I would like to tell you some things I have discovered about dental phobia, because I think that many dentists are unaware of the mechanisms that trigger this. Many believe that it is pain that makes patients anxious – or hysteria. I have heard many patients say that they have been scolded and have been asked to get their act together.
Dental anxiety is probably a more accurate description. A great deal of my patients had anxiety about going to the dentist. I used to ask them about what triggers the anxiety. Usually the patient doesn’t know. Some say pain, while others say it isn’t the pain, but don’t quite know what it is. I am of the clear opinion that pain doesn’t trigger anxiety unless it comes suddenly and with great intensity. We are all afraid of pain, but that doesn’t mean we are all anxious.
I have worked a lot with the psychological aspects and reached the following conclusion. There are three types of dental anxiety, maybe more, but these are the most important:
Those who say they are afraid of the pain are usually those who have been held down in the dentist’s chair by adults; in other words, subjected to abuse. They have had control of their lives totally removed. They can be helped by giving them that control back. Agree on a sign which will get the dentist to stop. There must be no question, of course, of the dentist not complying with this agreement! This type of person often finds it difficult to be sedated. Sometimes they are given 5-6 injections but still have full feeling in the tooth – until their treatment is finished, at which point the anaesthesia starts working with full force. This is logical: if you are anaesthetised, you can’t retain control, and then all sorts of unpleasantness can come upon you without you having the possibility of defending yourself. Perhaps you won’t survive – that is how the body is “thinking”. The brain can very often claim otherwise, but the body and its experience “win”. The body thus simply obstructs the anaesthesia from working.
Other forms of abuse, for example, sexual abuse, can also trigger this kind of anxiety.
Others are afraid of drowning. They have hydrophobia. They often swallow all the time during dental treatment. You can help them by using as little water as possible and letting them turn their head to the side so the water doesn’t flow directly down the throat.
The third group has, I think, become the largest. They are afraid of being suffocated. They find it difficult to allow X-rays in their mouth. They resist and find it anxiety-inducing when there are too many things in their mouth at the same time – cotton swabs, dental equipment etc. At first, I thought these were people who were born with the umbilical cord around their neck, and there are indeed some of them.
However, the majority are people who have been given a general anaesthetic. As a student, I witnessed people being intubated, i.e. having a tube pushed down into the trachea under a general anaesthetic. It looks pretty violent. The patient is sedated at the time, but not numb. The body registers the penetrating foreign body very clearly and is actually being choked at that moment. The body remembers and any situation similar to this thereafter will cause anxiety.
I had an interesting experience at the clinic one day. I had to drill into the rear tooth in the lower jaw of a 70-year-old woman. It was hard to get at; she was tensing her lips and her tongue. I put the drill to one side and asked if she had ever been operated on. With horror in her voice, she told me about an investigation of her stomach which she had undergone years ago. A tube had been put down her throat while she was fully conscious. It had been horrifying for her.
When we had talked about this, I started working again, and this time she was more relaxed. She had achieved an increased awareness that allowed her to separate things and allowed me to work.
There is nothing embarrassing about being afraid of going to the dentist! Many people think that it is just hysteria and that they should get their act together. Nothing could be more wrong. The brain and the mind are one aspect; the body and the feelings are another. What we have experienced is in the body and this must be taken seriously. Neither scolding nor reprimand works. Many anxious patients have told me horrible stories about dental visits where they were treated like spoiled children.
The only thing that works is acknowledgement of the feelings and an “unravelling” of the old trauma, preferably with professional help.
Dentists frequently lack the necessary training to deal with dental anxiety and are even anxious themselves about how patients will react. Fortunately, there is help, as many dentists have specialised in this area.
If you suffer from anxiety and can recognise yourself in one of these three types, you have to take responsibility for that and communicate clearly to your dentist what it is that makes you anxious. And if your dentist can’t handle this, my advice is for you to find a dentist who understands you and acknowledges your anxiety.