I have a real fear of going to the dentist. I know anesthesia isn’t harmful and is necessary, but I panic when I think about needles. I’ve heard some dentists use a medication to sedate the patient for the entire procedure, but I also worry about being “out of it.” All this fear and worry has led to poor dental care. How can I get over this so I can get the care I need?

Dental fears are common, and few people enjoy medical procedures using needles. However, when you forego the care you need, the fear may represent a blood, injection or injury phobia. Avoiding anxiety-producing situations tends to make the fear worse, and in this case may result in insufficient healthcare. You seem to have put your fear in perspective by recognizing that your health may be suffering and you need to do something about it. Behavioral therapists who are specially trained in exposure treatments for anxiety disorders can skillfully guide people in understanding, managing, and gradually facing their fears in a structured way. Two websites may be helpful in finding a therapist with this training:  www.aabt.org and www.adaa.org.  After pinpointing your fear, you can learn to put the fear in perspective (i.e., “My health is more important than the discomfort of an office visit.”)  For people with a history of fainting or panic attacks, practicing specific exercises (including applied muscle tension and interoceptives) can make visits more bearable. Furthermore, role-playing a dental exam improves the patients’ ability to tolerate an examination. When the patient is ready, the final stage is finding a good dentist and receiving the necessary dental care. May you find the courage you need to prepare for your dental visit.
 

Melanie VanDyke, PhD.
Licensed Psychologist
Anxiety Disorders Center
Saint Louis Behavioral Medicine Institute
314-534-0200 
www.slbmi.com

Dental anxiety is very common. There are pharmacologic (with medication) and non-pharmacologic (without medication) techniques to assist anxious patients. Pharmacologic methods range from light sedation or anxiolysis to general anesthesia. Anxiolysis may work for you. This can be achieved by using smaller amounts of sedatives or through the use of nitrous oxide (laughing gas). This technique can lessen your anxiety without you feeling “out of it.”  Non-pharmacologic techniques such as desensitization and modeling can be used to manage anxiety. By exposing a patient to gradual increments of dental therapy and through demonstration on other patients, anxiety can be relieved through experience. For many patients who have waited too long and who may be suffering from multiple infections, it may be more expeditious to have their dental treatment completed as soon as possible through the use of general anesthesia. In the dental profession, an oral surgeon or a dental anesthesiologist are both qualified to provide this service. 

Michael J. Hoffmann, DDS
President, Greater St. Louis Dental Society

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