Dentists often adapt approaches from children’s dentistry when helping adult phobic patients. And although they were originally invented with children in mind, there’s nothing intrinsically childish about them.
Baby Steps or Giant Strides?
Frequently used techniques include:
- the use of non-threatening language (and body language)
- interactive approaches based on tell-show-do techniques (direct interaction)
- structured time (taking frequent breaks)
- positive reinforcement (making positive comments)
Desensitisation and rehearsals are also frequently used, both in formal and in informal ways.
What all these approaches have in common is that they are based on rapport and interactivity. They’re aimed at building confidence and trust. They are about putting you in control.
By going slow and taking baby steps, many people find that they make giant strides and gain confidence quite rapidly!
Blue is the new white
The physical environment also plays an important role in easing fears. For example, the dental team wearing non-clinical clothes instead of the “white coat”, getting rid of the smells traditionally associated with dentistry, and playing music in the background can all help people by removing and replacing frightening stimuli. Some people also enjoy more obvious distraction techniques such as watching movies or listening to their own music during treatment.
It’s a kind of magic…
More specialised methods of help include hypnosis and systematic desensitisation. Systematic desensitisation is not used all that often by dentists because of the amount of time it can take and the additional training required. For hypnosis, the dentist needs special training, so it is quite rare to actually be offered this. But informal hypnosis is quite commonly used, often without the dentist even realising they’re using hypnosis.
There are other ways of making people feel at ease – for example, using humour or being particularly calm and confident. These are to some extent dependent on personality characteristics though and not always techniques that can be learned. Another major factor is trust – dentists who strongly believe in your ability to cope well are likely to be much more successful using psychological approaches. Trust begets trust. And although trust is a very powerful technique, again it takes a special kind of personality to put deep trust into another person’s ability to cope.
Relaxation and Systematic Desensitisation
Much of what has been written in journals and books on helping adults with dental fears is about using relaxation techniques such as belly breathing, or behavioural techniques like systematic desensitisation, or thought-based techniques such as cognitive restructuring (that is, challenging your thoughts about dentists and dentistry).
In practice, some of these techniques can be quite cumbersome and slow (this website is an example of an attempt at cognitive restructuring – and note how long it takes to read it!). They can take weeks or months to have an effect. Not surprisingly, not many dentists use them on a regular basis.
Even when a “traditional” cognitive-behavioural approach is used, rapport, confidence, trust and control is what it boils down to:
“It is interesting to take into account the views of people who have been provided with behavioural treatments for dental fear. From a psychologist’s perspective, techniques such as graded exposure, relaxation techniques or challenging catastrophic thinking are important. However, Gerry Kent, a clinical psychologist from the University of Sheffield UK, notes that from the patient’s perspective, interventions can be conceptualized quite differently. 1 He argues that high levels of anxiety or phobia should not be considered as residing simply within the individual or in the individual’s perceptions of dental care, but more within the relationship with the dentist. For example, when patients who had successfully completed a cognitive-behavioural programme were asked what had helped them to tolerate treatment, they mentioned factors such as the provision of information, the time taken, being put in control by the dentist, and the dentist understanding and listening to their concerns. 2 Such findings suggest that an interpersonal model of anxiety and anxiety-reduction is useful when trying to understand and treat dental fears.” (from Wikipedia – Dental Fear, accessed 20 March 2011)
You can find more information on all of these psychological techniques for overcoming dental phobia in this section (see the right navigation box for a list of links!). Each page also includes practical tips for dentists, which can be used straight away.