The Aftermath - And: When Things Go Wrong

Some people find that a few positive encounters with a dentist eliminate their fears altogether – if that’s the case for you, congratulations :grin:! Read no further!

Although it is said again and again on our forum that Doomsday is the hardest day by far, there can be situations when Life After Doomsday is not all plain sailing. But first of all:

Credit where credit is due!

Many people fail to realize how remarkable their achievement of actually having visited a dentist is – regardless of whether it went brilliantly or not so well (or even awful). Confronting your greatest fears is such a difficult thing to do. Perhaps even the most difficult thing you’ve ever done and will ever do. If you can face a severe phobia head on, you can do anything!

Also, there’s no point in beating yourself up over “what might have been” had you confronted your fear earlier. What matters is that you’ve done it now! It may sound clich├ęd, but it’s true… there’s no point in crying over spilled milk – and you deserve to feel very proud of yourself for your achievement!!

If you didn’t manage to find Mr. or Mrs. Right first time round, the above still holds true – you’ve confronted what is probably your biggest fear and you should be very proud of that, even if it doesn’t feel like that right now (you may want to jump straight to the “When Things Go Wrong” section, though).

(As always, take from what follows what you want, and if anything doesn’t strike a chord with you, discard it.)

If things went well…

OK, so you’ve overcome your dental phobia (well, at least you’re not half as scared as you were before, and there’s some hope!) – how cool is that?? Except… the next appointment is now looming, and you experience all those symptoms of panic you were sure were gone forever. Arrrgh… the fear has returned!! Or has it?

Fear Conditioning

Conditioning someone to develop a phobia is surprisingly simple. You can condition anyone to develop a phobia of virtually anything by repeatedly exposing the person to a neutral stimulus (such as a dentist) and pairing this with an unconditioned (reflex) stimulus (such as pain), which by itself will elicit fear. Actually, we’re so highly evolved that it may take as little as one bad encounter to change the wiring in your brain forever, provided the event is traumatic enough. While pain is the most obvious example, human beings are a bit more complex – they’re social animals – and even negative remarks can lead to conditioned fear. Also, pain on its own may not create a phobia if the dentist is perceived as kind and doing his or her best – it’s the social element which modifies our fear learning. If the dentist who inflicts pain doesn’t seem to care and admonishes you, the conditioning effect is hugely intensified.

Fear conditioning is both rapid and long-lasting. In fact, it’s been shown that the rewiring which occurs in the brain during fear conditioning is permanent. This may sound like bad news – which it is! (but, there’s always a but…)

Extinction Learning

Fortunately, a counter mechanism exists: extinction learning. For example, in rats, conditioned fear responses to a sound paired with a shock to the foot rapidly disappear when the sound is played without the shock. Similarly, if you are repeatedly exposed to a dentist in the absence of any negative events (or preferably, in the presence of positive events!), the fear response will all but disappear. Unfortunately, this effect doesn’t always last very long.

In rats, the newly learnt “extinction memory” will have completely disappeared after 2 weeks, as if the extinction learning had never happened. Rats show little or no fear response for about 6-10 days after learning there’s nothing to fear. But quite suddenly, the fear response “recovers”, and they’re back to square one.

Though not quite – the memory trace still exists, and the next time the sound isn’t coupled with an electric shock, the rat will relearn that there’s nothing to fear more quickly than the first time round. The extinction memory isn’t lost, but rather the rat fails to retrieve it immediately.

It is now thought that extinction learning can’t wipe out existing fear conditioning. They are two separate learning mechanisms. Instead, extinction learning works by forming new memories, which can offer a new way of interpreting things.

This is why you may not be able to truly eradicate a phobia. Of course you will never completely forget the old memories that made you fearful in the first place. But they can – quite happily – coexist with newer, positive memories. You could choose to look at it as a healthy skepticism!

Rats may not be quite as clever as we are, but their memory and primitive emotional systems of their brains are very similar to ours. So what can we learn from rats?

Spacing of appointments

Especially at the start, when you haven’t yet had repeated exposure to positive experiences, it is a good idea not to have your appointments scheduled too far apart. A lot of people are not fearful about an upcoming appointment in the days immediately following their visit, but as time passes, they feel the fear return.

Reward Learning

Reward learning is a much more powerful mechanism than extinction learning. Rewards, and especially social rewards such as praise, are powerful motivators which make us feel good. If you have a supportive dentist, reward learning can be a really powerful aid in unlearning fears.

One thing which can be useful is to replay, in your mind’s eye, any positive exchanges or events you’ve experienced with your new dentist. This helps to strengthen these memories and, to some extent, “overwrite” competing bad memories from the past. Think about how much time you have spent retrieving bad memories about dentists and dental treatment. This “rehearsal” has strengthened those memories and kept them alive. With bad memories, the rehearsal isn’t usually voluntary, but something that happens to us – the thoughts “intrude” on us. Unfortunately, good memories aren’t half as intrusive as bad ones. So you may have to make a conscious effort to exercise those mental muscles and rehearse any good things you’ve experienced with your new dentist in your mind’s eye. Like exercising a muscle, this will strengthen the positive learning you have done.

A fear reaction is not the same as fear!

You may find that there will be days or appointments when you’re gripped by a sudden sense of panic. This is entirely normal and again the result of how our brains are wired.

In the normal way, once we know there is nothing to fear, we are able to use the critical, thinking part of our brain to remind us that everything is ok. But sometimes, for example during times of stress or when we pick up a clue in the environment that is below the conscious level of our awareness, such as a certain smell, the thinking part of our brain isn’t fast enough to intervene and evaluate the potential “threat”.

One of the reasons why it may be so difficult to exert conscious control over fear is that the brain cell projections from the amygdala (the “fear” part of the brain) to the prefrontal cortex (“the voice of reason”) are far more numerous than those from the prefrontal cortex to the amygdala. So even when no danger at all is present, the amygdala can easily trick the rational thinking part of the brain into believing that a dangerous situation has, indeed, been detected – as long as it can catch the rational brain by surprise, before we’ve had the chance to critically evaluate the situation. It’s only a trick.

You’ll probably never be as carefree and confident in the dental chair as someone who’s never had a bad experience. But compared to the fear you felt when Doomsday was approaching, it is most likely a significant improvement – it’s the difference between an insurmountable fear and a fear that you can cope with. Remind yourself of how far you’ve come :grin:!

When Things Go Wrong

Maybe things didn’t go well. Maybe you just didn’t particularly warm to the dentist you met, or something about them just wasn’t quite right – they were pleasant enough, but you didn’t feel you could trust them. Do trust your instincts and keep searching – there will be a dentist out there who’s right for you!

Things are worse when the dentist you managed to see, after working up all this courage, was less than sympathetic to your needs, or maybe even downright horrible to you. This can be a truly shattering experience and you may question whether you have the strength and courage to keep on looking. It reinforces your fears that “they’re all the same”.

The first thing you need to realise is that you were not at fault. It’s just a case of really bad luck.

Take some time out and pamper yourself and pick up the pieces – it does take time for those wounds to heal.

When you have recovered, you may want to try again. And this time round, you’ve got a crucial advantage: experience. You can now think about ways of preventing the same thing from happening again.

Here are some threads from our forum which tell the story of people who got unlucky with the first dentist they saw, but then went on to find a dentist they really liked:

Nat’s story
Robotguy’s story
pumpkin’s story

Also have another look at the Finding the Right Dentist page and see if there are any tips which could help you with striking gold second (or third) time round! Or post on our dental phobia support forum for help.

When things go wrong later on

There may be appointments which don’t go as well as you would have liked, and you may feel disappointed for not being able to make more progress. But any progress is good and anything that you and your dentist try together that does not work is still progress, as you have identified something that you would prefer to avoid in future. You can then figure out ways, together with your dentist, of working around the problem you’ve identified.

Also, you may for some reason or other have lost trust in your dentist, and feel you’re back to square one. But this is not true – people usually find it much easier to try out a new dentist when they’ve done it before. Again, you will have the benefit of experience and you will be in a much better position to assess a new dentist.

The same goes if your trusted dentist moves away or retires. You have done it once, and you can do it again! And even if the new guy or gal can’t ever match your first love, you will have acquired the skills and knowledge to make this work with somebody else that you like.

There’s plenty of fish in the sea…