Dr. Brian Saby's Dental Blog

If you have dental fear, you are not alone.  While it is easy to say that going to the dentist is no big deal, if you are afraid, it is a big deal.  I don’t like heights and no one can convince me that there is no reason to be afraid of gravity’s effects.  My fear, like yours is real.  I also realize that there are things I can do to make it okay to be up high.  I ski and can ride a chairlift because they have safety bars.  Proper ladder selection and placement make it easy to climb and should push come to shove, my wife can clean the eaves trough. Unfortunately, you cannot get someone to have your dental work done for you, so you may have to come up with a way around this problem. 

So many people are afraid to go to the dentist that it is almost enough to consider it normal.  The apprehension levels vary from slight to extreme.  Many people will put up with considerable pain, discomfort and loss of function because of “dental phobia”.

There are a number of reasons for dental phobia.  The most common being a past experience that was unpleasant.  I would like to meet the “old horse doctor who put his knee on my chest to pull a tooth”.  I think he traveled around, inflicted pain and then took off.  The old knee on the chest method of yanking a tooth has not been used for a number of years.  The perception of a previous bad experience is very real, even though the actual experience may have been quite different.  Our memories are not the most accurate instruments.

Today, almost all dental procedures can be accomplished with little or no pain to the patient during the procedure.  Modern local anesthetics and local anesthetic techniques are very reliable and produce profound anesthesia.   There may be some discomfort after some procedures, but most of this pain is usually short lived and can be handled using pain medications.

Many people will avoid the dentist because they are afraid of the needle.  Again, the new techniques involved in delivering the anesthetic are quite amazing and can be accomplished with little or no pain.  Strong topical anesthetics prior to injection and new equipment like the computer-controlled injection have made dramatic improvements to anesthetic comfort.

One of the main reasons for fear of dental procedures is the loss of control.  When one is having dental work, they must become totally reliant on the dentist.  They must sit still and quiet while he or she works on one of the body’s most sensitive areas.   With not much else to do, they get to concentrate and postulate on what is going on.  Of course, there are some pretty wild sounds to help the imagination during the procedure. Watching television during the procedure helps to take your mind off what is going on.

There are a number of things you can do to overcome your dental phobia.  The first and most important is to find a dentist with whom you are comfortable.  You should interview any prospective dentists and make sure that this is a person who you can trust and feel comfortable with.  Set up an appointment just to meet the dentist, just to talk.  Let him or her know about your fears and what your expectations are regarding your dental care.  You can then evaluate if this is the dentist for you.

Once you have determined that this a dentist you would like to try, set up another appointment to have a full evaluation of your mouth.  This would include a dental examination and any x-rays that would be required.  If you and your dentist establish that you have some dental work to be done, you can come up with a plan to do it in such a way that it is most comfortable for you.  You may want to start with something simple like a cleaning appointment, or maybe even a small filling.  This would be an excellent way to establish a trusting relationship, which would help you overcome your fear.

Sometimes, it is necessary to use some form of sedation to help you.  Nitrous oxide or oral medications are available to help lower anxiety levels and have been used effectively for many patients. 

It is possible to overcome dental phobia sufficiently to allow you to have any required dental work completed.  Our experience has been that some patients even forget that they used to be scared to come to the dentist.  They may not enjoy it, but it is no longer a big deal.

Despite the publics increasing attention to improving their oral health, the thought of going to the dentist still evokes overwhelming fear in many patients.  In some people, the fear of going to the dentist is so great that they will put up with discomfort and even severe pain, rather than seek dental care.  Some will only seek dental help when the pain becomes intolerable.  They then choose to have their teeth amputated rather than fixed.

Why is it that dental fear is so prevalent?  Nearly everyone knows a person who has an exaggerated negative dental experience.  Of course the entertainment industry has not helped quell the fears of dental patients and even Blue Cross the dental insurance company uses a subtle reference to dental fear to help keep you from using your dental benefits.

Almost every dentist has heard the story of the “old horse doctor who put his knee on my chest to get the tooth out!”  Yet no dentist I know of has ever had to put a knee on a chest to extract a tooth, nor would this ever help get a tooth out. 

To some dental fear may arise from the belief that the procedure will be uncomfortable, while others fear the feeling that they have no control over the situation.  Some people associate the sterile smell of a dental office with medical facilities that may trigger associative fears. 

In the early years of dentistry, good pain management was unavailable and there was pain associated with dental procedures.  As science progressed, the effectiveness of dental procedures and local anesthetics became better and better resulting in more comfortable dental appointments.  Today, it is possible to perform dental procedures in a totally comfortable manner.  Excellent topical anesthetics and computer controlled local anesthetic systems allow for comfortable delivery of local anesthetics with profound effects.

In the modern caring dental office, the dentist must make every effort to make the patient feel relaxed.  It is important to establish a relationship with your dentist prior to having your work done.  You should feel comfortable with your treatment plan and be confident that this is the right treatment for you.  You should also have a signal worked out with your dentist to ensure that he or she will stop the procedure should you feel any discomfort or simply need a break.

Should you need a little more than TLC to help you with your dental appointment, there are other avenues that could be explored.  Today, many dental practices are marketing “Sleep Dentistry” to aid nervous patients.  Sleep dentistry is simply the utilization of medications to help a patient through the appointment.  A medication such as Atavan, or Halcion produce a sleeplike state but still allows enough alertness for response to verbal or physical commands.  In some patients, there is also an amnesic effect that results in little or no memory of the appointment.  The utilization of these medications has allowed for even very nervous dental patients to have great dental appointments.

If you have a fear of dentists and would like to find more information about techniques to help you get the dental care you desire, ask your dentist.

Throughout this series, I hope to help you get a better understanding of what modern dentistry has to offer.  This should help you make more informed decisions when choosing a dentist and determining the dental treatment you would like.

I have been practicing dentistry for over 29 years.  I learned early on that people don’t really like coming to the dentist.  They do however love the benefits that available through today’s dentistry.

When a person visits the dentist, they are not looking for fillings, gum treatment or any of the other treatments we provide….They are looking for  comfort, function, stability and beauty.   How we get there may involve fillings, gum treatment, crowns, and what not. 

To achieve your dental goals, your dentist must first do an examination.  The thorough dental exam will include an inspection of your face, head and neck. We will be looking for anything that may indicate a problem or potential problem.

Following the outside examination, your dentist will do an examination inside your mouth.  This will include an oral cancer screening, looking at your soft tissue, tongue, throat, floor of your mouth, palate etc.  He will be looking for anything that is not considered normal or may indicate pathology.

The examination continues with an assessment of your chewing muscles.  Palpation, or pressing, on the muscles of mastication (as we like to call them) should produce no pain or discomfort.  He will also ask about frequency of headaches as this may often be associated with painful bite muscles.

Your dentist will examine your jaw joint, listening for sounds such as clicking or popping.  He will want to know the frequency of the noises and if you have any pain in your jaw or ears.

An examination of your bite will occur.  This is often called an occlusal exam.  Here, the dentist will assess how your teeth come together.  He will look at how the upper teeth relate to the lower teeth, both in function and when the jaw is seated in the socket. He will also see how the teeth bite together and work when chewing side to side.

After these assessments, the dentist will examine your gums and supporting tissues around the teeth.  This will involve measurents called probing, where we see how deep beneath the gums the teeth are attached.  He will look for areas of gum infection and check for mobility of your teeth.

Next the dentist will look at the teeth and see if there are any areas that exhibit decay, cracks, or potential for fractures.

You and your dentist will also look at your smile to see if it is the way you desire.

Your dentist will also review any x-rays that were taken.

Armed with all this information your dentist will be able to make a treatment plan that will help you achieve your long term dental goals.