The fear of feeling powerless and at the mercy of the dentist
“I’m petrified of the dentist doing things to me and having little or no say in the matter.”
“I’m scared of not knowing what’s going on or what to expect.”
“I fear the overwhelming loss of control in the dental chair.”
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 proceeded to do things 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 lack of control, this page is for you!
It contains the following sections:
- Before your first visit…
- Stop signals (and coping signals)
- “Like a turtle on its back” – the dreaded chair
- Not knowing what is going on
- Not knowing what is going on during a procedure
- Taking things slowly and
- Ask a Dentist – “What if I’m afraid of losing control during treatment?”.
“The 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 as you can imagine 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 proceedings 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 surgery door. The fact of the matter is that, once you view the situation rationally, it becomes perfectly obvious that you’re in charge.”
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 phobias have a tendency to assume that dentistry is something that is done TO them, that they have no choice in the matter, and that they’re at the mercy of the dentist. However, the truth is that it’s entirely up to you to decide what you’d like your dentist to do – much like walking into a shop and deciding what products to buy (or not to buy). Today, most dentists view their patients as partners in their care, and will endeavour to come up with a treatment plan that takes your needs into account. This includes only carrying out treatment that you feel happy with.
However, if your demands are unreasonable and would amount to malpractice or neglect on behalf of the dentist (for which you could then sue them), they have the right to refuse to treat you. Let’s hope that’s not the case, though – usually, there are several treatment options available and you should be able to work out a treatment plan you’re happy with.
If you’ve had bad experiences in the past where a dentist wouldn’t stop even though you were in obvious distress, or a dentist or their assistant holding or pinning you down, it’s very likely that you’ll be terrified of losing control in a dental situation. 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”. Some examples of stop signals are:
- Raising your left arm
- Raising your leg
A dog clicker can be a 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! There’s also a nifty little contraption called “The Dental Button”, but sadly very few dentist have it (it would appear that it was only produced for a short period of time, though the dentists who do have it love it).
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), and making sure that they will indeed stop. It can also help to have a different stop signal from the one you used when the dentist didn’t stop in the past, for example, raising your leg slowly instead of raising your hand.
Secondly, many people find it almost impossible to give a stop signal because they either freeze, or they are simply too polite or intimidated by what they perceive as an “authority figure” and feel they might inconvenience their dentist. 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 very much 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 up) a trusting relationship is paramount.
- Another really useful strategy (known in the trade as structured time) is to talk to your dentist first, determine the likely length of treatment and agree to take breaks at fixed intervals (for example, 5 minutes). This way you do not suffer in silence afraid to interrupt the dentist, or worry that you’ll disturb them at an inconvenient moment. This is a great way of establishing trust.
“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.”
If none of these things make giving the stop signal any easier for you, there are some more tips on our page for abuse survivors (warning: may trigger).
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 or let them know if anything is uncomfortable or overwhelming for you. You should give permission to restart only when you feel ready.
Another great idea is the use of a coping signal, where your dentist checks on you periodically to make sure you’re ok, and you give a hand signal 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). You can learn how to use signalling on this page:
“Like a turtle on its back” – the dreaded chair
A lot of people hate the feeling of being tipped back in the chair or lying down as it makes them feel exposed, defenseless and helpless. Some dentists won’t have a problem with leaving the chair in a more upright position (for example, those who have been trained in special needs dentistry are well used to it). Here is one dentist’s perspective on this issue:
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/be anything that is not comfortable for them or without their permission and that permission may be undone at any time. They are always at choice and in charge (everyone is told this at introduction) but they are responsible for the choice and the consequences of their choice. Some 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. I always find it good to remember that dentistry is NOT that important in the overall scheme of things and that focus may be more appropriately put on dealing with the issues than trying to get other work done while dancing all around the issues that need attention.
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 it is important for the operator to be comfortable as well. A dentist would be unwise to undertake treatment while uncomfortable for many reasons. Often some compromise is arrived at. 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 a helpful trick in some cases because it allows the dentist to get closer to his/her optimum position without inducing the anxiety/panic that might happen if it were all happening at once.
The sitting up position was the norm in the 50’s and 60’s and the equipment was designed to match. Modern equipment is not so good at adapting to the sitting position. An older dentist with the older equipment would be quite at home in the sitting position. Having trained Trendelenburg [head down inclination], it is difficult to change positions for most with the biggest change producing the biggest problems from a comfort point of view. Suitability [of chair position] for different types of procedure would need to be evaluated.
It is easier for your dentist if they can assume a position that is comfortable for them. Some people quite enjoy lying down as it helps them relax, though many people feel out of control when having the chair tilted back so far that their feet are above their head level. The full Trendelenburg position appears to be more common in America, but it is uncommon in the U.K.:
“I can’t speak for U.S. dentists but I get the impression that most U.K. 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 also depends on the tooth being worked on. For example, it would be pretty difficult 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 can also be worth asking them what their preference would be if it was their tooth that was being worked on, and then working out a compromise position (or go along with their suggestion if you feel that the result would be better).
Here’s a 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)
Another tip is to let you, the patient, press the button to lay the chair back. Then you can take your finger off when you’ve had enough, and work towards lying in a flat position, like on a bed.
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 like a living, breathing person with feelings and emotions.
Dentists in the UK and Ireland nowadays are expected 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, what the alternatives are, and what the pros and cons of the various options are. You have to give your informed consent before any treatment is started. 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, for example because you need to think it over or you want to read up more on suggested options, this should not be a problem either. If you feel that a dentist is pushing you into making on-the-spot decisions, or that they are making decisions without you, then they are not right for you.
Things to ask your dentist:
- If it was your tooth/mouth, what would you do?
- What does the treatment involve/how is it done? What will it feel like?
- Are there any alternatives? If so, what are the alternatives? What are the pros and cons of these alternatives?
- Can anything go wrong?
- What happens if I do nothing?
- What are the costs for the various options?
- (for more fiddly or complex procedures, e. g. root canal treatments): 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 would 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 technique is also known as Tell-Show-Do and many people who fear the loss of control like being informed in this way. It removes the element of unpredictability and spookiness, as you’ll always know what’s about to happen.
- Ask your dentist to explain to you, at each step during a procedure, what is going to happen next and what sensations, sounds, tastes and/or smells to expect.
- If you like, ask your dentist to show and demonstrate to you any tools or materials s/he is going to use before actually using them.
- If you are more comfortable with your eyes closed because you are afraid to look at the instruments, but you need to know what is happening, 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 exactly the same sensation a moment later on my gums/teeth. Sometimes being told is just not enough.”
If you prefer to listen to music (using headphones) during treatment, you can ask for a step-by-step explanation of what is going to happen and what sensations to expect before you and your dentist start the procedure.
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 cannot possibly say these things face-to-face, write down your fears beforehand and make sure your dentist has read them.
Taking things slowly can also be really 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. Especially at the start, that might mean 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.
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. For instance, you may have heard the statement that “doctors make the worst patients,” but other professionals, including lawyers, teachers, engineers, high level business executives, etc. could just as easily be put into this category.
Although that statement is a generalization, 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. 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.”
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 may 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. (Please note that some dental procedures must be done before others for your benefit. Your dentist should give you a good, jargon-free explanation to help you understand why)”
© Jerry Gordon DMD, reprinted with permission
If you’re particularly worried about not being able to communicate with your dentist during treatment, an easy solution might be to bring a writing pad and pen along (keep it on your person though – it might be a tad inconvenient to have to rush off looking for your handbag).
Although through years of practice, most dentists are quite adept at understanding what you’re trying to say even with your mouth full!
You may feel that it’s impossible for you to actually 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, which was written by a survivor of childhood abuse (warning: may trigger). We would also like to encourage anyone working in the dental field to read this section.