Fear of the Dentist

It is our aim through a column in this Journal to inform you, the patient, of the way in which Homeopathy and other alternative therapies can be used in dentistry. To help you find a Homeopathic dentist and to touch on those areas of holistic dentistry in which the homeopathic patient may be interested. In this article I am going to concentrate on fear of the dentist.

Millions of people are afraid to go to the dentist. Fear of the dentist is called Odontophobia and according to the Phobic society this nearly always stems from a bad childhood experience.

Many of us will associate a visit to the dentist with a clinical atmosphere, strange antiseptic smells and a range of frightening looking instruments. However dentistry today is different. Dentists have become patient friendly and the profession now has more sophisticated techniques.

How can I cure my fear of the Dentist?

Our memory serves as a protector. It stores past experiences of pain and pleasure. These guides us to take appropriate action when confronted with a problem. Sometimes we have the wrong associated memories, that will guide us to take the wrong action. It is associations with visiting a dentist earlier in life that we carry around to every dentist for evermore. It is better to make peace with that memory and reassure it that that you appreciate the warning.

The dentist and the support team are more caring than in the past. They should do everything for your comfort, and introduce you to preventive measures. This ensures that long term problems do not occur. Once your memory brings pictures of reward, then the whole experience is much easier.

Identifying how frightened you are can help you cure your problem. Dentists are becoming more aware of patients’ problems. Student dentists now study courses on behavioral science that incorporate psychology and sociology. This enables them to appreciate fully the anxieties their patients may be feeling.

There are several things that you or your dentist may do to make your visit to the dentist more pleasurable.

• Find a dentist with whom you can talk and who listens.
• To allow you to feel more in control you may ask your dentist if you can raise your hand so you can stop for a moment. This is a simple signal that will help to increase your confidence.
• Your dentist should explain any dental problem you may have and how you can work together to make your mouth healthier.
• Dentists today usually have music in the room to help to put you at ease. Earphones can often be provided if preferred.
• Friendly chat and support may help you to forget that you are in the dental chair.

In today’s dentistry there are many techniques available to calm a patient’s anxieties. Some of the orthodox and complementary methods available are as follows:

Relative Analgesia (Inhalation Sedation)

This technique involves breathing in a mixture of Nitrous Oxide (laughing gas) and Oxygen that produces a comfortable relaxed feeling. The patient may feel drowsy but remains conscious. There are no after effects. The patient can if necessary drive home afterwards. Relative Analgesia is used mainly for children. In adults it is reserved for more simple procedures such as scaling and polishing.

Sedation

This type of medicine can be taken orally but is usually given by an injection in the arm. Sedative medicines will make the patient drowsy and oblivious to dental treatment, however the patient is still able to co-operate with the dentist.

The patient is not able to drink alcohol, drive or operate machinery for the rest of the day.

Sedation whether inhalation, oral or by injection is not treating the cause of the problem, i.e. the underlying fear. It is suppressing the problem on a short term basis. It cannot  help with the apprehension leading up to the appointment, except perhaps as a sleeping tablet the night before.

There are however more natural methods that can be used to relax the patient. Some of these are:

Relaxation Techniques

Our bodies produce substances that can lead to an anxiety state when we are faced with a challenge, real or imagined. By learning to relax we can train our bodies to counteract these anxieties. Relaxation exercises that can be used include Alexander Technique, Yoga and Meditation.

Hypnosis

With Hypnosis the patient concentrates on suggestions of relaxation provided by the therapist. Hypnosis is just relaxation, body and mind. There is no question of being controlled or manipulated. No drugs are used and at all times you are fully aware of what is happening. The feelings can be likened to daydreaming, though one is awake and in control. Afterwards you do remember everything. You cannot come to any harm and there are no side effects.

Hypnosis is a powerful tool. It can be used as hypnotherapy, hypnohealing and hypnoanalysis. It is a highly effective, enabling patients to identify past events that have created the traumas. It is a fast method for curing phobias and fears. Neuro-linguistic Programming can also be used to cure these problems so they do not reappear as  substitute phobias or fears.

Some dental practices have specialist hypnotherapists to provide this treatment. Working with a hypnotherapist in my practice has been of great benefit.

Aromatherapy

This is the use of pure oil essences from plants and flowers, that act as hormone like stimulants to improve health balance, in a natural and gentle way. Oils like Lavender, Bergamot, Sandalwood and Basil are useful to soothe, relax and calm, banishing depressive moods while increasing confidence. Aromatherapists can give guidance on the use of these oils. Some dentists use these oils to make their offices more inviting and homely.

Herbs

Herbs can be useful in promoting relaxation. Herbs such as Chamomile, Limeflower, Vervain, Rosemary and Valerian(Valium is derived from this herb) all have sedative properties. These are commonly available as teas. A trained practitioner can give further advice on quality and personal needs

Homeopathy

Homeopathy can be seen as a natural approach to general dental practice. During the last decade there has been an increasing number of dentists practising Homeopathy This safe natural therapy is non-addictive and effective with adults and children.

Homeopathic remedies improve the psychological status without the drugging effects of conventional tranquillisers. The three main remedies to be considered are:

• Aconite (monkshood)
• Gelsemium (yellow jasmine)
• Argentum Nitricum (silver nitrate)

Aconite is indicated in acute situations where there is fear, dread, panic or psychological shock. Especially where the mouth is dry. Mild cases may respond to 30c, but higher potencies (200-1M) may be required for more severe states or when rapid action is necessary. Frequent repetition may be required in the dental surgery (every 15 minutes). The same remedy may be given three or four times a day for several days before the next visit.

Gelsemium 30-200 may be given where the patient is uncommunicative, inactive and trembling. The patient feels weak in the knees and sick in the stomach. Similar to stage fright or examination nerves. Diarrhea may accompany the symptoms.

Argentum Nitricum 30-200 in contrast is indicated where the patient becomes excessively talkative as a result of anxiety and is constantly on the move when waiting. He sits down, stand up, looks at his watch, reads another magazine. When he enters the surgery he will walk around talking to avoid sitting in dental chair. These remedies are commonly given the night before, the morning of and an hour before the operation.

Some other remedies also used are Coffea, Ignatia and Arsenicum Album. A leading indication for Coffea is that the patient is very sensitive to noise of any sort, and insists that the background music is turned off. Toothaches tend to be better for cold water held in the mouth. The coffea patient is often excessively sensitive to pain and sleepless with worry the night before.

Ignatia patients are made to feel extremely ill by coffee or tobacco smoke and their general anxiety often stems from an unpleasant shock in the past. Arsenicum Album is indicated in extremely chilly and fastidious patients who have profound anxieties about their health.

For the fractious, nervous child Chamomilla is often the remedy of choice especially where the child is cross, restless and irritable but has a desire to be carried or petted.

Nutrition and Diet

Stress and tension are often linked to diet. Whether they be dietary excesses or deficiencies. Stress and tension exacerbate any fears or phobias that may exist. Excessive use of coffee, standard teas, salt and sugar will place severe burdens on the balance of the body. Smoking and alcohol cause inadequacies and deficiencies by increasing the body’s need for essential vitamins and minerals.

A general state of anxiety can result from an increase in the lactate/pyruvate ratio. The vitamins most likely to stabilize the lactate/pyruvate are Vit B3 (Niacin), Vit B1 (Thiamine) and co-enzyme niacinamide. Magnesium is the most important activator of the enzymes of glycolysis and a magnesium deficiency is yet another cause of an increased lactate/pyruvate ratio. Think of magnesium when the anxious patient has signs of neuromuscular irritability.

The neurotransmitter serotonin is involved in the regulation of anxiety. When tryptophan, its dietary precursor, is supplemented, it may have a mild sedating effect. The conversion of tryptophan to serotonin requires Vit B6. Vit B6 also effects the cell membrane transfer and utilization of magnesium.

Life Style

Good exercise and sleeping habits as well as the way we breathe can effect our ability to cope with stressful events. Before visiting the dentist see that you have several good nights sleep and take long steady walks using good breathing techniques. While in the waiting room ensure that you are sitting comfortably with a good posture, legs uncrossed and feet squarely on the floor. Place your arms and hands comfortably with no heavy articles on your lap. When going into the surgery, move calmly as this sets your body to the right frame of mind. Discuss your fears with the dental team as well as how you are going to communicate during treatment.

Before and during treatment it is useful to practise deviation of focus and breathing exercises. This is simply accomplished by concentrating on a feature in the room or in your mind and studying it in great detail. Breathing calmly and deeply, stretches the muscles of the chest and stomach, releasing stress. While releasing the breath, slowly and completely, stress and tension flow out of the body leaving you calm and relaxed. Concentration on this breathing technique is also a deviation of focus technique

Of course prevention is better than cure, so you should apply the following three steps to ensure that your teeth remain healthy:-

• Avoid sugary snacks and drinks between meals.
• Brush carefully twice a day with fluoride toothpaste
• Visit the dentist for regular check-ups