Jay W. Friedman, dental adviser to Consumer Reports, recalls that one of his first clinic patients when he was in dental school was a 16-year-old boy who had endured multiple surgeries to correct a cleft palate. The experience left him so fearful of injections that he barely allowed Friedman to look inside his mouth, where he found cavities galore.
The two of them talked about the boy’s fears and why he needed to have his teeth fixed. He began to relax a little. On his next visit, as he watched with a hand mirror, he allowed Friedman to very slowly inject some anesthetic and complete a small filling. Eventually, his fears receded to the point where he would sit down in the chair, open his mouth wide, mirror still in hand, and let the student dentist do his work.
The mouth is one of the most intimate and sensitive parts of the body, so it’s no wonder that up to a third of the adult population fears going to a dentist.
For some, a painful experience is the cause of their anxiety. Even before their first visit, many children are frightened by tales they hear from friends or parents. Some adults use the threat of a visit to a dentist to make children behave. People who have never had a bad experience might become more anxious as they grow older.
Fearing the worst, many people delay going to a dentist, which sometimes makes their dental problem worse and paradoxically increases the likelihood that they will experience discomfort during treatment.
The reality is that modern dental treatments aren’t especially painful. A recent survey of Consumer Reports subscribers found that among readers who had a dental procedure in the preceding five years, severe pain was uncommon, even for tooth extractions and root canal procedures.
If you fear dental treatment, discuss your concerns with your practitioner frankly and upfront. A dentist who can take gentle but firm control of the situation might be all you need to overcome your fears. Friedman reports that he has had plenty of patients sit down in the chair and announce, “Doc, I’m really nervous.” His standard reply is, “It’s okay for you to be nervous. But you really don’t want to make me nervous. So relax.” He finds that these simple words often work better than any tranquilizer.
Once past the hurdle of the initial treatment, you might feel great satisfaction at having mastered the situation. Even if it doesn’t eliminate all your anxiety, it might reduce it to a manageable level.
If your regular dentist can’t reassure you, you might want to go to one who specializes in treating anxious patients. Some dental schools have “fear clinics” that offer cognitive-behavior therapy to reduce dental phobia.
If tender loving care still doesn’t allay your fears, you might be a candidate for judicious pharmacological intervention. The least problematic of these is a tranquilizer that isn’t a tranquilizer at all: It’s a local anesthetic injection that is painless, or at worst feels like a tiny pinprick. Such an injection takes about 15 seconds to complete and will numb your mouth in about five minutes. Your anxiety about treatment might vanish completely or nearly so. Numbness that lingers for a few hours after treatment might be a small price to pay to avoid even mild discomfort.
If you are so fearful that the mere thought of the injection brings on an anxiety attack, a dentist might prescribe drugs or administer nitrous oxide or intravenous sedation to relieve anxiety and relax you so your treatment can proceed.
But be aware that drugs and sedation are not without risks. Repeated and prolonged use of narcotics, sedatives and tranquilizers can be addictive. And you should always tell your dentist if you have taken a sedative or tranquilizer before arriving at the office. Otherwise, he or she might administer the same drug or a similar one, possibly creating an overdose or a hazardous drug interaction.
In extreme cases, hospitalization for treatment under intravenous sedation or general anesthesia might be necessary. But such measures shouldn’t be your first option; they should be your last. Doctors who use tranquilizers as their first line of treatment are, like their patients, seeking an easy way out of dealing with anxiety.