May 29, 2007
Once a military dentist, Dr. A. W. Mercier Jr. says he can’t forget the burly fighting men who “could kill me if I sneezed,” but were nevertheless terrified of him.
“They looked up with fear in their eyes and said, ‘Don’t hurt me, Doc.’ ”
Today, to gain the trust of those who are too riddled with anxiety even to come to the office, Dr. Mercier has met new patients at coffee shops. “Once you gain their trust, you can help them.”
Dr. Mercier, who has his practice in South Dartmouth, uses air abrasion and hand-tool techniques to remove cavities. The combination, he says, is usually painless since the vibrations and heat of the traditional drill are eliminated. Often, no local anesthetic is needed. This is just one of many options for people who avoid dentists out of fear.
If the words “open wide” make you break out into a sweat, you are not alone.
The Massachusetts Dental Society reports that seven out of 10 people get clammy palms before going to the dentist, and between 30 and 40 million Americans are so afraid that they live with oral infections and pain rather than get the care they need.
For dentophobics, the descriptors “gentle dental” and “pain free” promise relief. They are catch phrases for new techniques and technologies that promise to take the anxiety out of sitting in the dentist’s chair, and they are showing up in a lot of advertising.
“The mouth is a very personal place. To have pain in there is a serious violation,” says Dr. Michael Jusseaume, who has a practice in Westport and is the Southeastern District Trustee for the Massachusetts Dental Society.
One way to make a dental visit less threatening is, obviously, to eliminate discomfort. Dr. Joel Weaver, director of anesthesiology for Ohio State University College of Dentistry, says that new drug compounds and slick methods of giving injections are making local anesthesia more effective than ever.
If blocking pain is the key to making people less anxious in the dental chair, then why are many still afraid?
Fear of the needle is a common problem. But, needles are so fine that along with topical numbing gels you’re not supposed to feel the puncture anymore. Doctors say that what stings is the pressure of the anesthetic entering gum tissues.
For that there is “The Wand,” a computer controlled syringe that delivers anesthetic in tiny doses. It’s touted as one of the new pain-free technologies. However, the injection takes longer, and most people want a needle out of their mouths quickly, Dr. Weaver says.
For those who sit rigid with anticipation that they might feel pain, the fast-acting inhaled sedative nitrous oxide (also called “laughing gas” for its ability to relax people to the point of giggling) has been used for decades as a calming agent. It is easy to regulate; with only a few deep breaths of air, patients clear their heads.
Dr. Michael Katz of Westport describes the effects of nitrous oxide as “almost like having a couple of drinks. There is no danger of loss of consciousness. It raises the pain threshold and makes time go by quickly.”
Virtual vision headsets are a drug-free alternative that Dr. Katz offers to reduce anxiety and make long appointments more comfortable. Watching a movie through the headsets gives patients an unobstructed view while the dentist works in their mouths. “It takes their minds off what we’re doing. It helps. I don’t know why more people don’t have them,” Dr. Katz says.
Of his gentle approach, he says, “I’m not doing anything that shouldn’t be done on a routine basis (by all dentists).”
Never mind being treated by a dentist, even the idea of being in a dental office, with its odors and sounds, is too much for some people. Anxiolysis (a fancy word for taking a mild sedative like Valium ahead of time) could be an answer and dentists are qualified to prescribe the medications.
Lisa Majewski of Swansea avoided the dentist for 10 years after a bad experience with a root canal. For her, Dr. Katz prescribed a mild sedative. “I’ve had two kids, but when it comes to my mouth I’m a big baby,” she says. “My biggest fear was getting hurt again and having someone make me feel bad for not going (to the dentist) for a while.”
Thanks to his gentle manner, medication and watching a movie on the headsets, Mrs. Majewski has been able to let Dr. Katz complete gum surgery, a root canal and two crowns.
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Sedation dentistry is a relatively new phenomenon that some people turn to who have developed major dental problems but cannot face the necessary work while remaining awake. Short of general anesthesia, there is an option called “conscious sedation” that allows the patient to be in what’s commonly called a “twilight state” without the need for hospitalization. Dr. Jusseaume says that conscious sedation is a “whole lot safer. The least amount of drugs is always the best. Every time someone is put to sleep they might not wake up.”
However, some patients determined to be completely knocked out go to the West Coast where general sedation dentistry is more common. One such practitioner is Dr. David Blende of San Francisco, who features “sedation dentistry for the fearful, phobic and special needs patient.”
Over the past 20 years, Dr. Blende has treated patients with severe dental phobias from 26 states and 16 countries, according to practice manager Amanda White. Often, their patients want to have decades of neglect cared for all at once. She says that the Blende Group is the “national leader in definitive full-mouth rehabilitation.”
While anesthetized in a hospital operating room, specialists can perform crowns, root canals, gum surgery, extractions and fillings that would normally require many dental visits. “A lot of patients, once they get through this massive process, are able to go in to a dentist for regular maintenance,” Ms. White says.
While medical insurance may cover the cost of the hospitalization, patients still need to cover the fees for all of the dental work. The bill for this specialized care can add up to the cost of a mid-sized car.
One of Dr. Blende’s patients flew across country from the Boston-area and forked over $25,000 to be sedated for a full mouth cleaning, five extractions, four crowns, four veneers and eight fillings.
Brian (who asked that his last name not be disclosed) says that he neglected his dental needs for 20 years following bad experiences as a youngster treated by novices at a dental school clinic. For Brian, even simple cleanings were out of the question.
“The whole idea of metal scraping my teeth terrified me. Sitting in the chair and having someone prodding around in my mouth was something I couldn’t do.”
In general, dentists seem to prefer not to use sedation partially because, in the long run, it does not help patients get over their fears. Dr. Jusseaume says that none of the modern gadgets or medications can substitute for a good old-fashioned relationship of trust between dentist and patient.
Mattapoisett resident Karen Cosgriff chose her dentist, Dr. Joseph Mills of Dartmouth, specifically because a friend recommended him as trustworthy. After years of avoiding dentists because of past problems with pain and gagging, she says, “I really like this guy. He’s quick. He doesn’t spend a lot of time with his fingers in my mouth making conversation. By the time I start to become my paranoid neurotic self, it’s over.”
Those who have trouble trusting dentists tend to be people 50 years of age or older who had painful experiences with techniques that are less refined than they are now, Dr. Jusseaume explains.
For the younger generation, he says, going to the dentist is not particularly scary. “Kids today are growing up with dentistry that is performed kindly and gently.”
The American Dental Society does not recognize a specific specialty in gentle dentistry. However, Dr. Michael Krochak of the Dental Phobia Treatment Center of New York says that “a lot of dentists do it intuitively.”
To find a gentle dentist the patient needs to “feel empowered to search. If you don’t get a warm-fuzzy on the first visit, move on.”
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