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Dental Anxiety

28
Nitrous Oxide Laughing Gas for Dental Visits
©Yuri Bathan/Shutterstock.com

In order to get certified to give patients nitrous oxide (commonly called laughing gas), I have to administer it several times to prove my competence.

Last Friday afternoon, I was able to give a patient nitrous oxide and literally change his perception of dentistry.

He loved it.  I asked him about his dental fear and he said something like, “You know when you’re in an airplane and there’s a sudden rush of unexpected turbulance, you grab onto the handles of your seat.  That’s how I am at the dentist.”

On Friday though, he said he felt great.  He was telling jokes in the dental chair and having a great time.  He said that the nitrous oxide made him feel great, he said he felt like he was drunk.

He was a fairly young guy that had simply avoided going to the dentist and ended up with a few lost teeth and a lot of teeth in bad shape.  Nitrous oxide has given him the ability to overcome his dental anxiety and sit in the chair.

Nitrous Oxide in Dentistry

Nitrous Oxide in Dentistry: Laughing GasAs you can see in this picture above, nitrous oxide is given to a patient through a mask that is placed over the nose.  In addition to nitrous oxide, we run oxygen into the mask so that the patient is always getting more oxygen than they would just by breathing in regular air.

An advantage of nitrous oxide over other forms of sedation is that it works pretty fast.  Within a few minutes, the patient is relaxed.  Also, when you have finished your dental procedure, the recovery is fairly rapid as well.  You are able to drive home after the appointment since you don’t remain drowsy.

Is Nitrous Oxide Dangerous?

Nitrous oxide is safe when it is administered with adequate oxygen.  Although side effects are fairly rare, the most common side effect of nitrous oxide is nausea.

Nitrous oxide may be harmful with long-term exposure.  This doesn’t really apply to patients, it’s more for those people who work at dental offices and get exposed to it every day for years.

Regarding possible long-term negative effects of nitrous oxide, Pinkham’s Pediatric Dentistry textbook states, “Retrospective survey studies of dental office personnel who were exposed to trace levels of nitrous oxide suggest a possible association with nan increased incidence of spontaneous abortions, congenital malformations, certain cancers, liver disease, kidney disease, and neurologic disease.”

Conclusion

Nitrous oxide can help many patients overcome their dental anxiety.  I have a patient with a lot of dental fear that gets nitrous oxide every time he comes in.  He loves how it calms him and allows him to get his needed dental work done.

Do you have any questions or comments about nitrous oxide in dentistry?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

13
Scary Dentist with Real Drill
©Alan Bailey/Shutterstock.com

One of my professors told me that he has often been told, “Hey Doc, it’s nothing personal, but I hate dentists.”  This professor also shared that he thinks statements like these just come with the job.  I know of another dentist who reacts when his patients tell him that onlineusadrugstore24.com they hate dentists by asking the patient what they do for a living.  He then tells them that he hates their profession.

In my few years of experience in the dental field, I have met more than a handful of people who openly share their dislike of dentists.  My first inclination is to find out why.  Was it a bad experience when they were younger?  Have they had difficulty communicating with their dentist? Have they had procedures done without good pain control?

As a kid, I loved going to the dentist because I would always get a new toothbrush. But I know I’m in the minority, or maybe just weird — probably both.

A lot of people hate the dentist due to dental fear (for example, here’s 15 reasons why people are afraid of the dentist), but I want to dig a little deeper and discover the root cause of all the hate.

Anyway, I’ve spent a significant amount of time thinking about this and I finally have my own personal theory of why people hate the dentist.

Why People Hate the Dentist

My theory actually has two parts. I’ll cover the first part this week, and the second part next week.

According to the first part of my theory, the reason that people hate the dentist is because teeth only feel pain.

Why do so many spouses buy massages for their loved ones on Valentines day?  Because a massage is pleasant — usually people want a back massage because it makes them feel good.

Unfortunately, teeth aren’t quite the same as our backs when it comes to senses. Teeth can only sense pain.  Imagine what it would be like if people craved their dental checkup because they were going to get their teeth massaged, rather than cleaned.  What would life be like if a root canal was called a deep massage and actually felt good?  You’d probably see lines at every dental office filled with people begging to get a root canal done so that they could have a full-tooth massage.

Brushing your teeth might make your mouth feel clean, but it’s more of a necessity than a feel-good experience.  Most people would agree that the only time you really notice your teeth is when there is a problem!

Why People Hate The Dentist

Tooth Massage
“I love a good tooth massage”

The Odds Are Against Us

Many dentists try to make going to the dentist a pleasant experience, but it’s hard when your teeth are capable of only feeling pain.  People usually go to the dentist for one of two reasons.  The first is to have a routine cleaning, which is relatively painless but can be uncomfortable depending on the amount of plaque to be removed.  The second reason people go to the dentist is because they have a problem, and more often than not it is a painful problem.  Either way, if your dentist does his job well, at best you would feel no pain.  But it is impossible for a dental procedure to feel good since teeth only feel pain.  I mean, when was the last time that you said this to your dentist: “That root canal was amazing!  Is there any chance you could do that to another one of my teeth at the next appointment?”

Dentists are in the business of preventing problems (although most of that falls back on the patient) and solving problems.  Most of these problems are painful, and in addition, most of these problems require more pain (from the procedures) in order to be solved.  If only your teeth were able to feel the good things that we do for them, people might not look at dentists with so much fear!

Why Do You Think People Hate the Dentist?

I realize that most people probably don’t actually hate “the dentist” but hate the experience of going to the dentist.  I may be wrong in assuming that, but most dentists I’ve met over the years seem like pretty decent people.  So it seems that people “hate the dentist” because of all they associate with visiting their dentist.  Guilt by association, right?

Do you hate the dentist?  Do you have any other theories?  I’d love to hear your thoughts.  Please leave a comment below and join in on the conversation.

Thanks for reading!

6
Comprehensive Dental Exam
©Sheff/Shutterstock.com

Have you ever wondered how thorough your routine dental exams are?

A dentist that I shadowed prior to dental school told me that he used to rush through patient exams trying to get as much done as he could.  Eventually, he got tired of this because he really wanted to spend more time with his patients.  He doubled the price of his exams and spent twice as much time with each patient, being as thorough as he could.  Rather than losing patients, he said that he gained many more patients because his exams were complete and his patients felt they were getting a quality exam at each visit.

What Is a Dental Exam?

At my dental school, we do our exams by-the-book — we’re pretty thorough!  We examine just about every possible thing that a dentist can.  I thought I’d write a post about what our comprehensive dental examination includes, so you can gauge thorough your dentist’s exams are.

What Is a Dental Exam?

A dental exam consists of several different parts.  Each part helps to ensure that you and your dentist understand what is going on with your oral health.  In order to better describe a routine dental exam, I’ve simply written what I do when I see a new patient at the dental school.

I’ve divided it into 10 parts.  You can read over them all to see what we do, or simply jump to the sections that interest you.  If you have any questions when you’re done, scroll to the bottom to leave a comment, and I’ll get back with you.

1 – Introduction

I meet the patient in the waiting area, introduce myself and then ask them a little bit about themselves to get to know them better and put them at ease with me as their student-dentist.

2 – What Does the Patient Want?

I ask the patient why they came to the school for treatment.  I also ask what they expect from their treatment and what kind of dental work they want to have done.

3 – Medical History

I next obtain a very detailed health history, including which medications they are taking and any past or current medical conditions.  I then take a blood pressure and pulse.  It’s important to get the patient’s health history because certain things, like joint replacements and certain heart conditions can affect your dental treatment.  Also, there are over 300 medications that can cause dry mouth, affecting dental health.  Finally, an accurate health history is important because the dentist needs to ensure that there are no systemic problems that will affect the dental treatment that will be provided.

4 – Dietary Survey

We then complete a dietary form that indicates whether their diet places them at a high risk of getting cavities.  Although there are many things that can influence your risk of getting cavities, (here’s 25 things that increase your risk of cavities), diet is one of the most important factors.

5 – Risk Factors

We complete a “risk factors” form that tells us the patient’s risk for developing certain diseases, such as periodontal disease and oral cancer.  This form also gives us a general idea about the patient’s risk for fracturing or knocking out a tooth.

Another part of the form discusses the patient’s dental phobia.  We ask what kinds of things make the patient anxious about their dental treatment.  If you want to pinpoint your dental phobia, take a look at 15 common reasons why people are scared of the dentist.

The “risk factors” form also discusses other risk factors.  For example, this is the form I talked about in a previous article about how wearing your seat belt affects your dental health.

6 – Head and Neck Exam

6 – After that, we perform what we call a head and neck exam.  We feel the neck to note any enlarged lymph nodes or any suspicious lumps or bumps that could be cancerous.  We also feel the TMJ to evaluate whether or not the patient has any joint problems.  We note any popping or clicking in the jaw, which is fairly normal but which can cause problems.

7 – Oral Soft Tissue Exam

Next, we move on to the intraoral soft tissue exam.  The soft tissue exam consists of looking at every area in your mouth.  We look at the lips, the cheeks, the gums, the roof of the mouth, every side of the tongue, under the tongue, in the back of the mouth, the throat and the tonsil area.  Your tonsils can tell us if your body is fighting off a disease and sometimes your tonsils can cause bad breath if there is a tonsillolith present.

It is necessary to perform a very thorough soft tissue exam because this is where dentists check for oral cancer.  If your dentist isn’t very attentive during the soft tissue exam, he or she may miss the beginning stages of oral cancer.  It is important to catch cancer early because it improves your chances of beating it.  If something looks suspicious, your dentist may biopsy the area and/or refer you to an oral pathologist, one of the nine types of dental specialists.

8 – Periodontal (Gum) Health

Another part of the dental exam is periodontal probing.  This consists of sticking a little instrument between your teeth and your gums to see how healthy your gums are.  We measure the space between the top of the gums and where your gums attach to your teeth.  If it’s too deep, you won’t be able to clean it out well and it could indicate that you have periodontal disease, which is a leading cause of tooth loss in people over age 30.  If you do have periodontal disease, your dentist may recommend getting a deep dental cleaning, which is technically known as scaling and root planing.

9 – Hard Tissue Exam: We Finally Check Your Teeth

Next we perform a hard tissue (teeth) exam where we look at every side of your teeth and note any existing fillings, crowns, implants, root canals, cavities, fractures, or if there are any problems with your bite.  We also look at all of your dental work to make sure that it is still in good shape.  Depending on the health of your teeth, we may order x-rays to better diagnose any problems with the teeth and the area around the tooth.  Want to know if you need x-rays?  Read the article How Often Should You Get Dental X-Rays Taken?

During the hard tissue exam, we will also evaluate the patient’s bite.  If we will be making any crowns or dentures for the patient, we usually take dental impressions as part of the dental exam so that we can evaluate the patient’s bite and make sure we don’t cause any problems with the way that their teeth come together when we place crowns.

 10 – Treatment Planning

After gathering all of the above information, we create a treatment plan with all of the dental work that we recommend having done.   Sometimes this is as simple as getting a regular cleaning and providing instructions on how to maintain better oral hygiene or it can be as complex as getting dentures, crowns, bridges, root canals, implants, veneers, braces, and other dental treatment.

Conclusion

This is the comprehensive dental exam that each patient receives initially at my dental school.  Your dentist may choose to do things differently.  For example, some patients hate the “risk assessment” form and the dietary questionnaire.  At my dental school, we are required to complete these forms with the patient.  If you don’t seem interested in those things, then your dentist may choose to omit those parts of the exam.

Remember, all dentists are different, and most dentists want what’s best for their patients and will try to provide you with optimal dental treatment.  However, some dentists aren’t thorough, and hopefully this list will help you evaluate what you want your dentist to address during a dental exam.

If you have any questions, comments, or concerns about your dental exams, feel free to leave a comment below.  Thanks for reading!

55
Reasons People Have Dental Phobia
©Robert Kneschke/Shutterstock.com

A few weeks ago, a teenage boy came into the dental school because one of his teeth was hurting.  I saw him in our pediatric dental clinic and we determined that two of his teeth couldn’t be saved and had to be pulled.

He seemed fine with everything.  I took him over to the oral surgery department to do the extractions and he started breathing heavily and acting very anxious.  I spent a few minutes talking with him about his dental anxiety.  When I tried to give him the anesthetic injection, he covered his mouth and shouted, “I decline treatment.  I have that right!”

Dental Fear and Anxiety - Dentist PhobiaI talked with him for a while and tried again.  I found one of our more compassionate oral surgeons and asked her if she wouldn’t mind helping.  The young man wouldn’t even let her give him the injection.

We scheduled him to get the teeth out under intravenous sedation.  He ended up not needing it because his mother had said that if she didn’t have to pay the $200 for sedation, he could buy something with the money that she would have saved.

Before we gave him the injection at the follow-up appointment, he tried to cover his mouth, but his mom was there with us and helped us hold his hands.  What I found shocking was that after the injection, he said he had barely felt the injection and now he has overcome his fear.

Unfortunately, not all dental fears are that easy to overcome.  Some people literally spend their whole lives being terrified of dental care.

If you want to learn more about dental fears and how to conquer them, I recommend the Dental Fears page over at Dental Fear Central.

Below you’ll find 15 common reasons why people are scared of the dentist.

15 Reasons Why People Are Scared of the Dentist

1 – The Drill. Even if you’re not getting your teeth worked on, chances are that you’ll hear the high-pitched whirring of the dental drill.  I’ve had patients who hate the sound of the drill so much that they wince whenever I turn it on, even if I haven’t touched their teeth yet!

2 – A Bad Dental Experience as a Child. A scary experience as a child at the dentist is all it takes for some people to avoid the dentist as an adult.  I would say that a majority of people who have a fear of the dentist had a bad experience at the dentist when they were young.

3 – Getting Your Teeth Scraped During a Cleaning. If I had to pick one reason to dislike the dentist (or dental hygienist), this would be it.  I used to hate it when they would scrape my teeth with the metal instruments.  It would send shocks through my body and give me goosebumps.

4 – The Anesthetic Injection. There are actually a few fears associated with getting injected.  I’ve divided them into five categories – feel free to add your own in the comments section if I didn’t cover your specific fear of the needle:

  1. Fear of the pain from the injection.  It’s usually just a little pinch, but some people (like the teenage boy in the introduction) have a fear of getting an injection.
  2. Fear of being injured by the needle.  Many people have a fear that the dentist will slip when giving them an injection and injure their mouth or face.
  3. Fear of getting diseases from the dental office such as AIDs or a cold.  How is your dentist doing when it comes to proper infection control?
  4. Fear of being numb.  Some people hate the feeling (or lack of feeling!) of losing sensation to a part of their lips and gums.  Sometimes when we give injections on the roof of the mouth, it can make it feel like it’s harder to breathe, causing a fear of suffocation in some patients.
  5. Fear of the side effects of the anesthesia.  Some people have allergies to the anesthetic or the preservatives used in the anesthetic.  Sometimes your heart races when you get a dental anesthetic injection – read this article to find out why dental anesthetic makes your heart beat faster.

5 – Getting Teeth Extracted. I’ve taken a lot of teeth out during dental school.  Some people think it’s cool, some people view it as a necessary evil, and others are extremely scared of getting a tooth pulled.  Something about having a body part removed that they’ve always had leaves some people feeling unsettled!

6 – Embarrassment. Many people are scared of the dentist because they are embarrassed of their teeth.  They have a fear of getting laughed at by the dental staff due to the poor condition of their teeth.  Trust me, we’ve seen worse!

7 – Demonstrating their Fear. Many people are scared that they will cry in front of the dentist due to their fear and end up making a fool of themselves.  This keeps them from seeking needed dental care.

8 – Having a Panic Attack. Similar to #7, many people are afraid that they will panic while at the dentist and have a panic attack.

9 – Your Dentist is a Jerk! Let’s face it, there are dentists out there who hate what they do − perhaps they got into the profession for the wrong reasons.  Hopefully these types of dentists are extremely rare.  In any case, if you hate having something done to you, and the person who does it hates doing it, it is a recipe for disaster!

10 – Not Having Any Control. Many people are afraid of the dentist because it puts them at the mercy of another individual.  They don’t have any control over the procedure while it’s happening.  One innovation to combat this lack of control is known as the dental button, which allows patients to stop the dental drill if they feel uncomfortable.

11 – Gagging or Choking. Many patients avoid the dentist because they have a fear of gagging or choking.  Dentists use many tiny instruments that can fall down the patient’s throat if the dentist does not take the proper precautions.  Stories like this one make the news and instill this dental fear in many people.  Many patients also gag when they get dental impressions taken.

12 – Allergies. Dentists use a variety of materials.  Some patients fear that they may be allergic to something in the dental office and don’t want to face the consequences of an allergic reaction.

13 – Sounds of the Dental Office. Aside from the drill, there are various sounds that can work up fear in certain patients.  If the person in the next room over is having a procedure done that you hate, chances are it will invoke a certain amount of fear into you.

14 – Smells of the dental office. The dental office has an interesting smell that is made up of a variety of things.  Read my article about the dental office smell to find out more about what exactly causes this interesting odor.  An interesting study found that those people with dental fear hate the smell of clove oil (a common dental material) while those who don’t have a fear of the dentist find the smell of clove oil to be “pleasant.”  Here’s what the study found:

In both groups, menthol was rated as pleasant and methyl methacrylate as very unpleasant, whereas eugenol was judged pleasant by non-fearful subjects but unpleasant by fearful subjects. Concerning autonomic analysis, only eugenol induced significantly different patterns of ANS responses between the two groups, with stronger variations for dentally fearful subjects, mainly observed through the electrodermal channel. These results suggest that eugenol can be responsible for different emotional states, depending on the unpleasantness of the subjects’ dental experience. This seems to confirm the role of odors as elicitors of emotional memories and to support the possible influence of eugenol odor on the avoidance behavior of some subjects toward dental care.

15 – Previous Sexual Abuse. There are many aspects associated with dental care that can bring back vivid memories of abuse.  These include being placed in a horizontal position, having someone in power that touches you and causes you to feel pain.  To learn more about this sensitive subject, I recommend reading this interview with Dr. Carmen Santos, an expert in childhood sexual abuse and its relation to dentistry.

Conclusion

There are many reasons that people may be afraid of the dentist.  Chance are that I missed more than a couple reasons.  If you have a fear of the dentist, please let everyone know what causes your fear in the comments section below.  If you have any tips for those with dental fear, go ahead and leave those in the comments section as well.

Thanks for reading!

14
Dental Fear You Are Not Alone
©Racorn/Shutterstock.com

Does the sound of a dental drill make you scared?  Is it hard to get up the courage to go and have dental work completed by your dentist?

Dental Phobia, Dental Fear, and the Dental DrillIf so, you’re not alone!  There are many other people who aren’t big fans of the dentist.  In fact, the Journal of the American Dental Association has estimated that 30 to 40 million people have dental fear.

How Common Is Dental Fear or Dental Phobia?

Many telephone surveys (like this one) have been conducted asking people about their degree of dental fear.  After looking at several of these, I would say that the overall breakdown of dental fear is the following:

About 20% of people have dental fear.

About 20% of people have a slight amount of dental fear.

About 60% of people don’t have any dental fear.

Who Has Dental Phobia or Dental Fear?

A dental unit that specializes in dental fear treatment was used to study 160 adult dental patients.  As I read over the study, I noticed some interesting facts that they found while studying people with dental fear.  They found that:

  • In 85% of the adults, dental fear had started in childhood and was the result of a traumatic dental experience.
  • A majority of those with dental fear were women (From what I’ve observed so far in my dental career, it seems that the gender of those with dental fear are about 1/3  male and 2/3 female)
  • Although there were more women that had a fear of the dentist, it was the men with dental fear that had worse teeth.
  • The average time that a patient with dental fear had avoided seeing the dentist was 16 years!
  • The most feared events were drilling, getting an anesthetic injection, and getting a tooth extracted.
  • The attributes they looked for in a dentist: Someone who is understanding and tries to avoid inflicting pain.
  • The attributes that they disliked in dentists: Being critical, remote, distant, and having a heavy hand.

Is Dental Fear and Anxiety Decreasing?

In a 2003 review of the studies on dental fear, it was found that studies done over the past 50 years “provide no clear evidence of dental fear either increasing or decreasing. Although several pairwise comparisons between study groups across locations suggest a decrease in dental fear over time, results of comparisons made within the same location are mixed and do not provide enough information to draw definitive conclusions regarding changes in dental fear over time.”

One positive point that the study found was that  “while dental fear is not dropping dramatically, it also is not rising as dramatically as is general anxiety in the United States. The fact that dental anxiety is not rising when dentists are treating patients who are increasingly anxious in general is—at least in part—a tribute to advances made in dental technology and patient management skills. In comparison with the rising tide of general anxiety in the United States, this relative reduction in dental anxiety is encouraging. The efforts of the last three decades appear to have had an impact on the problem of dental fear in our society.”

Basically, it would seem that dentists seem to be more aware of dental fear and are handling it better, thus holding the prevalence of dental anxiety down, while general anxiety seems to be increasing.

Conclusion – How to Decrease Your Dental Fear

The Internet does have a few sites that are dedicated to helping with dental fear.  One of the largest and best is called Dental Fear Central.  They have a forum there where you can get help from dentists and people who have successfully worked through their fear of the dentist.

Are you afraid of the dentist?  What have you found helpful in dealing with your fear?  I’d love to hear about any tips or hints you have for reducing dental fear in the comments section below.  Also, if you have any suggestions for what dentists can do to reduce your dental fear, I’d love to hear about them so I can better serve my patients who have dental anxiety.

Thanks for reading!

11
Dental Fear - Calm Your Dental Anxiety
©Sima/Shutterstock.com

Many of the patients we see at the dental school have developed cavities and needed extensive dental work for just one reason: They were too scared to come to the dentist before now.

Dental Fear Central LogoSomething changed within them that made them finally say, “Enough is enough.  I need to get my teeth fixed.”  Sometimes it’s severe pain, and other times it’s a badly decayed, discolored front tooth that needs some dental care and compassion.  Whatever the reason, it’s a shame that it took them so long to get in to see a dentist.  There is a lot of help online.

How Dental Fear Central Can Help You Overcome Your Fear of the Dentist

Dental Fear - You Are Not AloneFirst of all, it reinforces the fact that you’re not alone in your fear of the dentist.  There are many others out there who also get anxious when they go to the dentist.  The forums are great!  They allow you to share your own personal story.  I just read the story of a young woman who went to get her wisdom teeth out.  After a few moments in the room, she got up and left.  She eventually went back and had her wisdom teeth successfully taken out.  She described the whole process.  You can read her story here.

Another way the site helps is by detailing 19 common dental fears and how to cope with them.

Dental Fear Central has an article for those who were sexually abused and have dental fear.  There is also an article for abuse survivors, that is written by a survivor of abuse.  In it, the abuse survivor shares tips on how to cope with certain fears that are instilled in those who were abused.  For example, it can be difficult for an abuse survivor to be lying down in a dental chair with an unfamiliar person poking around in their mouth.

Finally, there is a section of the site dedicated to walking you through the steps you need to take to get you into a dental chair.  It helps you discover your fears, cope with them, and eventually make that appointment with the dentist.  You can find this section, the help section by clicking this link.

Conclusion

I want to disclose that I am not affiliated in any way with Dental Fear Central.  I value this website and believe that it can help people make it to the dentist and avoid losing their teeth.  Because of that, I wanted to share it with you, in hope that if you are anxious about your dental visit, you can get the help you need.

Do you have any questions or comments on dental anxiety?  If so, please leave them below in the comments section.  Thanks for reading!

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