With so many people fearful of dentists, I interviewed Dr. Piedra about his dental opinion on treating patients with dental fears and phobias.



What are the most common fears and phobias patients experience when going to the dentist?

The most common causes of anxiety when receiving dental care include:

A sense of being smothered by having their comfort zone invaded,

Fear of pain and injections,

Dental office sounds,

A sense of not being in control,

Financial loss, often including missed time from work.

What can a dentist do to help people with these dental fears?

The dentist should first realize that a fear of the dentist often stems from earlier experiences, perhaps as a child, and in the case of adults, is difficult (but not impossible) to overcome.

Naturally, fear of injections, reactions to dental office smells and sounds, feelings of lost control and the intimacy of the treatment area are stressors to most all patients in varying degrees. I experience something similar when I'm in the dental chair. People find that amusing, but I assure them a surgeon no more wants surgery than I want to have a crown done. I know all will work out, but I'm still human. Still, there is so much we can do to minimize fears and anxiety in most cases.

There are a number of medications taken by mouth or intravenously that are safe and effective by trained professionals in extreme anxiety cases. There may be increased cost to the patient but often times it can be worth it. There is always nitrous oxide gas, which is safe and also effective, except in extreme cases of anxiety. I recommend and use these as a last resort, because in most cases, I consider them a crutch and would prefer overcoming dentist fears by methods of trust, touch, reassurance, humor, reminding them that they are in control, providing information and by gentle dental care.

Injection phobia is at the top of the list of fears and phobias for most patients. Once a dentist helps a patient overcome that fear, most of the other things take care of themselves. In truth, 90% (if not more) of the injections should not be painful. If the dentist uses topical anesthesia application properly, goes slowly, uses smaller caliber needles (when possible) and infiltration methods that block injections when feasible, mepivacaine (which is less acidic and less painful when followed by stronger anesthetics). Also, by speaking in calming and sincere tones, most patients have virtually no discomfort and soon overcome most injection fears. Giving an injection is no time to be in a hurry!

Eliminating distasteful sounds is often a problem, but they be can minimized. Some of the newer tools are very quiet, such as drills. Having a water fountain can be very calming to the patient. I've found most patients consider the trickling water sounds soothing.

Televisions in treatment rooms, which can also be used in conjunction with an intra oral camera and video education, are common today. The use of headphones, where patients can listen to music of choice, is also gaining popularity. Calming color combinations, artwork depicting serene scenes and large windows to reduce the feeling of confinement are also important treatment room additions.