can relax the apprehensive, it also raises one’s pain threshold making anesthetic that much more effective. Certain prescription drugs can be prescribed for the night before to ensure a good night sleep and that can lessen the trepidations associated with dental care. During treatment music in the room, iPods, or television with headphones all offer nice distractions from the sounds especially, in conjunction with nitrous or other relaxants. But after all is said and done, having a compassionate caring dental team that is dedicated to patient well-being and comfort is the most important piece of the puzzle in reducing dental fear.
Over the years, I have had the wonderful opportunity to help many people cope with their apprehension and fears so that they could receive the long overdue dental care so desperately needed, to attain a state of oral health that never seemed possible, and to regain the smile they lost long ago. The sense of personal fulfillment and professional accomplishment knows no equal as the experience of helping the dental phobic overcome their fears and achieve success. Ironically, it is most often the anxious patient that questions whether he or she is my worst patient, when in reality the opposite is true.
If you are avoiding dentistry because of dental fear or anxiety, please call my office to either schedule a consultation visit or to speak with me on the phone. See if it feels right, see if the chemistry is right before working yourself up to a state of panic.
Talking never hurt anyone.
Dr. Michael Sinkin is a NYC dentist that has been in practice for over two decades. He truly cares about the experience his patients have and takes great pride in making them feel relaxed and comfortable during every visit. Come in for an appointment and experience a different kind of dental practice. To find out more about Dr. Sinkin, please click here.