Fear of Painful Dental Treatment
“Dentistry is simply too painful, I can’t handle that amount of pain. Going there is not safe.”
If you reckon that dentistry is simply too painful to bear, it is likely that you’ve had at least one very painful experience in the past.
This could have been due to a number of reasons: a dentist starting too early, before you were properly numbed; a dentist having trouble getting you numb; an active infection of a tooth; a painful injection; or you may have been refused local anaesthetic in the past. You may have had a dentist who wouldn’t stop even though you were obviously in distress and in pain. And, of course, some dentists are much more gentle than others – you do get the odd dentist (or dental hygienist) who simply doesn’t care about people’s comfort or who lacks the dexterity required for the job!
Dentistry is not painful if you’re properly numbed up (though if you fear the sensation of numbness, this may not be much of a consolation – see our page on Fear of Feeling Numb).
But what if I fear the injection?
There’s a numbing gel which can be applied to your gums first in order to numb them, before you are given the local anaesthetic. If you don’t like the sight of needles (and who does?), closing your eyes might help. If you are a severe needle phobic, there are both psychological and pharmacological methods (as well as gadgets!) available which can make it easier to receive dental care. You can find more information on our needle phobia page.
:?: “What’s the story regarding “painless dentistry”? Some dentists say it’s doable, others say pain is unavoidable.” – Confused
:!: “Painless dentistry is one of those “it depends” answers. For most procedures, I’d expect the delivery of the local anaesthetic to be totally painless for work in the upper back area and the lower front. For upper front teeth and lower back teeth, there would probably be a slight “jab” when the first drop or 2 of local anaesthetic (LA) went in. Piercing the skin is painless, if topical LA, or “the gel”, is used properly.
The key to minimising pain is in delivering the LA solution as slowly and smoothly as possible. It should take about 2 mins for a 2ml cartridge. There is a gadget called “The Wand” which is basically a computer controlled syringe which delivers the solution very slowly, although the same effect can be achieved with a good injection technique.
Some dentists when they’re dealing with an apprehensive patient fire in the LA really quickly. It’s the tearing of the tissues which this produces that causes the most pain. Other dentists are just impatient buggers and want the job done as fast as possible. They tend to attract stoical patients to their practice and they do very badly with phobic or nervous patients.
The actual procedure should be painless most of the time, there are some procedures which are likely to be painful and will require extra LA or perhaps an additional LA technique, such as doing a root canal on a very “hot” infected tooth. Anatomical variation can sometimes mean that unusual LA techniques are required. But this is actually quite a rare occurrence.”
(answer courtesy of Gordon Laurie, BDS)
Does numbing always work?
For most people, getting numb is easy – one or two injections in the right spot and they’re numb. Unfortunately, for a small percentage of people this approach doesn’t work. If dentists have not succeeded in getting you numb in the past, check out the following page: Can’t be numbed? What to do if local anaesthetic doesn’t work.
“How can I overcome my fear of pain?” by Dr. Jerry Gordon, DMD
The first step in overcoming fear of the dentist or dental treatment involves gathering accurate information to help you judge the veracity, or truth, of those fears. Knowledge can be a powerful weapon against fear. In fact, many people fear death because it is “the great unknown.” A comforting component of many religions is the promise of heaven and other rewards in the afterlife. Although I cannot promise you that your dental experiences will be “heavenly,” I can promise that it won’t fall at the other end of the spectrum!
Learning about how dentists deal with people’s fears is a good starting point in alleviating a fear of the dentist, himself. Most people have at least some fear of pain or injury in life – and that’s a good thing. It prevents us from touching a hot stove (more than once) or driving a car into oncoming traffic. Fear is a protective and instinctive emotion that helps keep us safe. It should come as no surprise that when we are confronted with a situation or environment that we believe to be painful, we try to avoid it. Some people who avoid regular dental care do so because they believe that all dental treatment is painful.
So what is the truth about dentistry and pain? I won’t tell you that dental treatment is never painful, on rare occasions, it is. But I will tell you that most of the time, dental treatment is either completely painless, or only slightly uncomfortable. And be reassured by the fact that most dentists are acutely aware of the impact of pain on their patients. Many dentists pride themselves on being “painless practitioners.” A dentist who causes a patient pain will sometimes lose that person as a patient, and there is a good chance that the person will tell many others about the bad experience they had at Dr. So-and-So’s office. Causing people pain during treatment is no way to build a dental practice and most dentists know that!
Dentists have many ways of reducing discomfort during dental treatment. The first step dentists take is to evaluate the treatment required to decide if anesthesia, given as an injection, is needed. There are many dental procedures that can be done comfortably without anesthesia, using modern dental technology. For example, shallow cavities on the side or biting surface of the teeth can be treated with a dental laser or an air abrasion unit, a new device that emits a gentle spray of an air-and-powder mix that smooths away tooth decay. These devices can silently and painlessly treat cavities a high percentage of the time without anesthesia.
If anesthesia is needed, strong topical anesthetic gels or patches are used to greatly reduce the discomfort associated with injections. Dentists also use very thin needles and inject the solution slowly to further reduce discomfort. The most important way a dentist reduces or eliminates discomfort during dental treatment is to make sure that the patient’s mouth is as numb as possible during treatment. The approach I initially take is to begin treating the tooth very slowly. I will ask the patient, “Are you feeling this?” If the answer is yes, I either give them more anesthesia or wait a few minutes and test again. It takes some people’s mouths a little longer to become numb.
I recommend that you always signal your dentist to stop if you are having pain. If the dentist doesn’t listen, you need to find a new one! In some instances, you may still feel varying degrees of pain even after everything feels numb. There are a few reasons for this, including inaccurate placement of the anesthesia, not enough time allowed for the anesthetic to work or severe infection in the area interfering with the potency of the anesthesia. The dentist can remedy these situations by redirecting the anesthesia (giving more), waiting longer before beginning treatment or postponing the treatment and prescribing an antibiotic to reduce the infection. Another important issue is that different people have different thresholds for pain. I have had patients who have expressed genuine discomfort from a routine dental exam, and others who easily tolerated root canal or dental surgery without anesthesia (though I don’t advise it).
Over the years, I have discovered an interesting irony when treating fearful patients. The vast majority of these patients have a very high pain tolerance. When you think about it, it sort of makes sense. Fearful patients often avoid dental care and endure years of discomfort from their teeth. It seems likely that if they had a poor tolerance for pain, they would visit their dentist the moment a tooth became sensitive. Because of this, once a fearful patient develops trust with their dentist, the fear quickly evaporates. The fearful patient soon learns that dental treatment is not nearly as uncomfortable as the pain they go through every day with infected teeth.
When I have patients who tell me they are afraid of the pain, I make them a promise. I say that I will not perform the procedure (extraction, root canal, etc.) if they are feeling pain – plain and simple. On rare occasions, I will even reschedule the patient for a different day if the treatment cannot be comfortably completed.
Some dental procedures can cause discomfort after the anesthesia has worn off. Fearful patients are often concerned that they will be in pain following a dental procedure. These procedures include dental extractions (pulling teeth) and other minor dental surgery, root canal therapy, periodontal (gum) surgery and multiple dental fillings. Dentists are just as concerned with managing pain after treatment as they are during it. One of the first things dentists do is to make sure that they perform the procedure as gently as possible. A dentist with a forceful technique can put excessive pressure on the teeth and gums, which can cause greater discomfort later on. Dentists can also use anesthesia that lasts longer (bupivacaine) or give pain medication like ibuprophen (Advil, Motrin) prior to some procedures, because these measures have been shown to reduce pain after treatment. Dentists are also licensed to prescribe potent narcotic drugs that are highly effective in reducing or eliminating any discomfort after dental treatment. The final step the dentist can take is to call the patient at home after a potentially painful treatment. This is something that I have done for years. I like to see how my patient is doing, if the medication is working, or if the patient has any questions about the treatment. Some dentists do this, and I suspect more will in the future. Aside from being the right thing to do, research has shown that people’s perception of pain is less when the dentist calls them at home to find out how they are doing.
Most dentists realize that pain is a very subjective thing. What this means is that a person’s emotions have a large impact on their perception of pain. For example, if a patient gets the feeling that the dentist is insensitive or lacks compassion, there is a good possibility that other concrete measures the dentist uses to reduce pain will be less than successful. On the other hand, a dentist who makes a worthy effort to reduce all discomfort associated with dental treatment, and empathizes with his or her patients, will have much better results.
This article is © Jerry Gordon DMD, reprinted with permission.
Some closing thoughts
- Most people with dental phobia are prepared to put up with a lot of pain in order to avoid having to see a dentist. Often, the pain will be worse than any pain experienced even during a rare painful dental procedure (a “hot tooth”). The underlying principle is simple: on a psychological level, it’s far easier to endure self-inflicted pain than pain which is perceived to be inflicted on you by someone else. Having pain inflicted on you by someone else can be akin to being tortured – if the act is deliberate or perceived as deliberate. However, this no longer holds true if you know that your dentist’s sole intention is to help you in the least painful way possible. Obviously, embarrassment and the fear of humiliation are also important factors in avoiding dentists, often more so than the possibility of experiencing pain.
- If a number of dentists have had difficulty getting you numb in the past, it could have been due to anatomical variation. While rare, this is very real and extremely unpleasant for anyone affected by it. Some dentists believe that some people are impossible to numb, due to anatomic variation. On the other hand, there are also plenty of dentists who believe that with the right techniques, you can get anyone numb. Both are right – the former group isn’t well-versed in those advanced techniques, the latter group is. If you’ve had trouble with dentists failing to get you numb in the past, you could try asking outright if some people cannot be numbed properly. If the answer is “yes”, ask around until you find a dentist whose answer is “no”. That might be the one who is good at dealing with anatomical variation.
- Nitrous oxide (Inhalation Sedation) and IV sedation can be very helpful for achieving profound numbing if you’d like to give sedation options a go. It is not entirely clear why this is. One theory is that in some people, anxiety might affect their metabolism of the local anaesthetic, and sedation helps with the anxiety and therefore allows the numbing to work better.
- If you’re scared of post-operative pain more than anything else, have a look at the late Jerry Gordon’s article above, which contains a lot of good advice (sadly, Jerry passed away in 2017). If post-operative pain is expected, a long-acting local anaesthetic can be used – make sure you start taking over-the-counter or prescription painkillers such as Ibuprofen (Advil/Nurofen) or Acetaminophen/Paracetamol (Tylenol) BEFORE the numbing wears off! It’s much easier to prevent pain than to stop pain once it has started.
No matter what your fears are regarding the pain factor, they can be overcome. Pain during dental treatment is either entirely avoidable, or avoidable with very rare exceptions. And for unpleasant surgical procedures (such as difficult extractions or other types of oral surgery), there are various sedation and even “knock-out” options available. A good dentist will be able to advise you if things could become too uncomfortable for your liking.