Dental Fear – A Dentist’s Perspective

I recently experienced a personal epiphany of sorts regarding the angst, anxiety, if not outright fear of the anticipated pain associated with medical treatment (In my world, this phenomena is commonly known as Dental Fear). This “eureka!” moment of clarity was inspired by pain – my pain – visited upon me (the patient) by a very caring and proficient health professional during still ongoing and regular treatment sessions (every Monday, Wednesday, and Friday at 7am). Waking up at 5:30 in the morning is difficult enough, but, getting-up knowing that I am rising so early for the express purpose of being tortured (my initial visceral feelings as slumber gives way to consciousness) is not the optimal way to start one’s day. And knowing deep down that I am being well cared-for by someone I both like and respect, does not mitigate the dread of what I anticipate.

It was exactly one month ago today that I was happily skiing on the slopes in Steamboat, Colorado. I was in ankle-deep powder, cruising the blues (I don’t do moguls, I don’t do trees, and I don’t push the speed envelope) and gleefully enjoying the Rocky Mountain High when a mishap occurred. I fell with my body going in one direction and my right knee going in the other. Three days later, I was back in New York, and with a knee swollen beyond recognition from a torn medial collateral ligament. The prescribed treatment course: physical therapy, three times per week for at least 8 weeks. Thankfully, no surgery is planned.

Now, I’m no neophyte when it comes to physical therapy. Having had two shoulder surgeries, a torn calf muscle, a dislocated collarbone (another skiing mishap) and arthroscopic neck surgery, I am an unfortunate veteran of rehab medicine. I guess that’s the price one pays when blessed with the bone structure of a brontosaurus and the ligaments of a hummingbird! So, when I showed up for my first physical therapy session with expectations based on previous experiences (and a familiar therapist) I was unprepared for what was in store for me.

Heretofore, physical therapy for me consisted of strengthening exercises, gentle range of motion movements, and feel-good modalities such as heat, electro-stimulation, ultrasound, ice compresses, etc. Never did I envision the scope and intensity of the pain associated with rehabbing a torn knee ligament. Basically Gerry and Ken, my trusted therapists, have the intent and determination to move my swollen, tender, immobile leg to where it does not want to be or more precisely: they move it to where I can’t and don’t want to move it because IT HURTS; I mean it really, really hurts! And as compassionate as they are and as nice as they are, they are “killing me” to get my over-sized appendage moving again by breaking up the scar tissue.

All of those catchy euphemisms be damned: ”No Pain, No Gain,” “It’s Got To Hurt To Help,” “Cruel To Be Kind,” etc.

So, it was while I was scheduling my next series of physical therapy appointments (ever mindful of my pain-provoked perspiration) that I made the connection between what I was feeling and what many dental patients or would be dental patients experience when confronting their dental fear. Fear of pain can be and is, a major obstacle for many in need of dental care.

While the importance for a dentist to have compassion, empathy, reassurance, and a gentle demeanor cannot be overstated, pain avoidance is of paramount importance. Mastering the technique of a virtually painless injection is not enough. Administering sufficient anesthetic and allowing enough time for each individual to achieve profound numbness (everyone is unique in that department) ensures a comfortable experience and instills a sense confidence and relief.

The most unsettling scenario in dental treatment is when the patient is not sufficiently anesthetized and feels an unexpected jolt of pain during care. From that moment on, no matter how much more anesthetic is given, no matter how completely effective subsequent injections are, the patient will be sitting on the edge of his/her seat waiting with clenched fingers to feel the next jolt….even if it doesn’t come. The memory of that pain can linger for a long time (for some people, even a for a lifetime).

I have been practicing dentistry for more than 30 years and have always made my patients’ comfort my first priority (well, maybe I have two first priorities; the other is providing excellent dental care). My recent experiences in the physical therapy “hot seat” have given me a deeper appreciation and greater insight into the psyche of the dentally anxious. And while there may be other factors and dynamics in play for those suffering with dental fear and phobia, it is the relief of pain, the avoidance of pain, and a commitment not to hurt those who seek help that lays the groundwork for successful care.