You’d rather face the IRS than the dentist? Relax, there are ways to fight the phobia;
Michele DerVartanian, a 25-year-old student in Medford, says she was 10 when she learned to fear the dentist.
She had a very sore, abscessed tooth, and “I had to have it pulled immediately,” she recalls. The whole family had plane tickets to Florida that they would have had to cancel unless her tooth was treated right away, she says.”From there on, it was downhill,” says DerVartanian, who adds that she’s “not completely” dental phobic, but does “get really stressed when I have something done to my teeth.”
For Amy Rothstein-Teehan, a 30-year-old sales rep from Randolph, the trouble began nine years ago when a dentist jabbed a needle in the roof of her mouth prior to wisdom tooth surgery.
“My feet literally went up in the air,” she recalls.”It’s the worst place to have a needle.”
She was left so frightened that when she later needed periodontal surgery, she delayed it for months, a pattern of avoidance that Jean, a 37-year-old Winchester mother, knows all too well.
“People think I’m nuts,” says Jean, who did not want her last name used, “but I’d rather have a child than go to the dentist. I just don’t like the needles. The smell alone gags me.”
If you hate going to the dentist and don’t go even when you should, you may have dental phobia.
And plenty of company.
Rationally, of course, we all know that we should brush and floss every day to get rid of the bacteria that can invade not just the teeth, but gums and the bones beneath them.
We all know, too, that we’re supposed to see a dental hygienist every six months. And that if we mess up on this basic stuff, the dental gods have ways of punishing us – like making our gums rot and our teeth fall out.
We even know, the cagey among us, that we can offer realistic-sounding excuses for skipping appointments, like the fact that dentistry can be very expensive – $ 47 to fill a cavity, according to national averages, $ 500 for a crown, $ 250 and up, up, up for a root canal.
The fact that most of us don’t have dental insurance – and that prices in Boston are higher than the national average – doesn’t help.
And then there’s always the old “if it ain’t broke, don’t fix it” rationale, which the American Dental Association says half of us use to justify going anywhere but the dentist’s.
Yet for all this, the fact remains that for many of us, it’s cold, sweaty fear that really keeps us away from the dentist, sometimes with unpleasant consequences.
An estimated 7 to 10 percent of adults feels “very afraid” to “terrified” of going to the dentist, says Tracy Getz, a psychologist and researcher at a place where they actually study such stuff, the Dental Fears Research Clinic at the University of Washington in Seattle. Another 13 to 20 percent feel “somewhat fearful” or “scared,” he says.
More than 90 percent of the time, these fears result from a bad experience at the dentist, often during childhood, though this pattern of fear, dentists hope, may get better as fluoride treatments, dental sealants and better dental hygiene keep more and more children from having cavities.
Typically, dental phobias start with fear of pain, then expand to become all-encompassing, says Dr. Michael Krochak, who runs the Dental Phobia Clinic at Mt. Sinai Hospital in New York.
A person “might have initially feared the pain. Over time, he says, ‘I should go,’ and now he fears, ‘The dentist will yell at me for not having gone.’ So the fear of embarrassment almost supersedes the actual fear of physical trauma.”
But recently, researchers have begun to recognize another significant cause for dental phobia as well – sexual abuse.
Childhood sexual abuse is an “identifiable factor” in dental phobia in about 7 percent of cases, says Getz, a co-author of a study on abuse and women’s dental fears published in April in Journal of the American Dental Association.
“Some women with early experiences of forced oral sex may have difficulty later with oral health care because of a symbolic re-creation of the experience,” his team wrote.
Adding to some patients’ fears is “the intimacy in the way you are positioned” in the dental chair, says Dr. Howard Howell, associate dean for dental education at the Harvard School of Dental Medicine.
“The patient is in a seated or supine position where they can’t get up and get out of the office. They feel trapped. And most of what goes on around them is in the region of the head and mouth, so they may feel suffocated by having people that close to them,” he says.
Nor are our cultural anxieties assuaged by the fact that we use root canals as a metaphor for any number of horrific things, says Dr. Robert Amato, an endodontist at Limited to Endodontics in Boston.
“You hear it all the time – ‘I’d rather have a root canal than see my accountant or pay my taxes.’ It’s almost a universal term for something people perceive as unpleasant,” he says.
Yet increasingly, dental work – including root canals and gum surgery – is much less painful than many patients think, in part because drugs for local anesthesia have gotten better and in part because dentists are getting better at dealing with patients’ fears and pain.
Many dentists now pinch the lip on the opposite side from where the anesthesia needle will be placed to distract the nervous system from the sting of the needle. Many dentists also routinely use topical anesthesia – a painkilling gel – on the gums before the needle goes in.
If you’re really scared, dentists may also suggest nitrous oxide, or “laughing gas,” before work begins. This short-acting gas can dramatically relieve anxiety.
But behavioral tricks – both yours and the dentist’s – may in some cases do the most to offset fears. For instance:
– Consider using the initial appointment just to talk. Phobia specialist Krochak says the interview process “serves as a catharsis, a release of angst, of anxiety.” While some clinics have psychologists talk to scared patients, he believes it works better for patient and dentist to discuss fears directly.
– Consider having a nurse in the room at all times, especially if you’ve been sexually abused. “I don’t even talk to patients without a nurse in the room,” Krochak says.
– A process called systematic desensitization may also calm fears. This involves calming the patient with techniques such as deep breathing, muscle relaxation and guided imagery, then gradually exposing him or her to the feared stimulus, such as the sound of the drill, and then the drill itself.
– If you fear gagging – such as when the dentist makes an impression of your teeth by putting trays of puttylike material in your mouth – you may feel better if you sit up straight and keep your chin tucked in. It may also help to have the dentist count off the minutes aloud as the impression is made.
– Distraction also helps. Some patients listen to music. Others watch tiny TVs placed near their eyes.
– If you hate the smell of dental offices, ask your dentist to use a bit of “aromatherapy” – scented candles and essential oils may mask medicinal odors.
– Consider having a few short visits instead of one long visit, to minimize anxiety, suggests Susan Cottrell, a hygienist at the Harvard School fo Dental Medicine.
– It can also help to work out in advance a system – such as raising one hand – to flag your dentist’s attention if you want him or her to stop, says Howell. Some dentists also make it a point to stop every few minutes and ask how you are doing.
– Many patients also feel reassured if the dentist talks to them as he or she works, explaining each step of the procedure.
Former dental phobics like Amy Rothstein-Teehan have their own hard-won advice. In her case, talking through her fears with Howell of Harvard helped substantially.
“He knows how to relax someone who’s nervous,” she says. “He walked me through the whole thing and said, ‘You can stop at any point.’
She has also learned not to listen to other people’s “horror stories . . . That makes you more nervous than you have to be.”
Michele DerVartanian is similarly grateful fo endodontist Amato because “he just totally took care of me.”
“He was wicked nice,” she says, adding a heartfelt, “and he was fast.”
The dire consequences of dental phobia
Although some people seem able to neglect their teeth and get away with it, at least for a while, for many others, avoiding basic care at home and at the dentist’s office can have dire consequences. The reason is bacteria.
Bacteria on the surface of teeth use sugars from food to produce an acid that weakens teeth by taking the minerals out of tooth tissue, says Dr. Howard Howell, associate dean for dental education at the Harvard School of Dental Medicine.
Initially, the result is tooth decay and cavities, which can be fixed by drilling away damaged parts of the tooth and filling the hole with silver or plastic materials. In recent years, campaigns to put fluoride in water supplies and in mouthwashes and toothpaste have greatly reduced the incidence of decay.
If decay is severe and the infection has invaded the nerve of the tooth, a root canal may be necessary, says Dr. Robert Amato, an endodontist at Limited to Endodontics in Boston and an assistant clinical professor at the Tufts University School of Dental Medicine. A root canal involves removing the inflamed tissue from deep inside the tooth under local anesthesia.
But as tooth decay has declined in recent years and more people are keeping their teeth, the unintended effect has been that periodontal disease in the gums and jaw bones has soared.
Periodontal disease begins with a bacterial infection in the gums, called gingivitis. You’re likely to notice gingivitis first when specks of blood appear during flossing or brushing.
Each side of the tooth surface may be home to a different strain of bacteria. Usually, the bacteria congregate in a kind of pocket called the sulcus where the gum meets the tooth.
Brushing and flossing – once a day is enough if you do it thoroughly – gets rid of most bacteria mechanically, by dislodging it so you can rinse it out with water. Listerine – and a slew of other mouthwashes that also carry the American Dental Association seal of acceptance – have also been shown to get rid of bacteria, as do prescription mouthwashes such as Peridex or PerioGard.
But home care is often not enough, which means you should see a dental hygienist at least every six months. The hygienist’s job is to measure the depth of the pockets around your teeth and remove bacteria, plaque (bacterial deposits) and calculus (a calcified layer of plaque) from the pockets.
If gingivitis is not taken care of, it can turn into periodontal disease, which can destroy the gums, ligaments and bones that support teeth, ultimately causing teeth to fall out. Periodontitis is not caused by bacteria per se, but by the body’s attempt to fight this infection – the inflammatory response which brings huge numbers of white blood cells to the area. Recent research suggests low doses of non-steroidal anti-inflammatory medications like ibuprofen may slow this process.
Sometimes, periodontal disease can also be controlled by scaling or root planing – deep cleaning of the teeth under local anesthesia. In severe cases, surgery may be necesssary to remove inflamed gum tissue and reconstruct damaged bone.
Bone grafts may also help. When she was 10, Michele DerVartanian of Medford had a bad experience with a hasty tooth extraction, and 15 years later she still finds going to the dentist stressful. 3. Dr. Howard Howell engages a patient in conversation to ease her fears about a dental procedure.