Who doesn’t know this small pinching in the stomach just before going to the dentist’s ? Approximately 30 % of the population asserts feeling dental fear before going to the dentist. Traumatizing experiences lived during the childhood are sometimes at the origin of this phobia which can show itself by accelerations of the heart, the perspiration, retching, but also by insomnias the night preceding the appointment.
But the phobia of the dentist is often a primitive, inexplicable fear. The fact that the dentist today “ does not hurt anymore”, is not often of a big help for the people affected by this phenomenon, who are moreover not often taken seriously with their anxiety.
The violent refusal, bounded to this apprehension, to go to consult the dentist, can have catastrophic consequences on the dental state as well as on the physical and psychic general state.
The treatment of dental fear
We propose in our office special methods of treatment, adapted to the needs of these patients, and who showed their ability.
We pursue two objectives during the treatment of phobic patients:
· performing in a optimal way, without stress nor anxiety, the dental sanitation of the patient.
· overcoming the fear of the patient and eliminating it in a long-lasting way.
To reach this purpose, we resort for several years to a strategy which showed itself very effective and centred on the following themes: put in confidence, absence of stimulation, soft and unthreatening treatments, an interactive discussion of the sessions.
Many patients experiencing dental fear report that, in the past, they were traumatized by a reliable break with the dentist. This situation can stretch back a number of years, further to a treatment imposed by an insensible or rough dentist. A promise made thoughtlessly by the dentist, and which will not be kept afterward can annihilate the reliable climate and be finally traumatizing.
We thus understood that the dental treatment of the anxious patients may succeed only if the patient trusts without reserve in his practitioner and his team. He waits not only for a good work, but also for clear and reliable information about the treatment, and for a certain attention, for the patience and for the understanding for the anxiety he feels.
So, in spite of the hectic rhythm of the everyday life in the office, our refreshed team of a high level of patience, is armed with the necessary psychological tools, and acquired with the experience a big intuition to seize the fears of the patient and by the same to gain its confidence.
The absence of stimulation
Because of its experiences made in the past, the dental office represents for the anxious patient a high-risks area : thus we take adequate precautions to reduce to a minimum the stressful stimulations:
Our treatment rooms are clear, spacious and bathed by light. The noise pollutions stemming from the cabinet, as well as the classic smells are avoided in the space of wait.
We make every effort to be on time, and so reduce to the minimum the deadlines of stressful wait. We have readings varied and renewed to distract the patient.
Soft treatments without stress
A treatment made softly and without pain should be an obvious fact today, and not only for the anxious patients.
The efficiency of the local anesthetic progressed so much that dental treatments, as the heavier interventions, can take place absolutely without pains. A technique and an equipment of anesthesia adapted to every situation, allow to give fast and satisfactory results in every case, by minimizing the pain of the insertion of the needle.
Our staff is formed to the realization of “smoothly” treatments, and possesses an adequate sensibility to recognize in time the needs for the patients, as for example when the patient wishes to have a break during the treatment or to rinse his mouth.
The medicinal sedation
Other sedative procedures with medicine became established in dentistry and proved themselves. As a general rule, it is about active ingredients belonging to the group of benzodiazepines or to the antihistaminics, used for decades as tranquillizers.
The inconvenience of this method is that, because of the residual effect ( hang-over ) of some medicine, the patients subjected to this treatment always need an accompaniment (even to use the public transportation) to be able to return home. Driving vehicles is authorized only 12 hours after the intervention.
These painkillers, used for decades, are very safe and count only some side effects, on the condition of being applied in a appropriate way and by an experimented practitioner. The correct dosage is not easy to realize because this one must be adapted to every patient. Certain patients need a very strong dose to obtain a sufficient sedation while for other people, half is enough for plunging them into a sound sleep.
Homeopathy and alternative medicine
In certain cases, we avoid medicine for the benefit of essential oil. Not only they are natural but they replace very advantageously the traditional pharmacopoeia. They are very effective and cure at various levels. Eugenol, for example, which is in fact a clove essence, disinfects, calm down immediately the pain with in addition, an effect “vitalizing” for the tooth which is going to boost the immunity and to fight against the devitalization. We also use orchids essences or homoeopathy to help patients to relax.
The conscious sedation
However, for the most part of the patients suffering from phobia of the dentist, all these measures are not enough to surmount at the beginning their often extreme fear of the dentist. The experience showed us that the conscious sedation with the nitrous oxide represents an ideal complement besides the aforementioned measures.
The term of sedation means in Latin “to reassure”. What is meant by this is a reassurance of the nervous system by means of medicine, what causes a slumber of the patient. The degree of sedation can vary of a light reassurance until the deep slumber. Consciousness, spontaneous breath and protective reflexes remain active.
The medical treatments felt as unpleasant or painful by the patient, as for example a gastroscopy, are often realized under conscious sedation. Sedatives also found their place within the dental medicine and represent an alternative to the treatment under general anesthesia.
There are essentially two types of sedation used at the anxious patients:
• The sedation by inhalation of nitrous oxide
• The medicinal sedation with tranquillizers
The conscious sedation with nitrous oxide
A suffering patient of dentophobia receives the treatment with the laughing gas: he inhales, through a light mask affixed down at the bows, a mixture of nitrogen protoxide and oxygen. He just has to begin to inhale the mixture to feel a light itch in hands and feet which indicates that the gas already begins to make effect. The fear then gives way to a pleasant feeling of heat and well-being. The patient is in a kind of trance and does not perceive any more what takes place around him. He follows the pleasant and suggestive thread of his thoughts and time goes by in a wink of eye. The sensitivity to pain and the reflexes unpleasant as gag or the gulp are widely limited.
The gas passes through lungs in the blood and harmonizes to certain receivers of the brain. It is at this level that he acts of three manners:
• Easing of pain (analgesia): a treatment with nitrous oxide allows to push away clearly upward the threshold of pain. The patient feels hardly painful stimulus minors. The injection of the dental local anesthetic (the shot of local anesthetic) which in other conditions is often felt as unpleasant, can be administered for example without the patient feels the pain. Even if the sedation in the laughing gas cannot replace the local anesthetic, we need less local anesthetic than on a patient who is not under painkiller thanks to the analgesic or analgesic effect (which calms down the pain) some laughing gas.
• Anti-anxious effect (anxiolysis): In most of the suffering patients of dentophobia, the sedation with the laughing gas clearly anxiety (anxiolytic effect). The fear and the present tensions initially give way to a state of comfortable trance which allows to support also more easily the long and painful treatments. As the laughing gas stimulates the thread of the pleasant thoughts and the imagination, from a subjective point of view the duration of the treatment seems to the patient more brief.
• Anti-nauseous effect (antiemetic): gagging and nausea are problems met frequently during the dental treatments, especially in case of the dental phobia. During a sedation with nitrous oxide, the nauseous reflex is widely limited. Even the procedures more difficult to support as for example an impression or an x-ray at the bottom of the oral cavity are so possible without causing nausea. When sudden jump are particularly important, the protoxide can be also combined with a medicine antiemetic (anti-emetic).
Advantages of nitrous oxide
A big advantage of the sedation with the laughing gas is the optimal control of the procedure: the anti-anxious effect begins as soon as gas is inhaled and the depth of the sedation can be influenced at any time by modifying the report of the mixture nitrous oxide/oxygen. At the end of the treatment, the contribution in protoxide is stopped and the patient inhales a few minutes of the pure oxygen.
As the laughing gas is not metabolized, it is quickly expired and eliminated completely from the body. The”hang-over” effect met to other tranquillizers, which stay longer in the blood system and which still make effect the hours later, does not exist with nitrous oxide. Contrary to the other methods of sedation, the patient is then able to leave alone the office. In the United States, where the legislation regarding responsibility is particularly rigorous, the patient is even authorized to return home by car having waited for 15 min. However, after a treatment with the laughing gas, we recommend to use the public transportation for safety reasons.
Another particularly crucial advantage is the reliability of the procedure which, if it is applied according to the rule book, causes almost no side effect, set apart the nausea which can arise occasionally. The laughing gas is used in medicine for more than 150 years and it is the reason why we have to make for one of the best studied painkillers. Scientific studies led on several million applications documented, made by dentists in the United States, revealed no mortal case or of dangerous incident for the health so that the laughing gas is considered in dental medicine as the safest form of sedation.
The medicinal sedation
Other sedative procedures with medicine became established in dental medicine and made their proof offering an alternative to the laughing gas. As a general rule, they are active ingredients belonging to the group of benzodiazepines or to the antihistamines, used for decades as tranquillizers.
The modern hypnosis has nothing to do with the big witches hypnotists putting under their influence their subjects. The patient keeps control and is going to play an essential role. The purpose is to put the spirit in a state of particular mental concentration, by visualizing mentally, for example, a place or a pleasant situation. By this thought, the spirit becomes indifferent to any other consideration or influences.
This modified state, but always of watch and not of slumber, is engendered by the therapist, by its voice, for example. He guides the patient, brings him to concentrate on his senses, his body, and it pulls into a dissociation of the consciousness allowing to reach a communication favored with the body and the psyche, the unconscious. The person can also herself induce this state, reason why we speak about autohypnosis.
We can compare the hypnosis to a kind of psychological Swiss army knife: practise, quick to open, to transform and to heal. Furthermore, the tool is easy to transport and usable at any time.
The Hypnosis is effective for numerous pathologies, but in particular in dentistry we shall be interested in his action against pain and dental phobias (80 % of success rates)