Can you believe that some people actually like going to the dentist? They’ll tell you annoying things like, “I love how my teeth feel so clean afterwards.” Puh-leese. These are the same people who finger-paint “wash me” on the back windows of minivans with those tedious honor-student decals on them.
For most of us normal people, of course, the appointment with The Chair is a gray day looming on our calendar, right up there with foolishly promising great-aunt Ethel you’ll take her to Show Boat. We do go, though, and grin and bear it as penance for all those days we forgot to floss. And because we live in a society obsessed with the Hollywood smile. And because we know from Borat what a toothless grin in Kazakhstan looks like.
For some people, however, the “I’d-rather-have a root-canal” jokes are no laughing matter. Spiders, bats, and big city rats—bring’em on. But the dentist’s office? Now that’s something to really be scared of.
Sometimes it’s understandable—a particularly painful childhood experience, for instance, or maybe just the pain threshold of an earthworm. Dentists, of course, slap the same label on all these poor souls—fella, you’re just phobic.
Where do these phobias come from? And how do dentists deal with them and get these patients to ever come back?
Dr. Robert S. Minch, who practices general dentistry in Lutherville, has his share of fearful patients “in all shapes and sizes,” and prides himself on managing their apprehensions so they do, in fact, keep coming back.
“There’s Janet, a 48-year-old mother of two who felt very claustrophobic whenever instruments were in her mouth,” says Minch. “We would need to stop every few minutes to let her ‘breathe.’ Then there was Tom, a 29-year-old furniture restorer, who was so nervous that he would only allow us to touch his front teeth [not the back teeth] for several appointments until he trusted us enough to let us look at all his teeth.”
But perhaps the best example is Sam, 56, whom the dentist met at a Little League game. “He had noticeable gaps between his upper six teeth and wanted a more aesthetic smile,” says Minch. “He’d stayed away from any dental work because of very bad experiences as a kid, including a dentist who didn’t give anesthetic and another who started working before the Novocaine kicked in.”
As they talked, Sam revealed his phobic triggers: that “dentist office smell,” 1950s and ’60s-era equipment and furnishings, the sound of the drill, of course, and having to wait for long periods until the dentist would come in, which gave him plenty of time to compound his fears.
Minch convinced him to come into the office, and made sure none of the triggers were pulled: “Greeting him was the aroma of fresh-baked cookies instead of ‘that dentist office smell.’ The office has a bright, modern décor and popular music playing, and there was no nervous wait—he was greeted right away with a warm ‘Good morning, you must be Sam.’”
“During the exam, I was able to pick up on the thing that would help him keep calm and relaxed—being in control. It sounds simplistic, but we’re dealing with a potent form of Post-Traumatic Stress Syndrome,” says Minch. “Anything that reminds him of his past horrible experiences will ramp up his discomfort. I did things like stopping the procedure the instant he signaled and took frequent breaks.”
And, no, knowledge is not always power: “Normally, I try to explain to patients what I’m doing,” says Minch, “but Sam actually didn’t want to hear about any of the procedure because he just wanted to escape. So, in his case, my dental assistant and I kept a running conversation about our kids, the news, and any bad jokes we could remember. Once we gained his trust, we’ve been able to create the smile he had always wanted.”
Another who has seen his share of fearful patients is Fallston’s Dr. Alan Scharf, a 25-year veteran of general dentistry.
One such phobic Scharf has treated is “Mr. J,” a 6-foot-5, 270-pound male psychiatric nurse. (If you don’t do what this guy tells you, you’re crazy.)
“He reminds me at each visit that ‘If you hurt me, I will hurt you.’ I take it seriously,” says Scharf with a laugh.
Another patient, Mrs. B, puts a clothespin on her ear to ease her discomfort. But a more common coping mechanism, says Scharf, is humming, which these anxious patients will do throughout procedures. “Other patients will wiggle their feet during the procedure, which makes it tricky working on a moving target. One patient, Mr. K, often jumps up anytime he feels anxious, and I have learned to react quickly to avoid injury.”
One of Minch’s patients, Chris Janoff, admits he avoided the dentist for years because of childhood memories.
“Ever since I was 5 or 6 years old, I remember the thing I was most afraid of was the ‘spoon,’ this sharp, razor-point tool the dentist would use to find cavities,” says Janoff, who works in the restaurant industry. “He’d push it into the tooth to find soft spots and I knew if it gave way, then it was cavity time and there was going to be drilling.”
“I went eight to 10 years without seeing a dentist, and by the time I saw Dr. Minch, I had eight cavities,” he says. He remembers calling him at 6 a.m. on a Saturday with intolerable tooth pain, and Minch opened up the office and dealt with the problem. Now he’s back in the dental fold: “Dr. Minch is someone I absolutely trust, and I like that he doesn’t have 10 offices, but just one, so he can focus personally on giving patients the best possible experience. At age 38, I’m finally trying to take care of my teeth.”
“There is no magic bullet,” says Minch. “Treating dental phobics requires an individualized approach. But my techniques have proven to be so successful that I have never felt the need to use ‘sedation dentistry.’”
Scharf, for his part, doesn’t give sedatives the automatic brushoff: He has no hesitation about using whatever is in his toolbox to meet individual patient needs. If a great bedside manner doesn’t totally make it, he can put you on Easy Street: There’s oral sedation (there are a number of new anesthetics on the market), nitrous oxide analgesia, and assorted high-tech equipment to help allay dental patients’ fears.
“There are people afraid of the dentist for a million different reasons,” says clinical psychologist Dr. Sally Winston, co-director of the Anxiety and Stress Disorders Institute of Maryland. “But most dental phobics fear having a panic attack in the dentist chair, either from feeling trapped or experiencing uncomfortable sensations like a rapid heart rate or a feeling of choking or some other scary sensation that they are afraid will provoke a panic attack,” she says. Some phobias are based on fears that they will somehow embarrass themselves, and other sufferers avoid the dentist “because it feels too intimate, icky, and out of control,” says Winston. “They have trouble trusting the dentist because of how vulnerable they are in the chair. But most fear having a panic attack in a trapped situation, similar to how they might feel in a plane, an elevator, trapped in a line of cars, or in the middle of a movie theatre. Still others just don’t want bad news.”
For the panic-attack crowd, a common dental anesthetic can make their fears self-fulfilling: Novocaine makes the heart beat faster, Winston says, so some times people get anxious because they notice their heart rate is up, then have a panic attack without realizing they’re reacting to the drug.
“There’s another local anesthetic, Carbocaine, that doesn’t have that side effect, but some dentists don’t feel it works as well,” she says.
So, do these patients ever say “Thanks” for all the effort that people like Minch and Scharf expend to overcome their fears?
“In fact, phobic dental patients often end up being the most-appreciative patients,” says Scharf. “I also find that the phobic patients are a great source of referrals if I give them a positive experience—in fact, dental phobics often refer other phobics to my practice.”
Think about it—you should thank them. Because dentists have fillings, too, you know.