John C. Chao, DDS, MAGD

Research Associate Professor, Post Graduate Program in Periodontics, SUNY – Buffalo (University at Buffalo)
Adjunct Assistant Professor, Behavior of Science (Anxiety Management), Ostrow School of Dentistry USC

(626) 308-9104

News & Press



John C. Chao, D.D.S., M.A.G.D
Anxiety Management,
Behavior Science,
Faculty, USC School of Dentistry

Dentists Welcome Cowards: Chicken Soup For The Dental Phobic

"Cowards Welcome!" is the caption of a best-selling, wall-mounted cartoon of a scared patient hiding behind a dental chair with only his big eyes and nose showing. Patients, often smilingly, point to that plaque and say such things as, "That's me," "I'm in the right room," or "I like that picture.” This picture tells the truth, which is that it’s common for dental patients to experience higher anxieties than they are ready to admit. The truth is also that dentists are experts at helping their patient overcome "dental phobia." The following is some chicken soup for overcoming dental phobia.

First of all, a dental patient should remember that it is perfectly normal and acceptable to feel anxious or nervous. In fact, you are already ahead when you articulate these feelings up front and discuss them with your dentist and the staff. You may be pleasantly surprise at how understanding they are. They probably already know from experience. Remember, your dentist deals with anxious patient's day in and day out. So don't hesitate to say, "I'm a coward, "I'm a chicken when it comes to dentists," or, "I'm a dental phobic." Some of the toughest men are totally "chicken" when it comes to dental treatment. So don't be afraid to admit it. It’s OK to be a chicken. Dentists are known to be "chickenologists."

Secondly, feel free to elaborate on how you came to feel that way and what specifically triggers those fears. When you have shared this with your doctor or a member of the staff, they will be able to offer reassuring solutions that will likely resolve your concerns. Your dentist may offer any number of ways of helping you. Remember, what you have learned through previous experiences can be "un-learned" through new, pleasant experiences under the care of your attentive doctor.

For example, if you are concerned with having pain from the Novocain injection, don't be. There are many solutions. One of which is the use of a new type of topical anesthetic gel (Oraquix) that numbs to a depth of 5 mm when applied to the gum surface. This is applied to the gum before injection and it takes away the sting that the Novocain sometimes produces. Another new device, called the "Vibrajet," emits a high-frequency vibration that is said to block out emissions of pain fibers during injection. A third device, called the "Wand," is used with a great deal of success by some dentists. This computer-assisted injection device emits a very small amount of anesthetic at slow and steady rate that generally holds any sensation below the pain threshold. Although there are a plethora of other kinds new injection devices, many dentists prefer to first offer their own favorite techniques of giving a virtually painless injection. You can trust your dentist's judgment as to what will work for you.

Some patients are afraid that the tooth will still not be painless after the injection.  This is also an easy problem to solve.  Newer type of anesthetics can produce deep, profound numbness.  New ways of introducing anesthetic to the tooth can resolve even the most difficult cases.  A frank discussion with your doctor about your concerns on this point will allow special procedures to be in place when treatment starts. 

Other patients dislike the sound or the vibration of the dental handpiece. It’s actually the vibration and the sound that is painful to the patient.  The answer to this problem is that the new "dental drills" run so true that there is hardly any annoying vibration or sounds compared to the last generation of dental drills.  For the minimal level of noise and vibration still present, you might want to wear ear-plugs or use CD players with ear phones.  Some offices can play your favorite DVD on the TV while you are waiting or while the procedure is being done.

Some patients don't have a problem with the injection, but "hate" the numbness that lasts for hours afterwards.  There are basically two ways to resolve this problem. Your dentist can use short-acting anesthetics that wear out in less than forty-five minutes.  As an alternative, special anesthetic devices can be used to numb only the tooth that needs treatment, leaving no sensation of numbness in the cheeks, tongue or the face during or after treatment.

Some patients have exaggerated gagging reflexes.  This makes it difficult for treatment in the posterior zones of the oral cavity.  There are a variety of methods to suppress and control this reflex.  One of the simple and effective methods is the "distraction" technique."  One of the common distraction techniques calls for the patient to raise one leg until some tiredness sets in.  Then a short procedure such as taking an X-ray, obtaining an impression and numbing up a tooth is done. The tiring of the leg muscle amazingly effectively distracts the gagging reflex. Finger pressure at certain acupuncture points on the wrist can also suppress the gag reflex in some instances.  Medications can be prescribed, when appropriate.  Topical anesthetic sprayed onto the gap zone is generally also quite helpful. These techniques resolve most concerns about gagging. 

For the exceptionally anxious patient, "conscious sedation" by medication is also available in some offices.  Some others offer Nitrous Oxide Sedation.  There are benefits and drawbacks to consider before these methods are used.   Whether these methods are suitable for you is a decision to be determined by you and your dentist.

Relaxation through taking slow, deep breaths is incredibly effective in raising the pain threshold (so that you are bothered less by the same stimulus).   Make your first appointment first thing in the morning, after a good night’s sleep and a good breakfast.  Since you are the first patient, there will be no waiting.  Stay as relaxed as possible.  Use Yoga or visualization techniques, if you have learned them.  Do not tense up and grab the arm of the chair.  Breathe deeply and slowly.  Visualize your "favorite things."  Make small talk with the dental assistant.  Joke around with the doctor. You can always find something or somebody to laugh about in the dental office.  Be light-hearted.  You'll be amazed at how pleasant your visit will be.

Dentistry has indeed come a long way.  You can look forward to even more astonishing innovations in the future.  But what never changes is that you can always count on your dentist to be caring and take good care of you and your special needs.


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