Overcoming Dental Phobia – Patience, Technological Advances Help People Conquer Fear of Treatment

The smell of freshly baked cookies wafts through the office at Dores Dental in Longmeadow, and a ‘comfort menu’ on the wall of the waiting room offers patients heated spa towels, movies, noise-canceling headphones, hot and cold drinks, and other items designed to help them relax before, during, and after a treatment.
The menu and idea of overcoming the smell associated with a dentist’s office by baking cookies all day are measures that Dr. James Dores and his staff use to help people overcome dental phobia, a severe, debilitating fear of having any type of dental work done.
And indeed, it’s a significant problem: the National Institute for Health reports the majority of people become anxious before getting dental treatment, and 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} have dental phobia. It tends to affect more women than men and can be detrimental to health as well as appearance.
People with dental phobia have fewer fillings and more decayed and missing teeth than their peers and typically contact a dentist only when they have pain that becomes unbearable, or when a major life event such as a divorce inspires them to do something about the condition of their mouth. However, waiting until that point often results in the need for complicated and traumatic procedures such as a root canal, which can further exacerbate and reinforce fear.
“About 75{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the population has some fear in regard to dental work. But there are definitely different tiers of it,” Dores said, adding that dental phobia can be resolved, but it takes caring and patience as it often stems from a traumatic, painful experience that occurred during childhood.
Dr. Jane Martone has seen patients whose mouths are in terrible condition because of their fears regarding dentistry. “Some people are so afraid you will hurt them that just walking through the door is a major step,” said the founder of Westfield Dental Associates Inc., who teaches at the Medical College of Georgia School of Dentistry one week each month.
Dr. Vincent Mariano, a board-certified prosthodontist and co-founder of EMA Dental in Northampton and East Longmeadow, has seen patients who need work done on their entire mouth, and may need as many as a dozen crowns.
“If they have neglected their mouth for years, they can have problems with functionality. Some people have worn down their teeth so much that they can’t chew, or they have teeth that are so loose, they’re just moving around in their mouth,” he said.
As a result, people spend hours in his chair, so it is critical for him to develop a relationship with them and make sure they understand exactly what will be done before any work begins.
“I treat patients with very complicated dental needs, so the relationship is of the utmost importance for success,” he said, explaining that, in addition to fearing pain, many people with dental phobia are embarrassed about neglecting their oral health, but once a patient knows he is not judgmental, there is a much greater chance of success of rebuilding their mouth or treating their problem.
Martone concurs, and has talked to people at length on the phone to allay their anxiety before they work up the courage to visit the office. But since most are in pain, the first step is to eliminate it, although it’s equally important to reduce their overall fear, as preventive care can reduce the likelihood of future problems.
“People have died from infections because they didn’t seek dental treatment at the appropriate time,” Dores said, adding that gum disease starts out as gingivitis (inflammation) which can easily be addressed in the early stages, but if it progresses into periodontal disease, it can destroy structures in the jawbone that support the teeth.
Researchers are also finding links between gum disease and heart disease, stroke, premature births, diabetes, and respiratory disease, and Martone has discovered medical problems during an office visit and referred people to their primary-care doctor to treat high blood pressure or other health issues they were not aware of.
In this edition, HCN looks at what local dentists are doing to help people overcome dental phobia and how advances in technology help to alleviate pain.

Treatment Choices
Dentists take different approaches to treating patients with irrational fears. They all believe it’s critical to establish a solid, trusting relationship, but some prescribe drugs to relax patients before a visit, while others offer sedation during procedures.
Dores calls every new patient the night before their first visit to welcome them to the practice, allay any fears they might have, and answer questions, and since he caters to people with dental phobia, the conversations can be lengthy.
“Some people have told me they are terrified and really appreciate the call because it shows that someone cares,” he said, adding that many prospective patients read online reviews that help boost their confidence in his practice.
When they do arrive, they are greeted warmly, then given a tour of the office, and before a treatment plan is drawn up, Dores talks to them about their previous dental experiences, taking note of things they didn’t like.
Many report an instance when they tried to tell a dentist they were experiencing pain, but were ignored. “I have had people tell me they were in tears and the dentist kept going,” Dores said, adding that, since people like to talk about bad experiences, it’s easy to have negative experiences validated and reinforced by friends, family members, or co-workers.
Certified dental assistant Diane Harvey, who works with Dores, assesses each patient’s body language before and during treatments, and says talking about their family or pets and using humor helps alleviate anxiety.
“It only takes one bad experience for a person to become scarred for life, and I have seen people shaking and crying before the dentist even comes into the room,” she recalled, explaining that she tries not to leave phobic patients alone in the room and reassures them if they tell her the the work will result in pain.
“I tell them that dentistry has come a long way, and in this day and age there should be no discomfort,” she said.
Mariano says patients need to know that if they raise their hand, the dentist will stop working on their mouth, which is critical, as fear of loss of control is almost as great as the fear of pain. To that end, he not only explains procedures in advance, but gives patients all of their treatment options and lets them choose what they want to have done.
“If a patient is going to lose a tooth, treatment could be a removable replacement or extend to a dental implant. But the patient needs to help make the decision,” he said, adding that he tells people not to focus on the procedure, but to think about the outcome, and since he is doing restorative work, that often means a beautiful smile.
Dores and Mariano sometimes prescribe mild sedatives for patients with dental phobia, which can be taken the night before a procedure and an hour before they arrive at the office. It means they need someone to drive them to and from the appointment, but Dores said their visits are always booked early in the morning so they don’t have time to upset themselves.
Martone said she is the only general dentist in the area who is board-certified in implant surgery, and is also trained and certified in intravenous sedation. She told HCN that many patients with dental phobia seek her services because they want to be sedated even for simple treatments, such as filling a cavity.
Surveys show that IV sedation eliminates embarrassment about the condition of teeth, as well as the fears of gagging, injections, not becoming numb when injected with a local anesthetic, pain, and drills.
However, before it can be administered, the person’s medical history is taken to make sure there are no contraindications, and while they are under sedation, their vital signs are tracked, and they are put on a cardiac monitor.
Since they are not under general anesthesia, Martone noted, people are able to talk and follow commands while they are sedated, but feel no pain and have no memory of what took place when the procedure is finished.
She believes IV sedation is safer than oral medications, as the onset is very rapid, and the dose and level of sedation can be tailored to meet individual needs.
“This is a huge advantage compared to oral sedation, where the effects can be very unreliable,” she told HCN.

Technological Advances
State-of-the-art equipment also helps eliminate pain or discomfort that might occur during a diagnosis or treatment.
Martone uses a DEXIS CariVu device that uses near infrared light to detect cavities. “It allows the dentist to see decay without having to take an X-ray,” she said, explaining that some people can’t tolerate having to hold film in their mouth, and the device eliminates that problem.
Martone and Mariano also have CT-scan machines in their office that allow them to take X-rays without having to put anything in the person’s mouth, and Martone adds that small things can make a difference. For example, she uses a numbing topical anesthetic before giving an injection so there is no pain from the needle. And since rapid injections can also be painful, she makes sure she administers local anesthetics slowly.
Dores employs a DentalVibe Oral Injection System to administer local anesthetics. The handheld device was created by a dentist and sends soothing vibrations to the brain that block any sensations of pain.
He also uses laser therapy to fill cavities and says he is the only dentist in the area with the machine to do so. The device he employs never touches the tooth and delivers anesthesia, eliminating the need for numbing injections, along with wavelengths of light that evaporate the tooth enamel. A drill still may be needed for refinements, but Dores said the majority of the work is done with the laser.
Still, dentists agree that one of the most critical factors in treating fearful patients is a good relationship. “Technology helps, but it is secondary to the main component,” Mariano said. “Pain control begins outside of the office.”
Things like sleep matter: if a patient does not get a good night’s sleep before a treatment, it has an enormous affect on their pain threshold.
Mariano recalled a patient he had worked on before without a problem, but during a visit where she had had three sleepless nights in a row, “she was such a wreck I couldn’t do the procedure. Many times the anxiety and pain patients feel in a dentist’s office is not related to the significance of the treatment,” he told HCN. “The patient’s state of mind is of the utmost importance in successful treatment.”
Which means if the person is going through a divorce, has lost their job, or has another major problem in their personal life, the anxiety they feel will be exacerbated, so they need to be comfortable talking to their dentist about anything that is affecting their state of mind.

Slow but Steady Progress
Dentists say they do their best to have their staff go above and beyond and take extra time with people with dental phobia.
“You have to gain their confidence, as somewhere along the way someone has hurt them,” Martone said, recalling a time when a patient traveled from Orange to see her and started crying as soon as she walked into the office. Another came from Sunderland, and although they had a long discussion about her dental fears, she was afraid to even sit in the chair.
“It takes time to get a person to trust you, and sometimes all you can do is treat their emergency. My goal is to win them over, but it’s not always possible,” she continued. “Their fear never really leaves them, but it is reduced each time they come in.”
Still, the goal is to develop a relationship where the patient feels safe and secure.
“The relationship is a life-long investment,” Mariano said. “It’s all about changing the quality of their life.”