I had a bad experience at a dentist where my heart started racing and I felt like I was going to pass out.
“Basically, I am very scared of the dentist and have been as long as I can remember.
It’s now been a long time since my last dental visit and I now have several teeth that need. Can you tell me about the steps you take with nervous patients and how you achieve ‘no pain’?”
– Question from Jamie of McDowall in Brisbane
Dr Darryl Marsh replies:
I see this quite often and there are a number of possible reasons
Anaesthetics often contain adrenaline
A number of dental anaesthetics have adrenaline in them so its possible that if you are having an injection it could nick a blood vessel and the anaesthetic can get into the blood giving you a spike in adrenaline. Also the anaesthetic can be absorbed through the tissues into the blood stream anyway. This can give some patients the feeling that their heart is racing.
Not always a fight or flight reaction that triggers adrenaline
In reality the amount of adrenaline that might be absorbed from the anaesthetic is only a small fraction of what the body can produce. Most of the ‘heart racing’ reaction, while some of it may be triggered by the adrenalin in the injection, is mostly from the patient’s own body as a consequence of their anxiety.
A fear so great that people don’t go to the dentist
We recently saw a person who was in her thirties and it was their third visit to the dentist. They had been once as a child, once as a teenager to have wisdom teeth removed and then this appointment in their thirties with a painful toothache.
The longest time between dental visits of all the patients I have seen is 26 years. Unfortunately a lot of damage can occur in 26 years as pain only comes about once the damage gets very deep whether the tooth is abscessed or decayed.
When does fear of the dentist turn into a severe anxiety disorder or PTSD?
I have treated a number of patients over the years that have had panic attacks, and it isn’t always at the beginning of the treatment. Sometimes it can be as we are finishing up.
Recently a gentleman told me how much he had to talk himself into not only making the appointment but also to walk in the door. He was so worried that his fear would result in him passing out.
Dental fear is anchored in the past
Many times these sorts of fears are anchored in a childhood dental experience, just like you associate some feelings or memories to a smell or sound. As these feelings are ones based on a bad experience they can be extremely deep seated.
Even my own sister, before she comes and sees me will get a nervous rash on her neck and chest. I have been her dentist for 25 years but she says this all stems back to a bad dental experience she had when she was 10 years old.
What is the best thing for patients who are afraid to do?
The very best thing a patient can do is talk to us and let us know how they feel. In my experience, the biggest help is having someone who is empathetic, listens without judging and tries to understand how you feel. Then, together you can explore all the options. In many cases building of trust and confidence of someone can set a patients mind at ease enough to get past their dental fears.
For some patients, where the thought of the dentist is far worse than the reality, we can prescribe Valium before the appointment to ensure they get a good night sleep the night. It is amazing the difference a full night of sleep can make before they come and see us and hop in the chair. Sometimes we will suggest Ibuprofen or anti-inflammatory medications before the appointment to reduce discomfort and swelling in the tissues. But remember to always tell your dentist about any medications you may have taken before you see them.
Once they are in the appointment we can use Nitrous oxide (also known as ‘Laughing gas’) during the appointment to really put them at ease.
Terrified? Pain has a high emotional component
Now while a lot of this treats the nervous symptoms you have to remember about pain is that it has a very high emotional component. If you are up tossing and turning the night before, worrying about what is going to happen, then you will be in a worse state in the morning.
In reality we can control 99% of any physical sensations you experience during the appointment using topical anesthetics and the other drugs we mentioned but as dentists it is important that we treat that emotional component as well.
Any dentist can treat their patients with a near pain-free approach. For us at Today’s Dentistry it comprises of two things:
- Attitude: you have to want to treat your patients without causing pain. This often takes a little longer. With injections, like many other dental procedures, quick can often be more painful. You have to spend the time with your patients to understand them and then you have to give the time needed to proceed through any treatment with the gentle touch. Slowly and gently is comfortable. Any dentist can do this, they just have to want to.
- Modern tools and techniques: Modern dentistry affords us the tools to give our patients a near pain-free experience.
Ultimately the most important tip I have is to make an appointment with the dentist to discuss you concerns and just check them out. By making a non-clinical appointment, talking with a dentist, you will quickly see if there is a personal connection there, if you trust them and have confidence in them then that will make a big difference to your fear.
I believe dentists have to earn their patients trust, it isn’t something that we get automatically. We encourage people in this position to just come into our practice, meet our staff and check out the place. I cannot overstress how important it is to be non-judgmental about how long it has been since patients last went to the dentist or what treatments they may have chosen in the past. The dentist’s role is to make them feel as relaxed and comfortable as possible so we help them get the very best out of their dental health.