Dental Phobia — Dental Fear lecture part 2 of 2

Dr. Jeff Dorfman, I am Director at The Center for Special Dentistry in New York. This is part two of a two-part credit course for dentists on dealing with dental phobia, dental anxiety, and learned helplessness and how to help patients overcome that, so that they can get the dentistry that they need.

Some of the objectives we’re going to talk about include the differentiation between dental anxiety and dental phobia. Dental anxiety as defined by the American Dental Association is just a general nervousness about dentistry, and we’ll go back to the other one, yeah! versus dental phobia and then specifically how can you deal or help a dental patient who suffers from dental anxiety or dental phobia. How can we help them actually? Many of them may need reconstructive dentistry. How do we get them there? The point of this is to teach dentists how to get an initial patient into their office, how to make them comfortable and how to ultimately accept the dentistry they need. All right! It’s important when you’re talking about this with patients, that they understand that dental phobia is very common. For those who are walking in now, there are seats over there on the left. Please feel free to grab the seats and we’ll stop for a moment, that’s fine.

So dental phobia, dental anxiety, it’s very common; and one thing I have found that my patients, when they come in, with that type of a problem, is that many people are embarrassed that they are afraid of dentists; and I explain to them that is very very natural to explain a fear or anxiety with dealing with dentistry. One reason for that is that the two most sensitive parts of the body are actually the genitals and the teeth. The genitals are naturally very sensitive, so that way people, or even animals, will reproduce; and teeth by design need to be particularly sensitive because we need to be able to clearly differentiate food from non-food. There are times that we may have a fish bone in a piece of fish or something like that, so there is an intelligent design behind the idea of teeth being sensitive. If someone has had one or more bad experiences with dentistry or they’ve had one or a series of failed dental procedures, or they go through crowns or root canals, or things like that, and a lot of the dentistry fails, and it’s painful or worse if it fails painfully, then people who are anxious or people who are phobic are actually behaving rationally; and if I explain that to people, a lot of times, a lot of the burden and the guilt, their embarrassment does make them feel better. So, for people who are phobic, there is an intense fear or dread. For people who are merely anxious, they’re just not comfortable.

In this practice, The Center for Special Dentsitry, we treat all kinds of patients, the majority of whom are not afraid of dentists. But, I have a particular interest when we have people who are afraid or anxious with dentists. I particularly like that kind of a case because from a psychological standpoint, I find it interesting and usually those kinds of people tend to need much more comprehensive care, so that if you’re doing some basic general dentistry, people may say, hey, that was great, thanks a lot. Whereas if you’re performing more complex reconstructions or smile makeovers for people who are really phobic, then it’s not just “hey thanks a lot, that was great”. It’s more like “hey you really changed my life, thank you so much.” It’s a different feeling. So I encourage those dentists in the room, and I encourage the dental students in the room, and those who are pre-dental that it happens to be very emotionally satisfying for me; and part of what I’m trying to impart to you guys during this two-part lecture is why I think it’s particularly enjoyable. Next slide please.

So, this is some more information about what can make someone have a traumatic event. It can be a one-time event. It can be a series of events. It can be something that’s unexpected; they’re unprepared. It can lead to- here they are talking being powerless to prevent it; there is a subsequent slide later- you don’t have to go to it yet, by Dr. Martin Seligman who was a professor at University of Pennsylvania, where I attended undergrad and dental school. He was a brilliant psychologist and I studied with him as an undergrad and wrote an independent research with him. His name is Seligman, first name is Martin – University of Pennsylvania – you can find him that way. I encourage any of the dentists or students in the room who have an interest in helping this kind of patients; you want to read Martin Seligman; and a lot of work about depression and learned helplessness is written by him and a lot of his work you’ll see a slide later, but since I’m going into it, I’ll talk about it now. A lot of his work talks about- when he’s dealing with patients, his patients who are particularly depressed; he gives them baby steps on things to achieve. Small achievable goals that when they can achieve those goals, they can take a breath and say “I’ve done it.” And in much the same way, what I will do with our dental patients is- we like to set small achievable goals; and we’ll go a little further in that or I could talk for an hour. Let’s see what the next slide is an if not…

Here the ADA is talking about that anxiety and pain control can be defined as an application of physical, chemical and psychological modalities to the prevention and treatment of preoperative, operative and post-operative patient anxiety and pain to allow dental treatment to occur in a safe and effective manner. It involves all disciplines of dentistry and as such, is one of the most important aspects of dental education. This is a worthwhile slide to stay on and I would say for dentists, is know your capabilities. So you can hear the two lectures. You can spend time in our office and study with us. You can read a lot of the stuff on which is our 4000 page website and see it and study it, and learn it, and think that maybe you can do it but it’s important to always stay within your skill set because you don’t want to start getting involved in these cases which can be very complex in terms of the dentistry; and if you also add the psychological component on it, stay within what you’re comfortable doing, alright? and I’ll answer if I see a hand there, I’ll answer questions a little bit later on, okay, when we get to the end, alright?

So, prior to the initial consultation, here we’re even talking about marketing website and you want to convey comfortable dentistry. You want to convey that you care; and I’ve read, I tend to ascribe to the philosophy, is, to avoid the color red. You know on websites, I think it is something that one should consider. It’s just a bloody color. Psychologically or not, it is a color I would avoid in web design; and some websites project being, I think, overly self-important. They have the dentists in their pictures are cropped with dark backgrounds and everybody looks like they’re trying to be a model or an actor in something. For someone who is afraid of dentistry, and I’m just going to talk about afraid, I’m not going to differentiate in the rest of this discussion, between dental anxiety or dental phobia, but someone who has those concerns, they may not be looking for the person who has the most perfect suit on, and with the most perfect hair style if they are picking a dentist. I think what they’re looking for is do they have the skills to perform the procedure. Do they project intelligence? Do they project honesty? Do they project compassion?