Frightening Memories, Frightening Behaviour

[Franca]

If we can't make it law that every dental professional must personally experience every procedure they put us through before they can be licensed to practice, then the following should be mandatory reading for them all: the dentist, the receptionist, and everyone in between:

_____________________________________________________________

by Elizabeth Sciarratta, RDH

You trudge back to your room and throw the chart on the counter. Your back aches, and your stomach is in knots. Mrs. Jones once again managed to ruin your day. She was late, she had to go to the bathroom, and she gagged and jumped every time you went near her gumline. When she wasn't sitting up to spit, she was telling you which teeth to avoid.

Patients like this are frustrating. I used to get frazzled when people were late, jumpy, and otherwise uncooperative. One day I had a revelation that helped to change my view.

The hygienist working in the next operatory was treating a woman who was the victim of a violent assault. My co-worker did her best to be kind and comforting. As she leaned over the patient to begin treatment, the woman became hysterical and the appointment had to be terminated.

My co-worker had never touched the patient. What I suddenly realized was that it wasn't the hygienist the patient was reacting to. It was the image of somebody looming over her.

The light bulb in my brain went on. My patients are not reacting to me; they are reacting to previous experiences!

Post Traumatic Stress Disorder (PTSD) is a psychological condition in people who have experienced a traumatic situation. It is a cluster of behaviors that occur together. It can be mild to severe. Diagnosis of PTSD involves three components:

• Re-experiencing trauma — The person experiences the initial situation as if it were happening at that moment, even if it was years before. These experiences can range from a fleeting picture in the mind to a condition that lasts for hours.

• Avoidance — The person goes to great lengths to avoid re-experiencing the initial trauma or anything that reminds them of the initial trauma.

• Hypervigilance — The person is acutely aware of his or her surroundings, and constantly surveys the scene for reminders. This makes them irritable, easily startled, and jumpy. This can also produce physical symptoms such as chest pain or shortness of breath.

If we apply these components to the dental setting, it's easy to see why many patients react the way they do.

Patients will go to great lengths to avoid this, so many avoid the dentist altogether. It is usually severe pain that brings them to the office, and this makes the visit even more frightening.

While in the dental office, they display symptoms of hypervigilance — nervous, jumpy, watching every move. They are easily startled, such as when the chair is moved or you touch them unexpectedly.

Therefore, a frightened patient may actually be experiencing PTSD, and their behavior is a result of their condition. Once you understand this, you can deal with it.

Fear and patient behavior

Patient behavior that is annoying to the dental professional is often based in fear, or an attempt to disguise that fear. Anger is a common mask for fear. A patient feels more powerful when he or she is angry rather than afraid. This is particularly true of men. Hostile patients can be rude, sullen, or outright cranky. I have had patients threaten physical harm or retribution if I "hurt them."

Fearful patients complain frequently. Sarcasm and jokes, particularly off color jokes, are cover-ups for fear.

Chronic lateness and breaking appointments are also based in fear. Avoidance is a symptom of PTSD. The easiest way to avoid an appointment is not to go.

Bathroom trips, spitting, rinsing, and gagging are all based in fear. These help the patient control the appointment. There may be legitimate physical reasons for these behaviors, but, more often than not, fear makes the symptoms worse.
Coping with annoying behavior

When I personalize, I interpret something as an affront or insult to me. Personalizing others' behavior creates stress when dealing with fearful patients. I was taking my patients' behavior personally and reacting defensively. It took me a long time to figure out it was my reaction to the patient that was the problem.

When I changed my attitude, things changed for me. I promised myself that I would try to make each patient's visit with me a positive experience.

Through trial and error, I have learned many techniques for reducing fear. The most important thing I've learned is that it isn't about me. I now accept people as they are and work from there.

Acknowledging and validating patients' fears goes a long way toward reducing them. This doesn't require a detailed analysis, just a reassurance that they are okay. Many fearful patients feel alone. When we tell them they are not the only ones, they feel better.

I have found that just a few minutes of conversation before a procedure works wonders. I talk to the patient about their situation. I reassure them that I am experienced and trustworthy. I smile and keep eye contact.

I ask frequently how the patient is doing. I tell them they are great and that I am proud of them. I use a gentle fulcrum and gentle touch, and try to support the jaw instead of pressing on it.

Mostly, I try to let them know that it's OK to be afraid. I remind them not to hold their breath or hyperventilate. I use humor when it's appropriate.

Most fearful patients feel ashamed of their feelings and their oral hygiene. I try never to add to anybody's shame. I keep my instructions honest but positive. I make helpful suggestions that patients can incorporate into their lifestyles. I can't change a person who doesn't want to change. When a patient is difficult, I breathe deeply. The more they fight me, the more I relax and try to feel love. It isn't always easy, and I am not perfect.

I truly enjoy the art and science of dental hygiene. I have found time and again that it benefits me as much as my patients to treat them with love.

Elizabeth Sciarratta, RDH, is a dental hygienist who has practiced for more than 15 years in Rochester, N.Y., and Colorado.

[Stress Doc]

Hi Franca

This is one of the best stories I have ever read on this subject. I agree, it should read by everyone in the profession. Thank you for posting this.

Where did you find this? I would like to contact her and schedule an interview for my radio show. If you could PM me with the info, I will be grateful.

Blessings

[Franca]

You have been PM'd!

[Totalwimp]

Very interesting Franca, some of the dental professionals that I have had dealings with have obviously read this, some, unfortunately, clearly have not. Thanks for posting!

[RP]

Unfortunately, I found the article very unsettling, she's describing me and she misses the mark. I think many dental phobics, myself included, would rather visit the dentist (understanding we can be terrified of the dentist) than the hygienist anyday, why do you think that is?

That's nice that she understands fear and PTSD, but she's wrong, she does contribute to it, someone needs to explain the phobic loop to her. Her patients are probably reacting to past experiences from her. If she was truly offering gentle, painless service, their behavior in her chair would not be annoying or difficult, they would have learned to trust her and that they had nothing to fear. Over time they would develop a positive relationship.

Maybe she does "hurt them". Most of what she details deals with the fear of pain, why else would someone get upset when she got near the gumline or threaten if she "hurt them" Try repeatedly poking my gums with a scaler and tell me that I'm doing great because I laid there and endured it, I'll probably want to poke you in the eye with it. Perhaps she needs to start offering a local or numbing gel or nitrous, instead of patronizing comments like she's proud of them. We're adults, not a 5 year old, it's embarassing enough dentistry has reduced us to acting like one, doesn't help if you treat us like one.

[brit]

RP
I don't think she was necessarily saying she hurts her patients at all. LA is an option for dental hygiene - gentle technique can however mean it is not necessary. In my experience it really does depend on the technique and care used (no time pressure is best) coupled with the severity of the treatment. If your gums are inflamed then you'll need LA. You can be a 'no pain' hygienist just as you can be a 'no pain' dentist. Not all dentists and hygienists even aspire to be painfree however.
Like Stressdoc I welcome her contribution and have stickied the thread.

Her point about dental professionals having to experience everything personally is also a great one but likely to become less and less the reality as more and more people are cavity-free.

[RP]

Go for it brit, honestly it gave me a panic attack, her patients are afraid of her and so am I, but I'm just a phobic who is terrified of getting my teeth cleaned.

[shelly0624]

I have a wonderful dentist. After years of avoiding them and only going when I was in extreme pain (which usually required a root canal or extraction by then)..I found one worth his weight in gold. When I filled out my information, (since I was a new patient), I told him I was terrified of dentists. He was kind, gentle and reassuring. He was respectful of me and gave me the feeling that I was in control of the experince. I had had better experinces with women, as I found men to be impatient..generally speaking. One was so scary and gruff that I was chomping down on the drill, without realizing it. I really hate drills.

When I had my recent experince with a nightmare surgery, I really expected him to be dismissive and cleave to what I thought would be the unspoken rule that dentists don't talk smack about another dentist's work. He immediately listened and validated my experience, especially having looked at the work that had been done. I had tried to save money (my husband and I live on a very meager retirement wage).
He had referred me to someone who knew, who was truly skilled. But I tried to stick to the list of dentists who took Care Credit (from what I understand, they take a $200 loss for every $1000 transaction) and also someone who would take our high option insurance plan. (The insurance plan was OK but the Care Credit doesn't necessarily attract the best surgeons). My surgeon got her money back by overcharging. I would have saved had I gone with somene else. Their prices were fair and compareable to the procedure done by other dentists. I will be paying $700 extra because the work will need to be redone. I didn't go with my dentist's personal choice of surgeon.

Plus, I will be dealing with real terror when I sit in the surgeon's chair. I feel like my dentist cares about people. He is a family dentist and those who grew up having him care for thier teeth, are now bringing thier own children to him. He specializes in dentristy for children.
If I had found him years ago..I would still have the 3 teeth that have had to be extracted over the years and the 2 root canals.
I wish everyone who experiences dental trauma could find one like mine.

[drummerswife]

I just have to chime in here. I read and re-read this article a couple times to fully absorb it. My reaction is very much like Stress Doc's. This is one of the best pieces I have seen on this topic. Many thanks to Franca for posting it. I am printing a copy of it to give to my Dr. Katy, not because she needs it, she doesnt but she works within a large network of dentists in our city. This is an issue she is quite passonate about and I think she would be really interested to hear this and pass it on.
Those of you who have followed my story know that I came to this website 17 months ago with an overwhelming terror of dentists that knew no limit. I had been so traumatized by other dentists in my childhood and young adult years that even the mention of a dentist was enough to panic me.
The writer of this article sat=ys that she has realized that her patients are not reacting to her but to their memories of dental experiences. For the most part, she is right. When my husband, after several months of persistent persuasion, finally got me to go with him to hos dentist, I was so hysterical she could do nothing with me. Was I afraid of this woman? No, I had never met her. I was afraid of the DDS behind her name and reacted accordingly. Mine was very much a PTSD reaction having nothing to do with the dentust herself.
That said, what this author doesn't say and which should be mentioned because its very important is: if the dentist does not treat the patient in a manner which puts their emotional needs FIRST they can easy become part of the trauma and at that point it could become about them because the patient will be afraid of them. I was helping my mother in law look something up in the phone book not too long ago and I came across the picture of the dentist who so terrorized me as a child as, unfortunately, he is still in practice. Seeing his picture sent chills all the way through my body. Even now, all these years later, even now when I have been blessed with a dentist who treats me with such gentle understanding, even now I am terrified of him. I am terrified of his name and his face. And that is about him.
When DR. Katy is working with me, she tells me frequently that I am doing great and she is proud of me. She does this not to treat me like a child but as an acknowlegment of the great courage it still takes, even now, to walk into her office, My trauma is healing but its still a work in progress and Dr. Katy knows this so her telling me these things is a way of respecting and recognizing how far I've come and the strength it has taken me to get there.
My dream is not so much for every dentist to experience their own procedures but for the Psycholgy of Dentstry to be required training in every denal school everywjhere. The only way we are going to truly stop this tragedy is to stop it from happening in the first place.

PS I recently learned that the dentist who terrorized me is now under investigation by the ADA as a result of numerous complaints. Color me happy

[drummerswife]

Go for it brit, honestly it gave me a panic attack, her patients are afraid of her and so am I, but I'm just a phobic who is terrified of getting my teeth cleaned.

RP,
You are not "just a phobic" You have so much strength and courage. You truly are an inspiration to me and no doubt many others.