February 23, 2011
Nearly one-quarter of all Americans avoid dentists because they’re afraid, according to American Dental Association surveys. And the fear comes in many forms.
In an attempt to win back fearful patients, dentists like Dr. Eda Ellis in New York offer spa-like services. WSJ’s health columnist Melinda Beck reports.
There’s fear of pain, fear of needles, fear of drills, fear of blood, fear of gagging, fear of feeling helpless or having personal space violated, fear of being lectured for not brushing or flossing adequately and fear of being admonished for staying away so long.
“I even hate that sucky thing that vacuums up your saliva,” says Carolyn Moody, a Bridgewater, N.J., mother of three who avoided dentists for 10 years. Now she makes sure to bring her iPod. “As soon as I hear that drill, even from another room, my fists clench, my body stiffens and my heart starts pounding,” she adds.
Of course, delaying cleanings and checkups only compounds dental problems. Neglected plaque creates cavities; cavities can lead to root canals; root canals require crowns and eventually implants or dentures or worse, a mouthful of toothless gums. Some oral-health problems also send bacteria into the bloodstream, raising the risk of heart attack, diabetes and dementia.
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Sedation. From nitrous oxide (laughing gas) to tranquillizer pills to intravenous drugs, patients now have many options to lessen their awareness of what’s going on in the dentist’s chair. Dentists must have special training and certification to give some forms of sedation, and patients must be accompanied to and from the dentist’s office.
Pain killers. Numbing sprays, gels and patches can make cleanings less arduous and reduce the pain of injections. Local anesthesia can sometimes be delivered with electricity from outside the mouth, or with computer-controlled devices that regulate the flow of anesthetic.
Entertainment. Headphones, flat-screen TVs–even virtual reality goggles for watching movies–can help patients pretend they are somewhere else.
Atmospherics. Quieter drills and citrus-scented candles help mask the typical sounds and smells of dentistry; some practices have stopped using eugenol, the clove-scented antiseptic; others even bake cookies to introduce a soothing aroma.
Spa services. Foot massages, warm neck rolls and paraffin treatments for hands help patients relax and pass the time. Whitening, veneers and other cosmetic treatments can lure in patients who would otherwise dread dentistry.
Now, many dentists are taking pains to win frightened patients back. Some practices let patients virtually sleep through the procedure. Others focus on maximizing soothing distractions while minimizing pain as well as the typical sounds and smells of dentistry that can trigger unpleasant memories.
Dental schools are also paying more attention to communication skills. At New York University College of Dentistry, third-year students practice interviewing patients–played by actors–with a variety of dental problems and phobias.
“You can’t just say, ‘Open up–you have nothing to fear,’ ” says psychologist Hillary Broder, who teaches the course. “You have to establish a rapport and find out what makes them anxious and reassure them that that’s not going to happen.”
“There is usually something that triggers that phobia, like a bad experience when they were a child,” says David Hershkowitz, associate chairman of the school’s department of Cariology and Comprehensive Care. He tells students, “Once you know the trigger point, you can do away with the fear.”
To be sure, not all dentists want to treat anxious patients. “There’s a fair number of dentists who are more phobic of the phobic patients than the phobic patients are of dentistry. They’re difficult to work on and you can’t work at your normal pace says George Kivowitz who has dental practices in New York City and Newtown, Pa. But he finds that kindness and communication can go a long way toward calming patients. “I promise that if I see an area of decay, I don’t have to prove it to you by peeling you off the ceiling.”
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