Feeling Powerless (Loss of Control)

Written by the Dental Fear Central Web Team and reviewed by Lincoln Hirst BDS
Last updated on January 17, 2021

I fear the overwhelming loss of control in the dental chair.

I’m petrified of the dentist doing things to me and having little or no say in the matter.

One of my fears is not knowing what’s going on or what to expect.

Many people are terrified of the lack of control they experience in the dental chair.

Maybe you’ve had a past experience where a dentist did things to you and didn’t stop despite you being in distress. Or you may have been physically, emotionally, or sexually abused in the past, and being in the dental chair reminds you of these experiences. Or perhaps you simply have a general preference for being in control of situations.

Whatever the reason – if you fear a lack of control, this page is for you!

Your page on fear of loss of control is what actually got me to come round to the idea of ever seeing a dentist again, and basically says that the dentist is not an ‘authority figure’ and you don’t have to do anything. Both of us have had experiences where we have been in pain or uncomfortable with something and either been told that we weren’t really in pain (?!) or just to shut up, which isn’t going to make someone feel comfortable with the idea of going back into that situation when no-one can legally force them to do so.

Neither of us had actually considered the possibility that we could walk out at any time, and oddly that knowledge is what makes us willing to go.



Before your first visit…

Whatever the reason for your fears, the sense of not being in control over what’s happening almost always begins outside the chair.

The thought that I could simply walk out if I didn’t like and trust the dentist completely had never occurred to me. Then again, it had never occurred to me that there might be some extremely nice dentists around, either… It seems totally obvious in retrospect, but many people with dental phobias feel the same. We tend to assume that “the dentist” is an authority figure who has full control and power over us once we walk through that door. The fact of the matter is that, once you view the situation rationally, it becomes perfectly obvious that you’re in charge.

The customer is (almost) always right!

A dentist cannot force you to consent to treatment. You are the customer, and you’re in charge! You don’t even need to go near “the chair” unless you’re perfectly happy that you like and trust your dentist. Always have a chat away from the chair first. It’s totally up to you if you even want to have a dentist have a look.

Dentists provide a service to you, the customer, which you can accept or decline. A lot of people with dental phobia assume that dentistry is something that is done TO them. They also feel that they have no choice in the matter, and that they’re at the mercy of the dentist.

But in reality, it’s much like going to a hairdresser’s. You wouldn’t let your hairdresser decide which haircut you should get, would you?

The good news is that nowadays, many dentists view their patients as partners in their care. Your dentist act as an expert adviser. As a team, you can come up with a treatment plan that takes your wishes and needs into account.

Of course, if your demands are unreasonable and would amount to malpractice or neglect on behalf of the dentist, they have the right to refuse to treat you. Let’s hope that’s not the case, though. Usually, there are several options available and you should be able to work out a solution you’re both happy with.

We’ve said this elsewhere on this website, but it’s worth mentioning again. When making decisions about your health, one of the best questions to ask is this:

If it was your tooth (or your mouth), what would you do?


Stop Signals

If you’ve had bad experiences with dentists in the past, you may be terrified of not having any control in dental situations. Maybe a dentist wouldn’t stop even though you were in obvious distress. Or a dentist or their assistant held or pinned you down when you were little. If this has been your experience, it’s important that your next dentist is one whom you can trust completely.

A stop signal is a signal that you have agreed with your dentist which means “stop – I need a break / I’m uncomfortable / I’m feeling pain”. The most commonly used stop signal is raising your left arm.

A dog clicker can be another great way of providing a sense of control. Basically, you hold the dog clicker in your hand, and press the button to indicate to your dentist that you need a break. Simples!

Problems with stop signals

There can be two problems with stop signals:

Firstly, some people may have been told to use stop signals in the past and the dentist didn’t stop when they used it. So your trust has been shattered. You can build up trust with your new dentist by using the stop signal just to test them when you don’t actually need to take a break. Make sure that they will indeed stop!

You may also find it helpful to have a different stop signal from the one you used in the past when you were ignored. Examples include raising your leg slowly or using the aforementioned dog clicker.

Secondly, many people find it almost impossible to give a stop signal because they freeze. Or they may be too intimidated by what they perceive as an “authority figure”. Another common scenario is that you’re overly polite and you don’t want to inconvenience your dentist.

Freezing is very, very common in victims and survivors of abuse.

How to overcome problems with stop signals

Ideally, you would practice giving the stop signal together with your dentist until you feel comfortable to do so:

My current dentist, when he mentions the stop signal, usually demos it by raising my hand for me which is good because it convinces me that he does want me to use it, if I need to.

Also, your ability to give the stop signal may depend on your dentist’s personality. If they feel more like a friend and an equal, it’s much easier to give the stop signal. Having (or building) a trusting relationship is paramount.

Rest Breaks and Counting

If you have trouble giving the stop signal, scheduled rest breaks can be really helpful. Talk to your dentist, find out how long a procedure will take, and agree to take breaks at fixed intervals (for example, every 5 minutes). This way you don’t suffer in silence because you’re afraid to interrupt the dentist. You also won’t worry that you’ll disturb them at an inconvenient moment.

Timed intervals are also a fantastic way of learning to give the stop signal without fear. This is how they work:

To help my patients feel in control, I usually tell them to count to 10 (internally) then we’ll stop on some agreed signal, then a count to 20 and so on.

Why have rest breaks?

It may seem obvious, but when you’ve given a stop signal, the break should be used to make you feel comfortable. You may find it helpful to be reassured that it is okay to ask for the chair to be put upright so you can regain composure, have some water, blow your nose etc. if appropriate. And, of course, to just talk to your dentist to check how things are going. Importantly, it gives you a chance to let them know if anything is uncomfortable or overwhelming for you.

Coping Signals

Another great idea is the use of a coping signal. In essence, your dentist checks on you periodically to make sure you’re ok, and you give a hand signal (thumbs up) to let them know how you feel. That way, if you don’t respond, your dentist will know that you’re not OK – unless you’ve drifted off to sleep, of course.

Wrist Squeeze

Here’s another idea which has been suggested on our forum: put your hand lightly around your dental nurse’s wrist. If you need your dentist to stop, give a light squeeze – your nurse can then alert your dentist.


“Like a turtle on its back” – the dreaded chair

You may feel like this turtle lying on its back in the dental chair

Being tipped back in the chair or lying down may make you feel exposed, defenceless and helpless. Some dentists won’t have a problem with leaving the chair in a more upright position. For example, special needs dentists are well used to it.

Here is one dentist’s perspective:

In a general sense, I will never refuse any request unless I perceived it to be a danger. One of my primary rules of practice is that I will never ask anyone to do or be anything that is not comfortable for them or without their permission and that permission may be undone at any time. Some people have wanted me to work without putting instruments into their mouth!! In these situations, time and care must be given to dealing with the phobia, before it is appropriate to begin dental procedures.

So I will indeed change the position of the chair to accommodate individuals. The angle of the chair is not that crucial in my view. But the operator needs to be comfortable as well. A dentist would be unwise to undertake treatment while uncomfortable for many reasons. Often we arrive at some compromise. I will sometimes bring the chair back little by little, allowing the person time to adjust to each position before moving further back. This can be helpful in some cases because it allows the dentist to get closer to their optimum position without inducing the panic that might happen if it were all happening at once.

The sitting up position was the norm in the 50s and 60s, and the equipment was designed to match. Modern equipment is not so good at adapting to the sitting position.

What chair position is best for dentists?

It is easier for your dentist if they can sit in a position that is comfortable for them. With modern equipment, this usually means that the patient is in a reclined position or lying down.

Some people find that lying down actually helps them relax. But when the chair is tilted back so far that their feet are above their head level, most people will feel out of control and defenceless. This position is called the full Trendelenburg position. It’s uncommon in the UK:

I can’t speak for U.S. dentists but I get the impression that most UK dentists do not work with their patients in a full Trendelenburg position. There are several experts on ergonomic working who will encourage dentists to work with the patient lying flat but not full Trendelenburg. The full position tends to be uncomfortable after about a minute or so. Modern chairs are very adjustable and allow virtually unlimited positions.

One can get a head-down without feet-up position by having the chair horizontal but the neck support dropped or tilted down. – Lincoln Hirst, BDS

Chair position and getting the best results

Chair position also depends on the tooth in question. For example, it would be rather tricky to treat a top back tooth in an upright position without significantly compromising the result. You can, of course, ask your dentist to only tip you back as far as absolutely necessary. But it’s also worth asking them what their preference would be if it was their tooth that was being worked on. Maybe you’ll want to go along with their suggestion if you feel that a better end result would be worth it.

Here’s a great tip:

Here’s something many of my patients find useful and you may too:

Ask if you can stay sitting up while the chair is reclined into the position the dentist wants it. When the chair is in its final position you can then take all the time you need to lie back and get comfortable.

This avoids that horrible loss of control feeling and the feeling that you are going to fall off the chair! – Mike Gow, BDS

If you have a disability which would make this difficult, ask if you can operate the button that makes the chair move back. That way, you can move it back gradually at your own pace, until you’ve reached the final position.


Not knowing what is going on

Many people complain that their childhood dentists never explained to them what they were doing or why. They were treated like a set of teeth rather than a living, breathing person with feelings and emotions.

Dentists in the UK and Ireland nowadays have to explain to you (in language that you can understand)

  • what treatments they are suggesting,
  • how they are done,
  • what a procedure involves from your point of view,
  • alternative options, and
  • what the pros and cons of the various options are.

You have to give your informed consent before any treatment starts. Also, you should ask your dentist what he or she would want for themselves if it was their mouth. Only then can you make an informed decision.

And if you need more time to make the decision, this should not be a problem either. For example, you may want to have a think about it or read up more on the suggested options. If you feel that a dentist is pushing you into making on-the-spot decisions, or that they are making decisions without involving you, then they’re probably not right for you.

Things to ask your dentist:

  • If it was your tooth/mouth, what would you do?
  • How is the treatment done? What will it feel like?
  • Are there any alternatives? What are they? What are the pros and cons of each option?
  • Can anything go wrong?
  • What happens if I do nothing?
  • What are the costs of the various options?
  • (for more fiddly or complex procedures): What is the success rate? Would it be worth seeing a specialist to increase the success rate? If it was you, would you see a specialist?

You may want to write down the questions you’d like to ask beforehand and take them along. It can be very hard to remember what you were wanting to ask when you’re nervous. So having a list of questions as a memory aid can be very helpful.


Not knowing what is going on during a procedure

Most dentists are happy to talk you through procedures and let you know what they are going to do, what sensations you can expect to feel next, what types of noises you will hear, and so on.

They can also show you what tools they are going to use and demonstrate them beforehand if you like. This Tell-Show-Do approach can work really well. It removes the element of unpredictability and spookiness, as you’ll always know what’s about to happen.

Some tips:

  • Ask your dentist to explain to you, at each step during a procedure, what is going to happen next. What sensations, sounds, tastes or smells should you expect?
  • If you like, ask your dentist to show and demonstrate to you any tools or materials they’re going to use.
  • Perhaps you are more comfortable with your eyes closed because you don’t want to see the instruments. But you may still want to know what’s happening. If so, try this:

When I get treatment or even just a check-up, I have my eyes tightly shut through the whole thing. But I am told exactly what is about to happen and always asked if I would like to feel it on my hand first – which I usually do. So without having to see the “scrapey thing”, I can feel it pulled along the back of my hand or have a puff of air blown onto it. So there is no surprise when I feel the same sensation a moment later on my gums or teeth. Sometimes being told is just not enough.

You may prefer to listen to music using headphones during treatment. If that’s the case, you could ask for a step-by-step explanation of what is going to happen and what sensations to expect before you start.


Taking things slowly

Starting off with (relatively) easy things can help you build up your confidence and trust. For example, if you cannot cope with the thought of having your dentist look inside your mouth while in the chair, you could ask if they can have a look first outside the chair, without a mirror. If the bit where a dentist calls out tooth numbers to their assistant is the stuff of your nightmares, ask if it’s possible to have a look without calling out numbers. You will feel much more in control once you actually start taking control.

If you feel that you may not be able to say these things face-to-face, let your dentist know in writing. You can also use the forms in our downloads section.

Taking things slowly can be just as useful when it comes to actual dental procedures. You may want to start off with whatever you find easiest and move onto things which you feel are more difficult for you later.

Also, it really helps if your dentist takes frequent breaks during dental procedures. Especially at the start, that might mean stopping every few seconds. For example, use the ultrasonic cleaner to the count of 3, then take a break, then try another 3 seconds, until you are confident that you feel comfortable with a procedure and able to cope.


Ask a Dentist – What if I’m afraid of losing control during treatment?

“Some people who fear dental treatment are those who are used to being in control at home, work and in personal and professional relationships. In today’s lingo, these people are sometimes referred to as “control freaks.” Despite this negative label, these controlling people are often highly intelligent and very successful.

Putting you in control

Although that statement is a generalisation, it is accurate to say that some of these high-powered people can be difficult patients because they are accustomed to controlling their environment.

When people who are used to being in a position of power are put into a situation where they must relinquish that power to their dentist, anxiety, confrontation and avoidance are the most common reactions.

The first step in overcoming this fear is to tell the dentist that you want to know what he or she is doing and why. Ask your dentist to explain X-rays, show you your mouth with an intra-oral camera, give you handouts or in-office presentations, or any other information to help you have a more active role in your dental care. When you know what the dentist is doing and why, you will have a greater sense of control during the procedure.

Stop signals

It is also important to ask the dentist how you should signal if you are having pain or any other uncomfortable sensation. Many dentists tell the patient to raise their hand if they are having pain, and the dentist will stop. I have had patients tell me that they had a dentist continue working on them even after they repeatedly raised their hands. This is not a dentist that you want treating you. It’s a good idea to test your dentist – even if you’re not having pain – to see if he or she will indeed stop. The dentist who follows through with that promise is what we call a “keeper.”

Choices

One technique I like to use is to let the patient have some input as to what procedure they want done first. Many times, there is no urgent need to have cavities on the left side of the mouth treated before those on the right side, or one crown (cap) done before another. I believe that it is perfectly appropriate for you to ask your dentist if you can have a particular procedure done first or last. If there is no urgent need, the dentist should comply with your wishes.

Allowing you to help “call the shots” can be an effective way to reduce tension if a loss of control is your main source of anxiety.”

© Jerry Gordon DMD, reprinted with permission


Some more tips

  • If you’re concerned about not being able to communicate with your dentist during treatment, bring a writing pad and pen. Or use a handwriting app on your phone.
  • You may find it impossible to voice your concerns or implement stop signals. This is very common in people who have been physically, sexually or emotionally abused. You can read more on this page on dental phobia in survivors of sexual, emotional or physical abuse (warning: may trigger). We would also like to encourage anyone working in the dental field to read this section.

Visit our support forum to get help with this and other fears, or to simply get things off your chest!


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