TREATING PATIENTS WITH DENTAL PHOBIA


A majority of patients in the United States suffer from some degree of dental phobia and approximately a 1/3 are extreme cases. It is ironic that the greatest need for dental treatment exists within this population due to avoidance exposure to dentists. They are primarily treated on an emergency basis and often fail to follow through treatment beyond alleviating immediate pain and/or infection.


Dental phobia refers to an individual's apprehension towards receiving dental treatment. It certainly has varying extremes. For most, it is a mildly excitable state of anticipation. For some it is a morbid fear which extends to fear of even routine checkups. It is developed either by negative prior experiences or by irrational expectations.


Individuals effected by previous experiences are casualty of dentists inexperienced with phobic patients or insensitive to their needs. This added responsibility may be taxing for a dentist not prepared for it. Individuals with irrational expectations are influenced by impressions of family or friends experiencing negative out-come or complications following dental treatment, without knowing all the circumstances. Also they may suffer from ignorance, and may not be aware of advancements in dentistry. Some individuals still associate dental treatment with a medieval concept. Most people simply associate dental treatment with pain and do not realize that they do not have to tolerate a dentist which causes severe unnecessary pain during dental procedures and that they can opt to see someone more sensitive and diligent towards reducing discomfort.


Unfortunately no consensus exists in the dental community on approach and treatment of the dental phobic patient. Each dentists usually through experience finds an effective modality. This leaves the phobic patient with uncertainty in finding a dentists versed in this matter.


Our goals at New England Dental Center have been molded by over a century of combined experience and have been proven to be very effective. We believe that a well educated and well treated patient is far more motivated to preserve the success of their dental treatment and can minimize their complications by knowing when to seek attention. The primary goals of the attending dentist for a phobic patient are:


Severely phobic patients should be invited to visit and tour our dental office on their first appointment. This allows the patient to become familiar with the environment and the people who will care for them. They will be less hesitant to ask questions, since they are not threatened with the possibility of immediate treatment. We want our patients to ask questions, and we want to give them accurate answers.


If the patient is worried about exposure to communicable diseases, they can inspect a demonstration of the sterilization process. This will assure them that there are no significant risks, when strict universal precautions are observed for every patient.


This will also give the patient the opportunity to become familiar with their potential future dentist and staff.


Patients should be encouraged to discuss the points of concern. It is important to determine the issues to which the individual patient is sensitive to. Phobias are generally focused around a central theme. To resolve the phobia it is first necessary to pin-point the greatest cause of fear and address it.


Motivating the patient to seek routine care will minimize the extent of treatment. Early treatment of most medical conditions in general will offer better prognosis and fewer potential complications during treatment.


If the patient demonstrates acute phobia just from being in the office then it may be appropriate to prescribe mild sedatives to soften their nervous state. It will serve to diminish panic attacks and difficult behavior. Some patients are better served with this approach.


It is prudent, whenever possible, to start with a simpler procedure that promises to be well controlled, tolerable and has limited potential for complications.


Immediate success is assured by disappointing the patient's phobic expectations. If they anticipate pain; utilize anesthetic patches and topical ointments, so they do not feel the pinch.


If they are afraid of the unexpected, then explain the procedure accurately but not with unnecessarily graphic words.


If they expect the procedure to take long then break it up whenever possible into several shorter appointment, if the patient accepts.


If they are hesitant over the Novocain injection, then do not show them the needle and take great care in administering the injection.


If they are nervous over the possible cost of the procedure then explain that early treatment will save them $ in the long run.


These patients are better served in a multi-specialty practice setting, so that their particular treatment aspects are communicated to any specialists involved in their treatment, and the attending dentist can be present to introduce them to the specialist. This often makes the transition much easier for the patient to endure.


Asking the patient frequently if they have any questions or if they are relatively comfortable will allow them to vent. They may be nervous and not have the initiative to come forth with their concerns. Instead they will dwell on them and work themselves into a heightened state.


Post-operative instructions should be very detailed and explicit. These patients may be slightly more prone towards hypochondria.


Waiting prior to the beginning of procedures should be shortened, so a patient does not have a chance to dwell on anticipation. Extended waiting can cause panic attacks in some.