Keep Smiling! (eBook)

Chapter 1

The Problems with Dentistry

In This Chapter

     chief complaints about dental treatment: pain and fear

     origins of fear of dental treatment

     dental phobia – causes and treatment

     coping strategies for the non-phobic dental client

     options for pain and anxiety control

     preparing a child for professional dental care

Chief Complaints about Dental Treatment: Pain and Fear

If dentists and other dental care providers had a dollar for every time they heard the phrase “nothing personal, Doc, but … ” followed by one of several common negative statements, they could all retire years earlier than they usually do. The problems with dentistry depend on from which end of the sharp instruments you are making the assessment.

For the recipients of care, the most common complaints are about pain, fear and (where insurance doesn’t cover services) paying for the experience. Less commonly voiced concerns include: officious staff, assembly-line practices and waiting in the reception room. From the providers’ point of view the main problems include dealing with anxious and/or angry clients and those who report for emergency services only.

Although sadistic dentists rank up there with greedy lawyers and crooked accountants as the butt of popular jokes, it is an interesting fact that polls show dentists among the most trusted of professionals. Research also indicates that the expressed negativity from clients takes a toll on dental care providers as well. Among the professions (medicine, law, accounting, engineering, etc.) dentists tend to have higher rates of substance abuse, family discord, depression and suicide. They also are murdered more frequently than practitioners in other disciplines.

With this information in mind, please try to handle your dental staff kindly. They may unavoidably be causing you some discomfort, but are often enduring considerable life stress associated with your care.

Origins of Fear of Dental Treatment

There are two major sources of fear of dental treatment. The first comes directly from Pavlov’s classic conditioning model. If you experience a pairing of a neutral stimulus (dental office, dentist) with an unpleasant effect (pain of treatment) then fear of an unpleasant consequence is associated with subsequent presentation of the stimulus. In short, if you have had an unpleasant dental treatment experience in the past, you are likely to be somewhat uneasy at subsequent appointments.

The second source of fear comes from the negative reports of others. There are several common types of such reports. One is careless adult talk about medical and dental procedures that is overheard by young children. Adults often describe for one another quite graphically, and often exaggerated for effect, medical or dental procedures that they have undergone. They usually assume that if children overhear such information it isn’t a problem because they do not understand what is being said. In fact that lack of understanding is precisely the problem. Children cannot realize that what they hear about adult medical concerns is not relevant to them. They do, however, remember parts of the information. When the time comes for them to enter into a medical or dental treatment situation, they recall parts of the stories they have overheard and already have some level of irrational fear.

Another source of negative influence can be older children. Siblings are the usual but not the only culprits of spreading or inventing medical/dental horror stories. During preadolescence, stories of superheroes, ghosts and goblins are common fare. Part of growing up involves coping with your place in the pecking order. Older children like to influence younger ones – not always positively. Children will be children. What better way to wield power over younger children than to tease them with a story you know isn’t true but they will believe because you are a credible source in their eyes? Many parents are unaware of these influences until, in spite of careful preparation, the younger child’s first dental visit goes less than smoothly, thanks to the influence of older children.

Although it is difficult to believe, there are still some parents who use threats of medical or dental treatment as a way to discipline their child. If the child misbehaves, the parent threatens to take him/her to the dentist if they do not co-operate. Anyone using this tactic should not be surprised later if the child’s dental appointments become struggles for all concerned.

For most people, the level of psychological discomfort when facing medical or dental treatment is manageable, thus they continue to access regular professional services. If, however, a treatment experience has been sufficiently traumatic, it can cause true dental phobia resulting in avoidance of dental treatment for years or even decades. Sadly this avoidance leads to increased levels of dental disease requiring more extensive and possibly more uncomfortable treatment which in turn leads to increased fear and avoidance. The pain, fear, avoidance cycle can become well established.

Dental Phobia – Causes and Treatment

If you are dental phobic you’re not alone! Studies estimate that in North America dental phobia affects five to 15 percent of the population. In Canada that translates into 1.6 to 4.9 million people who do not access regular dental care because of extreme fear of treatment. In other countries of the world where dental services are less prevalent, estimates of dental phobia approach 20 percent of those populations.

A number of polls taken in North America and reported in Health magazine have yielded a list of the most commonly reported fears. These are rank-ordered below.

The Top 10 Things We Fear

     speaking in public

     getting fat

     going out alone at night

     dental visits

     dying

     spiders and insects

     swimming in the ocean

     heights

     flying

     large crowds

Treatment of Dental Phobia

Although there is a variety of pharmacological pain and anxiety measures (described later in this chapter) which can be used in conjunction with dental treatment, none of these options treats the phobia itself. Mood altering medication should always be considered as a last resort for helping clients deal with routine dental procedures. All drugs have side effects ranging from mildly undesirable to dangerous. In addition, frequent use of any medication can lead to psychological and physical dependence. All good dental care involves aspects of client learning and participation, elements that are not available to the practitioner if the client is under the influence of anti-anxiety medication or profound anaesthesia.

If you see yourself in the definition of a dental phobic and are concerned that the state of your mouth is not contributing positively to your overall health, there is help available. If you are not experiencing any acute symptoms (pain and swelling), but you want to get back into the dental treatment loop you might want to consider visiting a good psychologist first. One commonly used treatment for phobic behaviour (not just regarding dental treatment) is called systematic desensitization. Most psychologists, and a few dental practitioners concerned with helping clients overcome serious distress caused by dental treatment, offer this technique in their practices.

Systematic desensitization (SD) uses a combination of relaxation therapy, conscious imaging and positive “self-talk” (encouraging statements that you repeat to yourself to help you adopt beneficial reactions to feared situations). SD is useful in helping people deal with irrational levels of fear associated with specific items (snakes, spiders) or events (flying, dental treatment). Fearful individuals are asked to imagine aspects around the feared item or event that upset them. Once the elements are identified and described in detail, they are ranked by the client from least to most fear-provoking. This set of statements is referred to as fear hierarchy.

For many dental phobics, the thought of calling to make a dental appointment causes stress. As they get closer to the office site and actual treatment procedures, fear levels typically escalate. When this is the case, a fear hierarchy may closely resemble a description of appointment events in chronological order. A sample dental treatment fear hierarchy where this is apparent is detailed later in this chapter.

If you seek counseling for dental phobia and the counselor suggests treatment with SD you will generate your own feared events list. The counselor will then teach you one of several possible relaxation techniques and ask you to practise it until you are able to put yourself in a relaxed state easily and quickly. Now you are asked to induce your state of relaxation while the statement regarding the least fear producing element of your hierarchy is presented. You are asked to imagine yourself in the situation described. You will then be instructed to stop imagining the scene described and to imagine a very...