Niall Neeson is a dentist at Boyne Dental in Navan, Ireland. He has a special interest in helping people who either avoid (or really dislike) going to the dentist. At Boyne Dental, he has developed a bespoke service for nervous patients called “Dental Fear Solutions”. Our DFC volunteer Nikoleta Gehrmann travelled to Navan in Ireland to find out more!
Nikoleta: How did you come across Dental Fear Central?
Niall: When I joined Boyne Dental, I knew there was a hot opportunity to channel my passion and my interest in that area. Initially, I came across DFC through a Google search. It’s an absolutely wonderful resource for people out there who feel like they don’t know where to reach and where to go. Having that community and being able to ask a question to dentists without having to physically walk into a dental practice or have that exchange, yeah, it’s a fantastic resource.
Nikoleta: Why did you choose to become a dentist?
Niall: For as long as I can remember as a child I actually always wanted to be a doctor. I had never considered any other option really, and then I did work experience in a hospital and by the end of the week I was thinking “I don’t like it!” (laughs). I’d probably had some romantic image in my head about what was involved.
Then I remember chatting to my Dad afterwards and considering options. We discussed dentistry and what I would like to get out of a job on a day-to-day basis. I’d still be able to help and people and care and improve people’s health. I liked the idea and went with it.
I have absolutely no regrets. I have been asked by many people “if you could go back and choose again, what would you do?”, and I still would go back and choose dentistry. It’s a fantastic job and I love it.
Nikoleta: What do you love about it?
Niall: I love the variety, no two days are the same. You meet different people and you have different interactions and different challenges. The thought of sitting at the desk from 9 to 5 working on a computer just doesn’t appeal to me in any way.
Maybe I’m naturally a bit of a people’s person. But also having that productivity, the results that come with it and being able to see the improvements in health, being able to help people who are in pain and of course being able to help people who experience dental fear or dental anxiety or dental phobia has always been a massively enjoyable facet of the job to me. It’s always been the thing I got the most kicks out of.
So that’s where I get my buzz on a day-to-day basis. It’s not looking at a beautiful crown or a beautiful restoration. I go home with the feeling that I really connected to somebody and helped them overcome what has been a massive barrier, and brought them further along that journey of rebuilding trust and confidence in dentistry.
Nikoleta: When did your interest in treating nervous patients started?
Niall: I suppose from day one. As a vocational trainee, I was very lucky to have as a mentor Bert Hay. He was my vocational trainer. He’s a fantastic dentist, a great guy, and naturally absolutely so in tune with helping nervous patients.
I was also lucky at that stage that he allowed me to take the time that I needed rather than worrying about productivity. He said, “take the time you need to do things right at the beginning, and the speed will come and the rest will follow”. I feel very lucky to have had Bert as a trainer and to this day, I’d still regard him as a mentor and really close friend.
So from the beginning, I’ve always really enjoyed helping people who were nervous.
I think some dentists are naturally more attuned to that. At the ISDAM (International Society for Dental Anxiety Management) conference in Glasgow in 2019, a dentist called Donald Sloss was speaking about it – one of the slides at the beginning of his presentation was something like “I just, you know, I’m good at it! I have a gift for it” (laughs). I think that’s how he said it and it didn’t come across as egotistical or big-headed, it was a very valid self-observation.
It made me think that probably anybody who has really developed a passion for helping with dental phobia, dental fear, and dental anxiety has a degree of that natural talent. Because there’s so much you can learn but there’s also so much that has to come naturally. I suppose it’s a personality thing.
There are probably a lot of dentists out there who have all the tools to be absolutely wonderful at it but maybe the practicalities of day-to-day dental practice don’t allow that development of the passion or interest. Time realistically is a massive factor, and particularly at the beginning, you have to invest time with people who are fearful. You have to have time to listen to them, to reassure them, and to come up with a path forward instead of looking at the clock.
Nikoleta: Tell me about Dental Fear Solutions.
Niall: Dental Fear Solutions is a patient-centred approach to support the specific needs of each individual person, right from the first point of contact. My approach to helping people is that everybody has such a unique background and factors that have contributed to getting to the point where they are at that moment. It’s not a case of one size fits all.
I find control and loss of control is a powerful element to a lot of people’s issues with coming to the dentist. From the beginning, it’s about connecting with the patient and letting them know that we work as a team here, that we both want the same thing, that we want to achieve your goals.
So if a patient calls and lets us know that they hate the dentist, we have trained the staff who answer the phone calls and emails at that stage to send a positive message of “We can definitely help you” and get an appointment booked. Because that first phone call could be a massive moment for that person. It might have taken them ten years to get to the point where they’re actually picking up the phone.
And I don’t think people are in a mental frame of mind to take in much more than that on that first phone call. So we have a member of the admin team, Emma Browne, following that up with a phone call a day or two later. This is to find out more about the person and to begin to plan how we can help them. And she also explains the different things we can offer to help. Then we forward questionnaires which people can fill out at home in their own safe environment where they’re more likely to be thinking straight compared to sitting in the waiting room before their first visit.
Then I would give them a call a day or two before their appointment just to introduce myself. Sometimes it’s a short sweet conversation, sometimes it’s half an hour of tears and emotion and stories from the past. Sometimes it’s just a voice mail and that’s often enough to help. They still hear the sound of my voice and they hopefully think “he sounds OK” (laughs). It was Mike Gow in Glasgow who suggested that and I thought “that’s powerful”. I found it being massively beneficial – the rate of people failing to come in has gone down to zero.
Nikoleta: Some dentists might feel there’s no point in spending so much time on people who may never even visit their practice…
Niall: It can seem a bit labour intensive to some dentists or some practices, but it’s been a real game-changer. If you give people a sense of control and trust, the rest will usually fall into place. I like to think that those processes certainly begin to build that trust, and then it’s over to us to provide that sense of control to people after that.
I think as dentists and as dental personnel, we often can forget about the person and how big a deal it is for them to be there. That’s one part of it, just opening your mind to take note of your own tunnel vision and thinking about the person.
Nikoleta: And what’s the other part?
Niall: The second important factor is the effect of anxiety on communication from a patient perspective. We’re all very familiar with the fight-or-flight symptoms of the heart racing and sweating and an upset stomach maybe, but another physiological side of the fight-or-flight response is that communication is hampered. I suppose from an evolutionary perspective it’s danger – you have to get out of this position. So people can come across as being maybe sharp, maybe being a bit angry or aggressive, and that’s not necessarily the person, that’s the impact the anxiety is having on them at that moment.
And also, they are probably able to take in so little compared to how they ordinarily would be that dentists can get frustrated at “I’ve told you this three times already, why are you asking me the same question again, I’ve explained that”. But it’s just another symptom of the fight-or-flight response. I think appreciating the state that people are in, knowing that they’re really quite anxious and that this is difficult for them, can make a massive difference.
Nikoleta: How does the first appointment look like in your practice?
Niall: With DFS (Dental Fear Solutions) we have an extended appointment time to allow for plenty of discussion, chatting, planning, past, present, and future, as well as a gentle examination and any x-rays if the patient is happy to do that.
We use questionnaires prior to that first visit as a starting point, I use the Modified Dental Anxiety Scale and the Hospital Anxiety and Depression Scale as well, and then I have a third page with just a few open questions. Sometimes people write a couple of words, sometimes they write three pages. And it never fails to move me whenever people recall the finest of details. They remember the words spoken, the tone, the smells, the feeling, how their body was feeling at that time, and in some cases it has haunted people for years.
It’s not always a bad experience that’s contributed, but those open questions are very helpful. So we ask “What do you feel has contributed to how you feel about the dentist?”. We ask are there any specific procedures that concern you, that you feel nervous about, so we can begin to target where we need to reassure them and find a solution for their concern. We ask what are your goals, what do you want to achieve by coming and how can we help you get there. We also ask is there any type of music that would help you feel more relaxed, more at home, any album or genre. It’s great whenever people give us some album and we have it planned for them coming in, it’s a nice touch, something familiar to them.
It’s that bit of effort, that personal touch. We have TVs on the ceiling as well so you also can ask is there anything you would like to watch in particular: wildlife, a comedy, that sort of thing.
We have plenty of information there and we use that as a foundation for a chat. We don’t go near the dental chair at the beginning, we sit and just have a chat. Often, it can be very emotional for people. We have a box of tissues at the ready and they are often used and that’s absolutely fine. We understand that it’s a massive deal for people sometimes to even speak about where their fears have come from, but we get so much from that discussion and sometimes that can go on half an hour, 45 minutes, just chatting.
At the end of that chat, we have a good idea about what we need to do to make them feel safe, we’ve got a fair idea of what tools we can use to achieve the objectives from a dentistry perspective and we have an idea of where they want to get to.
For a lot of people, the goal is to be able to come as a normal patient and that’s great, completely achievable and realistic. For others, it’s to be able to smile again. For others again, it can be more of a social benefit, their self-confidence. Often people are aware of the impact that their dental health and their dental appearance can have on them socially, professionally, in personal life as well.
Often, the dental examination part of it is simple after that. It’s natural if you’ve been avoiding a dentist for years to catastrophise about that – if you haven’t had a professional opinion in so long or if the last professional opinion was maybe a dentist making a humiliating comment or a rude comment about the condition of your teeth.
As a dentist, it always gets me whenever they reveal those comments that their dentists have made in their past that have stayed with them. That humiliation is often far stronger than the actual memory of any dental procedure. It’s often not the pain of the dentistry, it’s the interaction with the dentist that can stay with people.
So yeah, at the end of that first appointment most people are on cloud nine. I love to see people coming out with a good buzz, they’re motivated, they’re on board. It can really open the door that they maybe weren’t sure could ever be opened. Again, that’s powerful and so enjoyable to be a part of that journey and that’s what I love about it.
Nikoleta: How often do you actually use sedation for your patients in your dental practice?
Niall: Intravenous sedation maybe a couple of times a week and nitrous oxide maybe a few times a week as well. A lot of people come in expecting they would need it, but once they’re in and they’ve met us and they’ve seen the place and begin to feel comfortable, they maybe find out their treatment need is not as great as they expected it to be. If you provide that sense of control and you’re winning that trust then often it’s not needed.
To me, there are massive benefits in people achieving their goals without it because it’s much more empowering for them and much more of an achievement. They have done it themselves, it’s not the drug that allowed it to happen. With intravenous, obviously, the vast majority won’t remember much about it. At least with the nitrous oxide, they have a memory and they know that they can do it, and then it’s an easier step to be able to attend regularly and have treatment without the need for sedation. So it has a massive role to play, but not as much as people expect it to.
Nikoleta: Imagine a patient you haven’t been able to help. What would be a reason for that?
Niall: There are a lot of people certainly in the earlier stages of my career that I look back at with a degree of regret at how I managed things. Knowing what I know now, I think there are a lot of things that I could have done differently, I could have helped those people.
One challenge that I was finding was people who were showing signs of more generalised anxiety and maybe some other mental health challenges and it’s not as simple as just “you’ve had a bad experience, OK, I’ll give you a good experience and then you’re massively along that pathway”. That more generalised anxiety I found challenging. And that was one of the reasons why I chose it as a topic of my dissertation for my Postgraduate Diploma in Conscious Sedation – because I wanted to learn more about how to help that person more effectively.
Nikoleta: Is there anything your patients can do to enable you to help them better?
Niall: I always find it very useful and helpful when people are really open with you about how they’re feeling and about their emotions at that time, because it gives us more clues about how we can help them and reassure them.
If people come in and tell me genuinely how they feel, it’s so much easier to really make progress and build that trust and that relationship. Because it’s more targeted, more tailored to that person and their specific needs.
Nikoleta: So it’s useful for you to know where it comes from and how are they doing?
Niall: I know some people might say “What’s the point of being bogged down in the past?”, but I personally find it useful because they are telling me what they don’t want to have happen again, which is great. Then I can say “I can guarantee that will not happen here”, and even that alone can be useful for them and they can relax.
I recently had a lovely fellow, but his dental anxiety had led to avoidance which led the teeth to become broken down and he stopped going out socially, he stopped playing sports, it just shut down different elements of his life. And what’s that going to do to your general sense of well-being? You won’t be in a good place if you’re not getting those positive elements of your life. The dental health can end up having an impact on the psychological health of a person and on the social element. And that, in turn, can make the psychological condition worse, which then makes the dental health worse through neglect, and they all can have an outcome on each other. Breaking the cycle of dental fear is so powerful and that’s the real challenge.
Nikoleta: Do you see a dentist regularly?
Niall: Well… I was this year (laughs). Yeah, I’ve had a root canal treatment done this year on a molar by the wonderful Brian at the practice here. I’ve had no lack of dental treatment over the years myself, so yeah, even dentists have issues!
This was an abridged version – you can read a longer PDF version of this interview here.
You may also like:
- Interviews with (and tips from) dentists
- What can I do if I’m terrified of the dentist but need to go?
- Common Fears: Lack of Control
- Dental Fears Patient Form – you can print this out and give or email it to potential dentists
- What is Dental Phobia?
- How to fight ‘fight or flight’ – an article by Niall Neeson for dental professionals