Don't Fear the Dentist (cont.)
Fortunately, many dentists are specially trained in handling fearful patients; a variety of methods and treatments are available to reduce pain and alleviate fear in the dentist's chair.
The 'Root' Causes
Between 5% and 8% of Americans avoid dentists out of fear, estimates Peter Milgrom, DDS, director of the Dental Fears Research Clinic at the University of Washington in Seattle and author of Treating Fearful Dental Patients. A higher percentage, perhaps 20%, experiences enough anxiety that they will go to the dentist only when absolutely necessary, Milgrom tells WebMD.
Milgrom's dental practice specializes in fearful patients. About two-thirds of them relate their fear to a bad experience in the dentist's office, Milgrom says. Another third have other issues for which fear of dentists can be an unpleasant side effect, such as various mood or anxiety disorders, substance abuse, or posttraumatic stress experienced by war veterans, victims of domestic violence, and victims of childhood sexual abuse.
Fear of dentists stems not so much from the experience of pain as from the lack of control that patients experience in the dentist's chair, says Ellen Rodino, PhD, a psychologist in Santa Monica, Calif., who has studied dental fear. "You're lying prone, a dentist is hovering above you, and he's putting you in a situation where you can hardly talk or respond. That creates a lot of anxiety for some people because they don't feel in control."
Still, many dentists create unnecessary anxiety in patients because they assume that all patients have similar pain thresholds and will handle dental procedures in the same way, Milgrom says. "If all dentists were a lot more careful about pain control, took the time to be sure patients were comfortable, and didn't go ahead if they weren't [comfortable], then we would create fewer phobics."
Fearful patients need to be more assertive about their needs, Milgrom says. Patients should say to their dentists, "I want to talk about what can be done to make me more comfortable. I don't want someone to tell me something doesn't hurt me."
Treating Fear of Dentists
Some dentists who specialize in treating fearful patients go out of their way to create a nonthreatening environment. The place where Jack Bynes, DMD, works in Coventry, Conn., is barely recognizable as a dentist's office. It's housed in a renovated historic gristmill, with a treatment room that overlooks a waterfall. The waiting room contains a fireplace and soothing photography; it's free of posters depicting the horrors of gum disease. Bynes himself fancies bow ties rather than scrubs. Many "people have a fight-or-flight reaction" to the sights, sounds, and smells of a dental office, and taking away these cues has a calming effect, Bynes explains. And Bynes should know. He specializes in fearful patients today because he himself had to overcome his own medical phobias as he trained to become a dentist.