Fear of the Sights, Sounds and Smells at the Dentists
Sights, sounds and smells are powerful environmental triggers. If you suffer with dental phobia, merely evoking the images, sounds and smells you associate with dentistry is enough to generate intense feelings of anxiety or even panic.
Ughh… what’s that smell?
The typical clinging smells which used to impregnate dental practices were caused by eugenol (aka oil of cloves) and disinfectants, which create a strong antiseptic smell.
Smells are very powerful emotional triggers. This is because cells in the nose which process smell input send signals directly to the olfactory bulb, which is a part of the limbic system – an ancient part of the brain which is responsible for basic emotions like fear. Unlike other senses like seeing or hearing, the higher thinking structures are bypassed, and the sensory info is fed straight to the emotional center of our brain. No wonder then that we react so severely and immediately to smells that we associate with scary things.
Luckily, materials such as eugenol have become increasingly rare. Part of the reason is that it is incompatible with many modern dental materials, like white fillings and bonding agents. However, eugenol can be useful in some situations. For example, it is present in “alvogyl” – a brown substance used to treat the site where a tooth has been removed when it isn’t healing properly. Also, some temporary cements can have “the smell”:
“The smell is certainly less now, but there are certain materials used from time to time which have that distinctive ‘dentist’ smell. On occasions I come home from work and my wife will know if I have used a temporary cement for example because I ‘smell like the dentist’ apparently. I’m glad to say that it doesn’t happen too often!!” (Mike Gow, BDS)
This helps explain why one and the same practice may have no smell whatsoever on one day, but a “dentist smell” the next.
Generally speaking, fewer and fewer dental practices feature “the smell”. Practices interested in helping nervous patients are well aware of this problem and will try and ensure that their reception and treatment areas smell nice (for example by using aromatherapy to put you into a good mood). Some dentists choose to avoid the materials that create such smells.
Here’s a tip from dentist Fraser Hendrie:
“If this is a dental trigger for you, be sure to let the dental office know in advance and ask how they stop the ‘traditional dentists’ smell. An interested practice will know straight away what you are referring to, this might be another sign that you have found the right dentist for you.”
Some dental practice layouts, equipment and colour schemes are much more phobic-friendly than others. Does the place look clean (but not “sterile”)? Is there a happy atmosphere (or at least not a scary atmosphere)? What’s the overall feel of the place? Of course, the people who occupy the space (i. e. your dentist) can make a big difference in changing the overall atmosphere, but if the treatment room doesn’t look clean, this is a very bad sign. Avoid. And if the physical environment is important to you, do check out a few different practices first to have a look at their premises (often, they’ll have piccies on the internet – so you can check them out from the comfort of your own home!). You’ll be amazed at the differences between practices – some are downright spooky, while others have a much more homely, living-room like atmosphere.
“The Chair” is another major turn-off, but again, there are so many different models on the market these days, and many of them don’t look all that spooky anymore.
Do you remember the days when ALL instruments were laid out in plain view on a tray? Nowadays, you’ll be hard pushed to find a place where instruments (other than perhaps a mirror and a poker – and these can be hidden too if you so wish) are on display. The main reason for this is that modern standards of infection control don’t allow it (in the UK at least). At last – a Health and Safety regulation which actually benefits us!
Many people are scared of the sight of instruments being put into their mouths. The internet is full of stock photos of scary scenes where dentists come at their patients from the front with instruments held to their faces! Unfortunately, lots of websites choose to use these terrifying images, even though they are far removed from reality. Coming at you from the front makes zero sense ergonomically. The reality is that dentists work in such a way that you can’t really see the tools.
You may, however, wish to see an instrument beforehand and have it demonstrated to you. For example, many people find that having a better look at the handpiece, and having it demonstrated on their fingernail, takes a lot of the fear away. Or else, some people find that simply closing their eyes works for them while receiving dental care. On the other hand, there are people who like to see exactly what is going on, in which case you can ask your dentist to show you what they are doing with the help of mirrors.
Here are some more tips from Fraser Hendrie BDS:
“Sharing your fear with the dentist in advance of your visit via a phone call or an e-mail is often all that is needed to make sure that as much dental stuff is hidden or removed from the room before your visit.
Some practices even operate a very minimalistic approach and have almost everything out of the room only bringing in what is needed. While being quite an unusual way to practice, this can create quite a nice environment for someone who is anxious.
There are other simple things that your dental team can do such as keeping instruments covered until the last moment when they are needed or ensuring as much is set up in advance and kept in a drawer as possible.”
Many people equate the sound of the drill with pain. The logic behind this is simple: if you’ve had a painful dentistry experience in the past which was accompanied by the sound of a dental tool, you’ll have come to associate the sound with pain. Just hearing the sound may evoke a perception of pain. It can help to bear in mind that the sound actually has no correlation to pain once you are numbed up – it’s just air turbulence spinning the bur (unless it’s an electric handpiece – these are also quieter).
If you haven’t been to a dentist in a very long time, it might come as a relief to know that the instruments used nowadays may not be as noisy as you remember them. Technology has moved on a lot. Also, bear in mind that when noise is “inserted” into your mouth, it sounds much louder than it actually is. You could ask your dentist to demonstrate any instrument that makes a noise to you first (if you so wish), and sit up while being shown. Sitting up makes it easier to feel in control. Some people find that their mind has been playing tricks on them (images of Black & Decker drills come to mind!) and the reality is nothing like they had imagined.
You can find lots more tips (and even an mp3 to blend out the sound of the handpiece) on our Fear of the Drill page!
If you’d like to find out more about the importance of the environment, check out the excellent article Lloyd Jerome has written for Dental Fear Central on the use of distraction in dentistry: The Art and Science of Distraction.