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Frightening Memories, Frightening Behaviour

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Franca

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Jul 13, 2010
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If we can't make it law that every dental professional must personally experience every procedure they put us through before they can be licensed to practice;), then the following should be mandatory reading for them all: the dentist, the receptionist, and everyone in between:

_____________________________________________________________

by Elizabeth Sciarratta, RDH

You trudge back to your room and throw the chart on the counter. Your back aches, and your stomach is in knots. Mrs. Jones once again managed to ruin your day. She was late, she had to go to the bathroom, and she gagged and jumped every time you went near her gumline. When she wasn't sitting up to spit, she was telling you which teeth to avoid.

Patients like this are frustrating. I used to get frazzled when people were late, jumpy, and otherwise uncooperative. One day I had a revelation that helped to change my view.

The hygienist working in the next operatory was treating a woman who was the victim of a violent assault. My co-worker did her best to be kind and comforting. As she leaned over the patient to begin treatment, the woman became hysterical and the appointment had to be terminated.

My co-worker had never touched the patient. What I suddenly realized was that it wasn't the hygienist the patient was reacting to. It was the image of somebody looming over her.

The light bulb in my brain went on. My patients are not reacting to me; they are reacting to previous experiences!

Post Traumatic Stress Disorder (PTSD) is a psychological condition in people who have experienced a traumatic situation. It is a cluster of behaviors that occur together. It can be mild to severe. Diagnosis of PTSD involves three components:

• Re-experiencing trauma — The person experiences the initial situation as if it were happening at that moment, even if it was years before. These experiences can range from a fleeting picture in the mind to a condition that lasts for hours.

• Avoidance — The person goes to great lengths to avoid re-experiencing the initial trauma or anything that reminds them of the initial trauma.

• Hypervigilance — The person is acutely aware of his or her surroundings, and constantly surveys the scene for reminders. This makes them irritable, easily startled, and jumpy. This can also produce physical symptoms such as chest pain or shortness of breath.

If we apply these components to the dental setting, it's easy to see why many patients react the way they do.

Patients will go to great lengths to avoid this, so many avoid the dentist altogether. It is usually severe pain that brings them to the office, and this makes the visit even more frightening.

While in the dental office, they display symptoms of hypervigilance — nervous, jumpy, watching every move. They are easily startled, such as when the chair is moved or you touch them unexpectedly.

Therefore, a frightened patient may actually be experiencing PTSD, and their behavior is a result of their condition. Once you understand this, you can deal with it.

Fear and patient behavior

Patient behavior that is annoying to the dental professional is often based in fear, or an attempt to disguise that fear. Anger is a common mask for fear. A patient feels more powerful when he or she is angry rather than afraid. This is particularly true of men. Hostile patients can be rude, sullen, or outright cranky. I have had patients threaten physical harm or retribution if I "hurt them."

Fearful patients complain frequently. Sarcasm and jokes, particularly off color jokes, are cover-ups for fear.

Chronic lateness and breaking appointments are also based in fear. Avoidance is a symptom of PTSD. The easiest way to avoid an appointment is not to go.

Bathroom trips, spitting, rinsing, and gagging are all based in fear. These help the patient control the appointment. There may be legitimate physical reasons for these behaviors, but, more often than not, fear makes the symptoms worse.
Coping with annoying behavior

When I personalize, I interpret something as an affront or insult to me. Personalizing others' behavior creates stress when dealing with fearful patients. I was taking my patients' behavior personally and reacting defensively. It took me a long time to figure out it was my reaction to the patient that was the problem.

When I changed my attitude, things changed for me. I promised myself that I would try to make each patient's visit with me a positive experience.

Through trial and error, I have learned many techniques for reducing fear. The most important thing I've learned is that it isn't about me. I now accept people as they are and work from there.

Acknowledging and validating patients' fears goes a long way toward reducing them. This doesn't require a detailed analysis, just a reassurance that they are okay. Many fearful patients feel alone. When we tell them they are not the only ones, they feel better.

I have found that just a few minutes of conversation before a procedure works wonders. I talk to the patient about their situation. I reassure them that I am experienced and trustworthy. I smile and keep eye contact.

I ask frequently how the patient is doing. I tell them they are great and that I am proud of them. I use a gentle fulcrum and gentle touch, and try to support the jaw instead of pressing on it.

Mostly, I try to let them know that it's OK to be afraid. I remind them not to hold their breath or hyperventilate. I use humor when it's appropriate.

Most fearful patients feel ashamed of their feelings and their oral hygiene. I try never to add to anybody's shame. I keep my instructions honest but positive. I make helpful suggestions that patients can incorporate into their lifestyles. I can't change a person who doesn't want to change. When a patient is difficult, I breathe deeply. The more they fight me, the more I relax and try to feel love. It isn't always easy, and I am not perfect.

I truly enjoy the art and science of dental hygiene. I have found time and again that it benefits me as much as my patients to treat them with love.

Elizabeth Sciarratta, RDH, is a dental hygienist who has practiced for more than 15 years in Rochester, N.Y., and Colorado.
 
Hi Franca

This is one of the best stories I have ever read on this subject. I agree, it should read by everyone in the profession. Thank you for posting this.

Where did you find this? I would like to contact her and schedule an interview for my radio show. If you could PM me with the info, I will be grateful.

Blessings :)
 
Very interesting Franca, some of the dental professionals that I have had dealings with have obviously read this, some, unfortunately, clearly have not. Thanks for posting!
 
Unfortunately, I found the article very unsettling, she's describing me and she misses the mark. I think many dental phobics, myself included, would rather visit the dentist (understanding we can be terrified of the dentist) than the hygienist anyday, why do you think that is?

That's nice that she understands fear and PTSD, but she's wrong, she does contribute to it, someone needs to explain the phobic loop to her. Her patients are probably reacting to past experiences from her. If she was truly offering gentle, painless service, their behavior in her chair would not be annoying or difficult, they would have learned to trust her and that they had nothing to fear. Over time they would develop a positive relationship.

Maybe she does "hurt them". Most of what she details deals with the fear of pain, why else would someone get upset when she got near the gumline or threaten if she "hurt them" Try repeatedly poking my gums with a scaler and tell me that I'm doing great because I laid there and endured it, I'll probably want to poke you in the eye with it. Perhaps she needs to start offering a local or numbing gel or nitrous, instead of patronizing comments like she's proud of them. We're adults, not a 5 year old, it's embarassing enough dentistry has reduced us to acting like one, doesn't help if you treat us like one.
 
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RP
I don't think she was necessarily saying she hurts her patients at all. LA is an option for dental hygiene - gentle technique can however mean it is not necessary. In my experience it really does depend on the technique and care used (no time pressure is best) coupled with the severity of the treatment. If your gums are inflamed then you'll need LA. You can be a 'no pain' hygienist just as you can be a 'no pain' dentist. Not all dentists and hygienists even aspire to be painfree however.
Like Stressdoc I welcome her contribution and have stickied the thread.

Her point about dental professionals having to experience everything personally is also a great one but likely to become less and less the reality as more and more people are cavity-free.
 
Go for it brit, honestly it gave me a panic attack, her patients are afraid of her and so am I, but I'm just a phobic who is terrified of getting my teeth cleaned.
 
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I have a wonderful dentist. After years of avoiding them and only going when I was in extreme pain (which usually required a root canal or extraction by then)..I found one worth his weight in gold. When I filled out my information, (since I was a new patient), I told him I was terrified of dentists. He was kind, gentle and reassuring. He was respectful of me and gave me the feeling that I was in control of the experince. I had had better experinces with women, as I found men to be impatient..generally speaking. One was so scary and gruff that I was chomping down on the drill, without realizing it. I really hate drills.

When I had my recent experince with a nightmare surgery, I really expected him to be dismissive and cleave to what I thought would be the unspoken rule that dentists don't talk smack about another dentist's work. He immediately listened and validated my experience, especially having looked at the work that had been done. I had tried to save money (my husband and I live on a very meager retirement wage).
He had referred me to someone who knew, who was truly skilled. But I tried to stick to the list of dentists who took Care Credit (from what I understand, they take a $200 loss for every $1000 transaction) and also someone who would take our high option insurance plan. (The insurance plan was OK but the Care Credit doesn't necessarily attract the best surgeons). My surgeon got her money back by overcharging. I would have saved had I gone with somene else. Their prices were fair and compareable to the procedure done by other dentists. I will be paying $700 extra because the work will need to be redone. I didn't go with my dentist's personal choice of surgeon.

Plus, I will be dealing with real terror when I sit in the surgeon's chair. I feel like my dentist cares about people. He is a family dentist and those who grew up having him care for thier teeth, are now bringing thier own children to him. He specializes in dentristy for children.
If I had found him years ago..I would still have the 3 teeth that have had to be extracted over the years and the 2 root canals.
I wish everyone who experiences dental trauma could find one like mine.
 
I just have to chime in here. I read and re-read this article a couple times to fully absorb it. My reaction is very much like Stress Doc's. This is one of the best pieces I have seen on this topic. Many thanks to Franca for posting it. I am printing a copy of it to give to my Dr. Katy, not because she needs it, she doesnt but she works within a large network of dentists in our city. This is an issue she is quite passonate about and I think she would be really interested to hear this and pass it on.
Those of you who have followed my story know that I came to this website 17 months ago with an overwhelming terror of dentists that knew no limit. I had been so traumatized by other dentists in my childhood and young adult years that even the mention of a dentist was enough to panic me.
The writer of this article sat=ys that she has realized that her patients are not reacting to her but to their memories of dental experiences. For the most part, she is right. When my husband, after several months of persistent persuasion, finally got me to go with him to hos dentist, I was so hysterical she could do nothing with me. Was I afraid of this woman? No, I had never met her. I was afraid of the DDS behind her name and reacted accordingly. Mine was very much a PTSD reaction having nothing to do with the dentust herself.
That said, what this author doesn't say and which should be mentioned because its very important is: if the dentist does not treat the patient in a manner which puts their emotional needs FIRST they can easy become part of the trauma and at that point it could become about them because the patient will be afraid of them. I was helping my mother in law look something up in the phone book not too long ago and I came across the picture of the dentist who so terrorized me as a child as, unfortunately, he is still in practice. Seeing his picture sent chills all the way through my body. Even now, all these years later, even now when I have been blessed with a dentist who treats me with such gentle understanding, even now I am terrified of him. I am terrified of his name and his face. And that is about him.
When DR. Katy is working with me, she tells me frequently that I am doing great and she is proud of me. She does this not to treat me like a child but as an acknowlegment of the great courage it still takes, even now, to walk into her office, My trauma is healing but its still a work in progress and Dr. Katy knows this so her telling me these things is a way of respecting and recognizing how far I've come and the strength it has taken me to get there.
My dream is not so much for every dentist to experience their own procedures but for the Psycholgy of Dentstry to be required training in every denal school everywjhere. The only way we are going to truly stop this tragedy is to stop it from happening in the first place.

PS I recently learned that the dentist who terrorized me is now under investigation by the ADA as a result of numerous complaints. Color me happy
 
Go for it brit, honestly it gave me a panic attack, her patients are afraid of her and so am I, but I'm just a phobic who is terrified of getting my teeth cleaned.

RP,
You are not "just a phobic" You have so much strength and courage. You truly are an inspiration to me and no doubt many others. :)
 
Drummerswife,
Why not throw your own account of what he did to you into the pot, even if it has become time-barred, it shows he has always been a discredit to the dental profession?

RP - I have also experienced the reluctance re the teeth cleaning thing as well- I had a bad painful experience within the last 5 years but have no problems with my current hygienist. It's actually quite common for dental hygiene to be a trigger for dental fear..for the reasons you described..that sometimes it hurts (unnecessarily).
 
You're very welcome, drummerswife.
 
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Brit--Im already ahead of you lol!. I went to the website where I found this bit of info (which I discovered quite by accident) and there was a place where you could post your comments so I wrote my story detailing how this man tortured me which meant that I had to go through those awful memories again which made my hands shake as I was typing but I did it because, as you say, it shows a long standing pattern of behavior. WhenI was done I felt a sense of justice just having had my say. And I wasn't the only one. There were a number of other stories posted from other adults who, like me, had been tortured too as children and youths.
And the shortest one was perhaps the most telling. It said in capital letters "DO NOT TAKE YOUR CHILDREN TO THIS DENTIST. HE IS EVIL"
His name had an * in font of it and down at the bottom of the page it said "currently under investigation by the ADA" I hope they throw the book at him.
:devilish:
 
Good for you, DW! May the:devilish: be truly brought to justice.

RP, you are a wealth of courage and inspiration! Hardly "just" ...well any adjective. I continue to check out your story because I so admire your strength and of course am rooting for you all the way. Similarly to a certain "DW" in fact. Both of you, along with everyone else on here are indeed so very admirable.

This thread struck me to open/reply due to an experience I had 2 weeks ago. First, a little relevant side info. As some of you know, I am extremely blessed to have a truly fantastic dentist. I think the world him. His hygieniest, someone I've known forever, is also caring and kind to take time and extra care with me, particularly due to my TMJ issues. However, I fully admit to preferring to see my dentist anyday over having my teeth cleaned! the hygienist does now use numbing gel which both helps make the visit and aftermath (on my jaw) easier but still, not my favorite place to be.

Back on topic, two weeks ago I went to see my former pediatrician/family doctor for a minor health concern. As a fully grown up woman, I still do not have a "real" medical doctor. I don't have the full phobia as some on here do about dentists, just lingering childhood abuse related issues along with less than ideal doctor experiences. I digress. Due to that along with lack of $ for a "real" one new doc, I sought advice with my old one who very kindly did see and help me. Growing up, I did have some issues with him bought it honestly was not so much about him, like others have said about dentists, as it was the idea of being trapped in a doctor's office, specifically in my case freaking out in case a shot was needed.

All the above said, while I was waiting for the elevator inside my former doc's building, who did I see enter the lobby but his colleague. This was a man, who I had the misfortune of being a patient of once, when my regular doctor was out and my family did not want my cold or whatever to remain unseen. Other than knowing of this man, obviously seeing him from time to time in the office when I was there for my doctor, I had no experience as a patient with him. Let me just say that afternoon, over 20 years ago now still reasonates in my memory as not helping to relieve me of my med doctor qualms. So 2 weeks ago, to suddenly see this person, was somewhat shocking. I even dared to ask my doc's longtime nurse about him, if he was indeed still practicing to which she went on to gush about the guy. :o I don't think I ever did tell her or my former doc what exactly did happen with their colleague.

Other "memory" is one from much more recently as in last Fall. Before lucking out (finally) in finding my wonderfully compassionate TMJ doctor, I spent a lot of time and money on the search. Horribly that included my seeing one extreme :devilish:. This "doctor" both physically and to some extent psychologically hurt me a great deal, definitely at the time setting me back in terms of TMJ progress. The truth that I sat there, letting him continue haunts me as I said every so often still. Luckily he is long gone, in his place someone his exact opposite.

:respect:to everyone on here for sharing.

Mona
 
For all the kind words thank you. :XXLhug: Before I reply again, suffice it to say that I'm going to get my teeth cleaned under GA/Deep Sedation when they do the implants. My new dentist is sending a hygienist to the oral surgeon's office, so it's that bad. I've dealt with a lot and I'm making great progress but there's just some things......

I'm sorry, I see her points and all of yours but I also still contend she needs to look in the mirror at pain free visits. I realize she may be writing for affect, but "Mrs Jones, once again" was the key for me. Once again means Mrs. Jones still hasn't had a positive experience and doesn't trust you yet.


To Franca, according to my dental anxiety coach/therapist, who is Stress Doc by the way, I too had/have PTSD but all dental related. And I was leaving the adult at the door as the 5/6 year old who was tortured was going to the dentist. My issues were abandonment, my mother was phobic and my father a strict disciplinarian. I had no one to comfort me when the dentist hurt me and only someone to beat me if I misbehaved....Once I understood and forgave, rewrote the story, it has gotten better. Unfortunately through out my life I have experienced much pain at the hands of dentists and hygienists and it takes time to heal and trust.

I can actually carry on an adult conversation with a dentist now except to tell the story of how, why, what makes me afraid- I have SD for that. So treating me like a child, sends me back there and I won't. We are using hypnosis and I am in safe place while having dental work, but it's me, the adult, dealing with it. Not the child.

I too have a terrible fear of dentures but it is due to being threatened by them since I was about 15 while undergoing painful dental work, you can picture that I'm sure. "You need to sit here quietly and let me work on your teeth or you are going to lose them all and get false teeth" all while not being numb. I got a temporary orthotic today and its gagging me. It just sits on my lower teeth- I can't do it.

That being said, I made it through a three hour dental appointment today with absolutely no chemical help, just hypnosis. I'll detail in my journal in a bit. I'm exhausted.
 
3 hours wow! RP!! Way to go!! The longest appointment I have had thus far is 90 minutes so I applaud you :jump::jump::jump:

Something for you to consider. As I read the article I too was struck by the "Mrs. Jones again" line but my perspective was a bit different because I thought about how many months it took me to begin to trust Dr. Katy even though she had done nothing to make me afraid of her. It wasnt that I dudnt have a positive experience with her, it was that my other experiences had been so overwhelmingly negative that it took several months before I began to feel safe with her. Looking back on those early months, even thouh I was sedated, I was not a wonderful patient by any stretch and I wonder how many times I probably tried her patience. Maybe it was the same with Mrs. Jones.
 
Thanks, DW, I appreciate that, unfortunately it gave me a panic attack, it brought out all the reasons I'm petrified to get my teeth cleaned and I can't over think it, I don't want to anymore. It is what it is and my reaction was uncontrolled and spontaneous. Her response/technique to her frightened patients, no matter how kind, did nothing to suppress my fear or bring me comfort.
 
And I certainly appreciate that GF. You are such a beautiful spirit and it makes me so sad that you were so badly mistreated in times past. And yet you have come so far and I am truly inspired by your strength and courage as are so many others here. What a blessing you are to all of us. My prayer for you, my friend, is that someday you will celebrate a happy ending to this long journey.

I think about my reaction to the first dentist my husband took me to see. She has worked with my drummer boy for years and was surprised to learn he had gotten married. I think back on that day sometimes and what she must have thought of his new wife I can only imagine. My reaction was exactly what you say "spontaneous and uncontrolled" I was shaking like I was having a seziure before they called my name. I burst into tears at the sight of the dental assistant and drummer boy took my hand saying "Its okay honey"
And it just went rapidly downhill from there. When the dentist walked in the room I was so far gone I couldnt even speak. She pulled hubby out in the hall and asked him what had happened to me. He was clueless and quite disturbed by my reaction as he had never seen me lose control like that. I owe her one though because she recognized what was happening and even if she didnt know why she knew what to do. She left me sit there while she called Dr. Katy and told her about me. She arranged an appointment for me and we left. After I calmed down I remember feeling so embarrassed by my reaction and I thought she probably thought "Good grief what a nut job!"
 
No, DW, I think she understood, that's why she sent you to Dr. Katy. Someday when hubby has a dental visit, why don't you go back and thank her, ler her see you as a strong woman with a kind heart. Tell her how that brief encounter was life changing for you! :XXLhug:
 
Gppd idea GF. Thanks.
 
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