Managing dental phobia

According to a recent survey by the American Association of Endodontists (AAE), fear of the dentist plagues more than 80 percent of American adults, and more than half say fear may keep them from going to see the dentist. However, avoiding regular check ups due to dental phobias can put one’s oral health at serious risk.

“Between 20,000 and 30,000 cases of oral cancer are diagnosed every year in the dental chair,” Dr. B. Ray Storm, a St. Peters dentist, said. “It’s an appointment that can save lives.”

Basic dental anxieties, fears and even serious phobias develop for various reasons. Many adults grew up in an age when dentists performed procedures without much explanation and often without anesthesia. Traumatic dental experiences as a child can cause fears of the dentist in adulthood. Fear of needles also comes into play, because for many dental procedures, a Novocain injection is necessary. 

“For many people, it’s a claustrophobia feeling,” Storm said. “The mouth is a magnifying organ. For example, a tiny piece of food between our teeth can feel like a two-by-four – it’s amplified. So when we move into that space, the little things seem very big and concerning. Some people begin to have feelings of choking or not being able to breathe, greater increasing their anxiety.”

An increasing number of dental offices are offering non-traditional practices and services to help their patients manage basic anxiety and full-blown phobias. Simple distractions like DVD players, iPods and massaging dental chairs are a few tools used to help people relax; but some dentists, like Storm, have incorporated entirely new philosophies into their dentistry to eliminate the cycle of fear.

“Our main principle is using relationships,” Storm said. “If you have a patient that you turn into a friend, they are much more calm and open to the care you are giving them because it is a friend taking care of them instead of someone they don’t know. We find that if we can just work with patients awhile, walk them through the process and allow them to control the pace, they become much more at ease.” 

Not feeling in control is a big issue for many people, especially for longer and more complicated procedures. A new invention called the Dental Button is helping combat some of those feelings. Created by a Missouri dentist, the Dental Button is a hand-held button that allows the patient to stop the dentist’s drill should they become uncomfortable or fearful. 

Ellisville dentist Kevin Postol is one of only three dentists nationwide using the Dental Button in his practice.

“Just this morning I gave it to a patient and her comment to me was, ‘I didn’t need to use it, but it made me feel much more comfortable to be in charge,’” Postol said. “I’ve used it about 50 times and have not had one person actually press it yet. It just makes them more at ease to have it there.”

For patients whose phobia is too serious to be managed with such techniques, sedation in the form of an intravenous injection (for total sedation) or inhaling of nitrous oxide gas (for conscious sedation) may be required.

Kehrs Mill Family Dental Care in Ballwin offers sedation dentistry through Premier Dental Anesthesiology, a service group that provides in-office dental anesthesia administered and monitored by board-certified anesthesiologists. 

Because of risks associated with sedation and anesthesia, patients should discuss with their dentist their experience, training and outcomes regarding sedation and anesthesia to determine the best option.

Not all insurance plans will cover sedation. 

“It really depends on the client’s plan design, but most commonly, benefits for such services are limited to cases involving complex oral surgery or when it is medically necessary for other reasons,” said Katie Chatfield of Delta Dental of Missouri. “When used solely to relieve patient anxiety, it is considered a patient payable expense.”

Some dentists, like Postol, do not charge for nitrous oxide gas because they do not want cost to prohibit their patients from being comfortable. 

Most importantly, being comfortable at the dentist depends on being comfortable with the dentist. 

“If you don’t feel like you have a good relationship with your dentist, you should find one with whom you do,” Storm said. “Know what you want from the relationship, find a dentist that you like and you will be more apt to go regularly.”