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Overcoming Dental Anxiety – Part 4

In this concluding section we will look at some more issues, in particular the importance of good pain control and techniques for relaxation.

 

Fear of being awake for treatment

One major difference between dentistry and other medical specialties is that, most of the time, patients remain awake for treatment. Many patients with a dental phobia say that they would like to be “knocked out” (have a general anaesthetic) for treatment but there are reasons why a general anaesthetic (GA) is not used routinely, but only as a last resort, in dentistry. There are risks associated with having a GA and it is required that general anaesthetics are only carried out in a fully equipped hospital. Weighing the risks against the benefits, GA is generally only justified for complex oral surgery or for urgent treatment when other methods, eg. psychological techniques and sedation, have been tried unsuccessfully. In addition, having treatment while asleep will not help a person with dental phobia overcome their fears and it will not be possible to keep having treatment under GA in the future. It is much better to find a good, sympathetic dentist who will work with you as we have discussed in part 2 of this blog.

Fear of “the drill”

For many people, even the sound of the dental handpiece (or drill) can make them very anxious. This may be due to a previous bad experience where the tooth was not sufficiently numb and/or the dentist did not stop treatment when they felt pain.When a tooth is properly numb, the only sensations that should be felt are vibration and slight pressure (see more about this in under subheading “fear of pain”). However, for some, the vibration itself can be uncomfortable. If this is the case, using an electric tooth brush at home may be help you get used to the vibration sensation.Many people do not like the sound of “the drill”. Music can be helpful to blend out unpleasant sounds. Some dentists have music in the treatment room, or you could bring your own mobile device with your favourite songs or music for relaxation on. Of course, you would need to turn the music off when you need to speak to the dentist.Other distractions, such as watching a video, either on a screen above the dental chair or by wearing virtual reality goggles, may also help. Sometimes it is helpful if your dentist tells you that they will need to use the handpiece for 5 or 10 seconds at time and even counts this out loud. Don’t forget, you can let your dentist know that you need to take a break by raising your hand. This is called the “stop signal” which we discussed in part 3 of this blog

Fear of Pain

If you have had a past experience of painful treatment at the dentist this will have most likely have led to fear and anxiety.
The reason for pain could have been:
  • Not having local anaesthetic (LA) to numb the tooth when it was required.
  • The dentist starting treatment without allowing sufficient time for the local anaesthetic to work – this can take between 5 and 15 minutes, depending on the tooth and procedure.
  • Infection in the tooth or surrounding area may prevent the LA working properly. This can sometimes be a problem during root canal treatment and antibiotics or a sedative dressing placed in the tooth between visits may be required.
  • Painful injection (see next paragraph).
  • The dentist not stopping when you felt pain to make you comfortable or give more local anaesthetic.
All of these problems can be overcome with a combination of good communication and using the right techniques. Don’t be afraid to tell your dentist if you experience pain so that they can do something about it.

Fear of injections

Maybe when local anaesthetic injections were mentioned in the last paragraph, you thought “but that is my biggest fear!” This is quite common, to the extent that some people would rather suffer pain during treatment that have the numbing injection. Generally, the thought of having an injection is much worse than the reality and there are ways that your dentist can help you:
  • A good relationship with a dentist you can trust goes a long way in relieving anxiety.
  • A topical gel or spray can be used to numb the gum first, this takes a couple of minutes to work.
  • Injection should be slow and gentle – fast injection can cause pain.
  • Distraction – your dentist may talk to you or you may listen to music or watch a video.
  • Relaxation techniques (discussed below).
  • Try to think about the benefits of your tooth being numb so that you will not have pain during treatment.

Fear of choking or gagging

Some people have a strong gag reflex or have a fear of choking while at the dentist. There is a physical aspect to this but anxiety will also cause these problems to be worse. The following solutions may help:

  • Discuss the problem with your dentist so that they can find ways to help you.
  • Slow breathing through your nose. For those who have a problem with this, a nasal spray used beforehand may help.
  • Your dentist could use a numbing throat spray to make the area less sensitive. Some people also find rinsing with salty water or putting salt on the tip of their tongue has a similar effect.
  • Desensitization – you could ask your dentist if you can borrow a mouth mirror to practice placing it in your mouth at home.
  • Distraction or humming to yourself.
  • Relaxation techniques (discussed below).
  • Inhalation sedation using nitrous oxide mixed with oxygen (discussed below) is also known to reduce the gag reflex as well as anxiety.

Relaxation Techniques

Relaxation is the opposite of anxiety and it is impossible to be relaxed and anxious at the same time. There are various relaxation techniques that you can try to see which works best for you. All of these need to be practiced regularly at home. They will not work if you start while in the dental chair.
Click on each for a link with more details:

Sedation

So what if you have tried the techniques suggested and you still can’t cope with dental treatment?
This is where conscious sedation comes in. Sedation is used to reduce anxiety and aid relaxation, making dental visits more comfortable. You will still be awake but less anxious. You can discuss the options with your dentist. If they do not offer the type of sedation which is right for you, they may be able to refer you to someone who does.
There 3 types of sedation commonly used in dentistry:

  • Inhalation sedation - a mixture of nitrous oxide (laughing gas) and oxygen is inhaled through a rubber cup which fits comfortably over the nose throughout treatment. The sedation reduces anxiety so that you feel happy and relaxed. This is the safest and gentlest form of sedation with few side effects and fast recovery time. It can be used for children and adults. Inhalation sedation is available at Smile Station in Bangalore. You can contact the practice for more details.
  • Oral sedation -  a medication (usually a benzodiazepine) prescribed to be taken in the hours before a dental appointment, or sometimes the night before, which has sedative and anti-anxiety effects. These should only be taken on the advice of your physician and/or dentist as they have side effects and may interact with other medication. You should not drive or operate machinery after taking oral sedation.
  • Intravenous (IV) sedation - a sedative drug is administered into the bloodstream through a vein. This induces a deeper state of relaxation but you will still be awake. It may give either partial or full memory loss during the time of sedation. IV sedation is only recommended for adults and impairs ability to drive or operate machinery.
Remember, sedation is never a substitute for a good, caring dentist who will work with you to overcome your fears.Finally, here is a testimonial from Chelsea – a patient at Smile Station who has been able to overcome her anxiety:“Smile Station, a place I never thought would actually be pleasant to go to. Simply because it was a dentist’s clinic. but my experience here made me change my entire opinion and made me feel extremely comfortable. A root canal from what I had heard was supposed to be the most painful thing, but Dr. Gurudev being so experienced made it feel like a cake walk. He was extremely gentle and helped me get over my fear of the dentist. The facilities are extremely good too! I am so happy I chose to come to Smile Station and I would recommend this clinic to anyone!”If you have any comments on this blog, or would like to see any other topics covered, please post a message below.

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