Now I will teach you exactly how to be afraid of the dentist

When using an insulating scarf like this on a claustrophobic patient, we can make a hole in an unimportant place: otherwise the patient will be afraid that we will suffocate him

Adults are afraid of us more than other doctors. In second place, perhaps, are surgeons, but they are not feared for long. About a third of patients suffer from dental phobia or dental phobia.

The best fear is rationalized. “Ahh, doctor, I’ll open my mouth now, and you’ll stick a huge long needle in there and do something” - great. “Will you infect me with hepatitis from your dirty tools?” - even better, everything is extremely rationalized. By the way, demanding a demonstration of sterilization is your completely normal right. “And if the drill breaks in my mouth, will the fragments fly out or in?” - in general, the best thing to work with, because the patient has a specific scenario. More precisely, even two!

Fear of a doctor is most often irrational. Somewhere, once upon a time, someone got into a patient’s mouth unsuccessfully in childhood, and now the doctors first became evil old women, and then a complex like “I’d rather die, but I won’t give in to them” simply formed. It is normal to feel fear, and you can work with fear. The question is how. For example, women may cry in the office from emotional stress - this is normal; up to a third of patients do this. But men act differently. They have a wonderful life hack: they don’t come.

In general, come in, I will teach you to be afraid of dentists. Let's talk about the causes of fear, methods of working with it, and a little about real risks. Well, thanks to the Soviet compulsory medical insurance approach, I now have boxing with anesthesia in every clinic.

What is dental phobia or dental phobia?

This is when you are afraid of dental treatment.
You may also be afraid not of the treatment itself, but of the dentist, of medical devices, and of opening your mouth in general in front of strangers who are trying to do you good. Or any other element of the dentist’s office - from smell to sound. Physiological manifestations are completely normal, as for any other fear. For example, if you don't have dental phobia, you can jump with a parachute and remember the sensations on the plane. A mentally healthy person should experience irrational fear of the same nature.

Dental phobia is characterized by the following reactions:

• Increased blood pressure. Very convenient when you need to run away from a doctor or fight with him.
• Increasing muscle tone also increases your chances in a fight with a doctor from an evolutionary point of view.
• Pupil dilation (a side effect of activation of the sympathetic nervous system, the original meaning of the reaction is almost lost).
• Discomfort in the gastrointestinal tract: because you urgently need to take resources for something else, and this system is rushed without control. By the way, if you also start to smell terrible, this will increase your chances in battle. And it will be easier to run, so the effect is also evolutionarily useful.
• Degradation to the level of trained quick decisions, often reflexive - without the participation of complex conscious processes.

Basically, it's the classic prolonged fight-or-flight response that turns into a long flight, flight, flight response.
The only thing is that evolutionary progress has not yet affected adaptation to dentists. There is another reaction - “freeze.” In this case, the patient sits motionless in a chair with a pale appearance. As a rule, in this situation, resources are pulled from the periphery to increase supply to the brain, so there are far fewer problems with the “freeze” reaction. The patient consciously understands that everything is going as it should, he just feels uncomfortable. In this case, it is especially helpful to give the patient back control over what is happening through a very detailed explanation of what is happening and the ability to generally control the intervention. I'll tell you more about this below.

And there is also dental phobia - an even more interesting type of reaction, when fear is caused not by the intervention itself here and now, but by the thought that one will have to undergo it. As a result, the patient systematically avoids dental appointments because he is afraid of treatment. Over time, the need for this treatment begins to grow, but the patient understands that its volume will also increase - and is proportionally more afraid. As a result, this leads to the situation described above, when a masculine man endures to incredible limits, sometimes surprising even experienced surgeons. And in dentistry, you know, it’s quite difficult to bring your condition to a dangerous level. To do this, you need to make real efforts and endure pain for quite a long time, which will bring even the strongest among us to their knees. But the men cope, and then I have to assemble a new jaw for them - or call a surgeon to pump out pus from the cellular spaces of the skull.

How does a dentist help fight dental phobia?

For a dentist, dental phobia is a problem no less serious than for a patient: it interferes with effective treatment and prevents proper dental care. A good doctor will assess the severity of the phobia in advance and will make every effort to help the person cope with the fear. Dentistry itself is now developing along this path: patients are offered comfortable treatment methods that reduce not only pain, but also the level of stress. For this use:

• relaxing soundtrack. This could be soft, calm music or sounds of nature;
• distraction: the ability to watch TV, films during the reception;
• methods of psychological work with the patient. Sometimes a smile, light conversation or reassurance is enough to immediately reduce the level of fear. In other cases, the patient may be reassured if the doctor tells him exactly what he is doing or how much time is left until the end of the procedure.

Treatment can be adjusted to simply remove the most frightening aspects. If a person is afraid of the sound of a drill, chemical or ultrasonic methods, or simply “quieter” equipment, can be used to prepare teeth. If the phobia is associated with the smell of drugs, they select drugs that lack it or prepare them at a distance from the patient so that he does not feel them. You can almost always find an acceptable treatment option. The main thing is to contact your doctor and try to stop being afraid of the dentist.

The Good News: Fear is Normal

Being afraid of something is a normal physiological state.
It is not considered a psychiatric diagnosis as long as you can overcome your fear. If you can’t, then questions already arise (but this is not a diagnosis yet). It is believed this way: if you received treatment, although you were terribly afraid of it, everything is in order, you deserve to be called Sapiens. If not, then you need to do something about it next. For example, pathological fear of the dentist is not a fictitious dental phobia, but a so-called congenital one, which cannot be controlled at all, or, for example, acquired in early childhood, can be corrected by prescribing daytime tranquilizers (benzodiazepine series). They won’t completely remove the fear, but they will at least allow you to get to the clinic and get treatment. True dental phobia is a pathological story and requires treatment. A person cannot cope with it without outside medication or preventive behavioral therapy.

Often patients are afraid of pain, not the doctor. In this case, there is no need to try to overcome fear. This is even more normal, rarely does anyone like pain, although this does happen. The fact is that we can offer different means - from the Viking combat cocktail (nitrogen) and local anesthesia to medicated sleep and anesthesia.

What causes fear of the dentist?

The first step to how to stop being afraid of the dentist is to understand the reasons that cause fear. Each patient has their own, but in general, common negative factors can be identified:

• experience of painful treatment. The patient could have suffered from “Soviet” dentistry as a child - the emotions experienced at an early age are remembered for a long time. Minimal anesthesia, noisy drill, painful manipulations - it is important to know that all this is a thing of the past. Dental treatment is now painless, under complete anesthesia, in comfortable chairs;
• unknown. During an appointment with a dentist, the patient does not see or feel what kind of manipulations the doctor is performing. He is not in control of the situation, and this can be very scary. If this is the cause of fear, a preliminary conversation with the dentist will help. During it, he will describe the treatment plan in detail;
• poor dental condition. If a person does not visit the dentist, he does not treat his teeth, and their condition quickly worsens. The longer the patient delays the visit, the worse the condition of his teeth becomes, and going to the doctor is even more difficult. In such a situation, the large volume of treatment, the attitude and reaction of the doctor can be frightening. In the first case, you can solve the problem step by step. In the second, communicate with the dentist in advance, warning him about the problem;
• fear of looking ridiculous. It usually occurs in girls and women; they think that they will look funny or ugly with their mouth wide open. There is no need to be afraid of this: the doctor is not interested in the patient’s appearance, but in the health of his teeth;
• physiological or mental problems. A low pain threshold, a gag reflex that occurs if a foreign object gets into the mouth, increased sensitivity to odors during pregnancy - all this can become a serious obstacle to a visit to the dentist. Another group of problems is caused by a mental state: the patient may not tolerate the touch of other people, be unable to spend a long time in one position, or experience fears associated not so much with dental treatment, but with the moments accompanying it - for example, with the need to contact other people. Each of these problems can be solved if the patient is willing to cooperate with the dentist.

The Bad News: Fear Is Mostly Irrational

This means that it can only be “overpowered” or bypassed, but not removed by any rational reasoning or action.
More precisely, there are several components of fear, for example, fear of the unknown, misunderstanding of the duration of the intervention, constant anticipation of pain, and so on - they can be reduced. And there are irrational factors with which nothing can be done. And fear of the dentist is usually a complex of these things. The most common irrational fears arise:

• Due to childhood psychological trauma, for example, successful treatment (suspension) of caries using a Soviet drill of the “bzzzzhrrrrr” model with the smell of burnt tissue (overheated dentin).
• The guilt is that you will be reproached for being in such a state. That is, the patient first brings himself to a serious state by being afraid of the doctor, and then begins to fear that the doctor will scold him for bringing himself to this point. Great combination.
• Constraints. For example, that previously there was no money for a dentist, and this will have to be explained somehow (in reality, of course, not).
• And just some kind of life attitudes, superimposed on the whole complex of the fact that you will have to get to the doctor, tell him something, open your mouth in front of a stranger and allow foreign objects into it, feel pain (if you are unlucky) and feel psychologically and physically helpless throughout the entire procedure.

Oddly enough, dental phobia can be congenital, that is, genetically determined. It's not very clear how this works, but here's a quote from a 2021 study:

It is clear that, in addition to environmental factors, genetic influences are important in the etiology of dental fear and anxiety, and should be considered in future studies of fear and anxiety associated with dental treatment and, potentially, interventions aimed at reducing distress that is a barrier to dental treatment utilization. Toward a Genetic Understanding of Dental Fear: Evidence of Heritability (doi: 10.1111/cdoe.12261)

How to get rid of fear during dental treatment

• Treatment under sedation (“in your sleep”). Sedation plunges a person into a state of complete emotional and physical relaxation, and after treatment he easily returns to the waking phase, feels great, and does not experience negative manifestations. But treatment under anesthesia, as a counteract to panic fear, is not recommended; the problem of dental phobia may even worsen.
• Relaxing music and an interesting program are also an excellent calming and distracting tool.
• Trusting relationship with a doctor - going to a dentist with whom a strong contact has been established is psychologically more comfortable than turning to a new specialist every time.
• Choose a clinic where it is most comfortable and calm, with a cozy atmosphere, without a pronounced medicinal smell, or queues outside the offices.

What can you do to relieve fear?

In my experience, it is often easier for adults to overcome fear by increasing awareness.
A person is afraid not of the intervention itself, but of the unknown. The patient somehow scares himself, describes what is happening in his imagination, and relies on unreal things. True, there is also a point here: it may turn out that the real intervention is in fact more terrible than what the patient imagines. Therefore, in preventive conversations I do not show huge needles during a tour of the office, and in general, before such conversations, it is better to understand what exactly the patient is afraid of, so as not to frighten him even more with a demonstration of the arsenal of the Inquisition. From experience, no one is afraid of a spatula; I show it first.

In general, the psyche works like this: if some terrible thing happened to you and you are afraid, then the doctor can say:

- Well, patient, my tongue has turned green. Happens.

And then the doctor names some Latin word.

Hop - and you calm down, because in this short phrase there is information that you have something known, understandable, it has a term, and this happens not only to you, but to many in general. And if there is a term, it means that the phenomenon becomes not an unknown dangerous thing, but an understandable dangerous thing. It’s the same with fear: this is a unique event for the patient, but for the doctor he has hundreds of episodes a month. People are afraid that they are not like everyone else, and knowing that a doctor sees fear every day is also reassuring.

There is a lot of fear of losing control. The doctor gains power over you - and this is terrible. Therefore, you need to agree on the process and give the opportunity to manage it.

- When you say “ahh” or “stop” or blink twice, I will stop.

When I was a student, while studying pediatric dentistry at the department, children with moderate fear (without panic) were given a toy remote control on a wire before an intervention, and the wire stretched somewhere beyond their field of vision. The doctor turned on the drill and asked to press the red button on the remote control. The child pressed, the doctor saw that he was pressing and released the pedal. At this point, anxiety was greatly reduced. Then the duration of iterations was longer: drilled, washed, drilled again - these are far from modern devices. The main thing is to really stop when the patient asks, and not “now, just a second.”

Patients are also often afraid of the whistling sound of the turbine tip - this is the same dangerous bzzzz, turning into an inhuman whistle, which you may have heard in childhood. In our country, nozzles with such a rotation speed are rarely used; in the expensive segment, it is possible to afford other materials that allow us not to choose a turbine design. As a result, probably once every hundred patients I take out turbine tips (they are now used to saw massive structures).

Some are afraid of a rubber dam (cofferdam) - a latex scarf for isolating the oral cavity, which is generally needed for any more or less invasive interventions, including working with caries. If the patient is prone to claustrophobia, then he will be afraid of isolation - because the main fear there is the fear of suffocation, and the curtain of the oral cavity causes the same fear. You can make a hole in an unimportant place in the rubber dam - it will be easier for the patient.

Patients also like it when they are told in advance how long they need to endure. They are often afraid or embarrassed to ask questions. You tell a person that the worst thing lasts 15 seconds on this tooth and 25 seconds here, he understands the time distribution and does not panic ahead of time.

A very important point in fear is that a person has to face the inevitability of losing the illusion of immortality. We don't see atherosclerotic plaques, we don't see ulcers, we don't see how joints age and wear out. And here you cannot miss the evidence of mortality in dentistry, it is obvious and is in an area that is emotionally charged. And this is one of the hardest experiences in life. This fear is on a level with loss of reason and existential fear of loneliness and is one of the honorable three most terrible things for a person. But usually it is tested before going to the doctor. Often - instead of going to the doctor, alas.

Treatment methods

Dentophobia can be dealt with using the following methods:

• Psychotherapeutic method.
• Medication method.

Medication method

Drug treatment consists of using special antidepressant drugs. An interesting study was conducted at psychiatric institutes in Russia, the result of which showed that dental phobia is well treated with the help of serotonin-selective antidepressants. Such drugs, for example, include cipramil. The drug allows you to completely eliminate anxiety, due to the fact that the production and metabolism of serotonin in the head is normalized.

Long-term treatment with antidepressants is not addictive and is quite well tolerated by patients. A person begins to feel a weakening of fear after just three weeks of taking medication. For a sustainable effect, treatment will be required for at least three months.

Antidepressants are prescribed for severe phobias. In case of a mild form of the disease, it is enough to talk with the patient, give pain relief before the injection and administer modern painkillers.

For more persistent dental phobia, premedication is recommended. Its essence is to take sedatives in advance of the procedure. Such medications can be taken in various forms: tablets, injections or syrups. Premedication is permitted both several hours and several days before the intended treatment.

Psychotherapeutic method

The psychotherapeutic method helps to find out and eliminate the very causes of the disease. The main goal of treatment with a psychotherapist is to convey to the patient the information that his fear can be easily controlled, and ignoring dental treatment will certainly lead to more serious consequences.

Depending on the severity of dental phobia, treatment takes different times. The efficiency of the process is affected by the forces applied on both sides.

Psychologist's Arguments

1. Every person in the world is obliged and must visit the dentist. How many people in the world have already done this and nothing terrible, much less fatal, has happened to them. No one has ever died from dental treatment.
2. The psychologist advises using a special method called “anchoring.” A person must remember moments in life when he experienced a tremendous sense of courage, complete fearlessness, strong endurance and absolute calm. The dentophobe must anchor these feelings in his memory. While in the dental office, the patient should try to reproduce this anchored image in reality.
3. Psychologists advise treatment under sedation. This is a special method that allows the patient to completely calm down and fall into a shallow sleep. Upon completion of treatment, the person does not remember any unpleasant sensations. He clearly understands that there is nothing wrong with dental treatment. Next time, the dentist will completely trust the doctors, knowing that the treatment process is painless.
4. Dental treatment is improving every year. Science is moving in this direction by leaps and bounds. Recently, manufacturers have released modern equipment that allows for more productive and painless treatment. In addition, modern anesthetics make the process of being in the dentist’s chair completely painless.
5. There is one more point that lies in the peculiarities of the human psyche. It has been proven that even the most intense pain is erased from memory after 3 hours. If you try to recall a serious painful sensation experienced in your memory, you will not be able to do this.
6. A psychologist may recommend taking a loved one with you to the dentist. The presence of a soul mate nearby will facilitate the treatment process, having a calming effect on the person.
7. If a patient is afraid of contracting AIDS, HIV or hepatitis, then he can be recommended to undergo a special program called “Anti-AIDS”. The patient must understand that medical institutions have strict requirements for sterility. In dentistry, they use only disposable instruments, which also includes drills.

Fear and cowardice

Fear has nothing to do with cowardice.
Fear is the body's response to circumstances. Cowardice is the result of decision making. A fearless person is not one who is not afraid, but one who knows how to work with his fear. Every mentally healthy person is afraid in principle. Physiologically, fear is the mobilization of the body for an optimal reaction.

The good news is that the ability to work with your fears can be trained.

For example, in the case of dental phobia, you can start with small amounts of treatment, and then gradually get used to it. If you have diagnoses typical for 40-45 years old that require treatment, but do not require it right here and now, then you can start by stopping caries, hygiene, then do something else, and then move on to serious interventions - if the indications allow . This plan usually suits male patients. For our part, we do everything so that you spend as little time as possible in the clinic and get the finished result in a minimum of visits. Dentistry has become much more humane over the past ten years.

Nitrogen

The simplest thing we can suggest to you is to breathe nitrogen. The same thing that makes a person fearless and joyfully laughing at pulled out teeth. It doesn’t remove pain in any way, but it perfectly turns off its emotional coloring, and this is a large part of the perception of pain. Children often play “fighter pilots” with these nitrogen masks and think that going to the doctor is fun and cool (if the nurse works properly, of course, she should know child psychology). Nitrogen is worth trying at least once as part of general development if you have any doubts: it is quite safe and can make your life very much easier during complex interventions.

Tranquilizers

Next, you can use tranquilizers, but they should not be prescribed by a dentist, unless we are talking about a serious surgical intervention.
If you take your pills “to go to the tax office,” then keep in mind that they are needed only to get to the clinic (and not inside during the intervention) - and you definitely need to tell the doctor about them, otherwise a lot of interesting things await you at diagnostics and cross-reactions with other drugs. Our patients come on benzodiazepine medications - they help overcome dental phobia and generally get to the doctor. It is better not to drink before visiting the dentist. Alcohol will greatly interfere with the doctor’s proper work. And it also enhances the effect of some drugs, changes some, and reduces others. On top of everything else, you probably don't want the local anesthesia to turn off at a random moment, just when you have a foreign object in the doctor's hands in sensitive tissue.

Of course, there are situations when we work with “date” patients. There are a number of diseases in which the pain becomes more active in the evening, and the patient is already in a state close to calling his ex. If emergency intervention is required, it will be provided. But if the situation is planned, for example, the patient comes in an altered state of consciousness for hygiene, we will most likely refuse him.

Situations often arise when a patient drinks a mild painkiller available at home, it is not enough, and he washes it down with alcohol just to have enough strength to get to the clinic. When the patient accurately reports the dosage of alcohol and lists the medications taken without unnecessary questions, in general we are ready to understand him and meet him halfway. But just remember that this may prolong the diagnosis by half an hour and greatly worsen the sensations during treatment.

But after dental intervention, you can already wave a stack, if the doctor allows it.

Why is it dangerous to be afraid to treat and remove teeth?

Some people, not knowing how to overcome their fear of the dentist, prefer to endure toothache until the last moment, and go to the doctor only if it becomes unbearable. However, there are situations when such behavior becomes truly dangerous, especially if the pain is caused by the onset of some kind of inflammatory process.

So, with acute pulpitis or periodontitis, an infectious disease such as phlegmon can develop. This pathology poses a danger not only to human health, but also to his life.

Various infectious processes in the oral cavity can lead to inflammation of the lymph nodes - lymphadenitis, which, if left untreated, often leads to serious complications.

The presence of advanced caries, infection, periodontal disease and dental trauma often leads to abscesses, the main treatment for which is surgery. Without medical intervention, the disease is fatal.

In addition, caries slowly but surely destroys dental tissue, and if it is not treated, over time there will be no chance to save the tooth.

Therefore, for people who have no idea how to overcome their fear of the dentist, despite severe pain, it will be enough to simply assess the consequences of postponing a trip to the dentist.

Local anesthesia

We choose the articaine series as the safest in terms of duration/quality of action, possible side effects, and potential allergic reactions.
If you are afraid of injections, don't be afraid. They are not felt. Some doctors first use gel anesthesia, and then insert a syringe needle with an anesthetic into this place. In our clinic we have needles of 27-30 gauge (this is the outer diameter from 0.5 millimeters to 0.3 millimeters), this is another advantage of expensive paid medicine. By the way, the insulin needle starts with 26 G, that is, with 0.46 millimeters of outer diameter with a lumen of 0.26 mm. Injections with such needles can be done without application of anesthesia; you still won’t feel anything. Well, we also have a device that greatly speeds up and simplifies this process. If you don't tell what's going on, patients don't notice. This is where we really

to be afraid of practicing dentists: they are able to give an injection to any person without him even feeling or recognizing it.

Local anesthesia perfectly cuts down the necessary bundles of nerves nearby. If the intervention is serious, you will have a lisp until the next morning. If not, you simply won’t feel a couple of teeth and part of the gums for a while. Nerve problems are extremely rare as side effects. Extremely rare - if a doctor comes across something like this in 20 years of practice, then he won the lottery. More precisely, he lost. There are also cases of “Doctor, you gave me anesthesia a week ago, today my legs are paralyzed” - this is not for us, but the dentist can seriously write out a referral to a psychiatrist in such a situation.

Needles thinner than 30 gauge are used extremely rarely, as they lose mechanical strength. For some types of deep local anesthesia, a thicker needle is needed to push the tissue apart: it requires elasticity, that is, a larger diameter. In this case, the gel will still be used.

We have a rule: we spend as much time as possible on pain relief. You may not know, but therapists really don’t like symptoms with pain with limited appointment time. In our country, it’s hard to find the source of pain: in some cases it takes up to an hour just to find the cause and relieve the pain. Therefore, when we have a patient with a telephone history of acute pain, we do not limit the time for the appointment. If this is a regular client of the clinic, then it is normal for the doctor to go out just for him. If this is an emergency primary patient, then we leave a long pause between appointments. If this is one of the last appointments (and our doctors work for half a day), then we transfer the patients further to another doctor, and this one deals only with the patient with pain - as long as necessary to solve the problem. It is important to note here that a clinic patient with acute pain is actually a signal that treatment or preventive observation is not going well, because this is not the case in the plan. On the other hand, primary patients with acute pain have the unpleasant property of disappearing after we remove the primary symptom and still offer treatment. The worst thing is if the primary patient with acute pain made an appointment, but did not show up and did not tell anyone. If he warns you and doesn’t come, that’s normal. But if we prepared resources, cleared the doctor’s schedule, but he didn’t arrive, that’s bad.

Why does dental treatment not hurt now?

Thanks to regular developments by pharmaceutical companies, today it is possible to treat teeth and carry out any other dental procedures absolutely painlessly. New generation painkillers help get rid of fear of the dentist. They are of such high quality and fast-acting that even surgical interventions, such as implantation, are completed for the patient without pain or discomfort. They have no side effects and can be used during pregnancy and childhood.

The doctor selects the method of pain relief, the drug and its dosage individually, according to the clinical picture. All that is required from the patient is to inform about chronic diseases and allergies to medications in order to eliminate the risk of a negative reaction of the body.

Sedation and drug-induced sleep

This is propofol, a hypnotic that causes a feeling of deep moral satisfaction and helps you sleep.
True, it is better not to use it without the supervision of an anesthesiologist; it can end sadly, as the experience of some musicians proves. You may have experience receiving supervised propofol if you have had an EGD (“bowel swallow”) or colonoscopy under sedation. Propofol does not anesthetize you in any way, it simply erases your memory. That is, it will still hurt, but you won’t remember it. Propofol in small doses is conveniently combined with local anesthesia: the patient can fall into a shallow sleep, enough to lose the will and follow simple commands like “open your mouth.” At this point, you should seriously think about the use of propofol by various intelligence agencies and begin to really be afraid of dentists for the second time. Alas, it cannot be used as a “truth serum” - the patient is not able to think enough in his sleep to answer coherently. As a plus, you will get an incredibly good mood that will last a long time after the intervention. In small doses, propofol works as a sedative (you won’t care about anything), in medium doses it puts you into a shallow sleep, then the sleep becomes deeper, but does not turn off the nervous system. Anesthesia shuts down the nervous system. This is the best way to do something serious surgically, because the patient will be unconscious and will not twitch in response to even thoughtful sawing off of the arm. You can turn off either the lower part of the body or the entire body at once, because, alas, there is a large nerve node on top. Anesthesia very much depends on the active substance. We use sevoran, here is more about it - as well as about other ways to turn off consciousness in dentistry. Briefly: safe, children allowed, no “helicopters”. We use sevoran with children using natural breathing through a mask (shallow anesthesia); for adults, the optimal choice is propofol and local anesthesia.

Just know that we have it all. It is because of those who fear the “drill” more than anesthesia that operating rooms with oxygen are built in expensive clinics.

Or we can give you a referral to a psychotherapist (don't be alarmed) so that he can give you antidepressants for dental treatment. This also happens, but usually rarely, because a Russian person is not only afraid of a psychotherapist (psychiatrist), but consciously avoids them. By the way, you really should be wary of psychotherapists at the end of March, June, September and December, whose quarterly plan for hospitalizations is on fire. Kidding.

Both in the case of anesthesia and in the case of sleeping under propofol, there is a slight chance that the drug will not act as it should. When the body is immobilized, and you feel everything - the cases are described. There was a case when one foreign patient showed an atypical reaction to propofol - it did not cause the characteristic retrograde amnesia. Her son arrived with a machine gun and said that he would now take the surgeon to teach him manners. The conversation was very unpleasant, we managed to defend the doctor. The anesthesiologist's surgeon also failed.

How does dental phobia arise and develop?

If there is strong fear that interferes with normal dental treatment, it is necessary to determine its root cause. Any previous pain can develop into a strong phobia that is difficult to eradicate. The task of doctors is to help a person get rid of anxious thoughts and convince him that modern dental treatment is a safe and painless procedure. Today, dentists have at their disposal modern equipment and anesthetic agents that allow them to carry out any dental operations almost painlessly. If previously local anesthesia was used only for complex operations in the oral cavity, today even the treatment of minor caries is carried out with anesthesia. And more complex dental treatment is increasingly performed under general anesthesia. Most patients are unaware of this and are afraid of experiencing severe and prolonged pain again. It is this ignorance that fuels their phobia. To understand how to get rid of the fear of dentists, it is necessary to identify the causes of its occurrence. Most often, phobias have the following causes:

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• Acquired dental phobia usually develops as a result of negative experiences with dental treatment. In addition, the cause may be hypochondria or other mental disorders.

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• The congenital form of phobia often occurs as a result of genetic pathologies or intrauterine processes that affect the development of the fetus and the metabolism of serotonin and norepinephrine in adulthood. These hormones have a strong influence on sensitivity and pain threshold, as well as on the tendency to anxiety and groundless worries. Most often, the innate fear of the dentist is explained precisely by disturbances in the metabolism of serotonin and norepinephrine.

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• Imaginary dental phobia develops after reading frightening stories in the media or after stories from friends who colorfully described and embellished their negative experience of visiting a dental office. A person’s general distrust of doctors can greatly influence the development of imaginary dental phobia. Sometimes such fear can develop even in childhood, when the child is constantly frightened by the doctor, generously telling him what horrors await him if he does not brush his teeth.

Regardless of the primary cause of dental phobia, a visit to the doctor cannot be delayed, since the fear will only intensify and the situation will worsen. Ideally, you should go to the dental clinic at the first sign of tooth decay. In this case, the treatment will be as effective, fast and comfortable as possible.

Let's do it again

• It’s normal to ask for anesthesia for any fear.
• It is normal to request anesthesia for discomfort that interferes with treatment (for example, an instrument rubbing against your teeth or tickling during hygiene).
• It’s normal to ask to see how instruments are sterilized.
• Asking for an explanation of how each device works in a doctor’s office is normal (just don’t abuse this opportunity or warn in advance that you need a tour, there are patients further away).
• It’s okay to cry in the office if you feel like it. This is part of the compensation for fear, our body does this. Nothing unusual.
• It’s normal to reschedule your appointment to gather your strength. Sometimes this is necessary due to bowel behavior.
• It’s normal to know the meaning of every doctor’s manipulation.
• Bringing someone with you to hold hands is at the doctor's discretion.

Willpower is trained.
If you can conquer fear in small things, then it will be easier to defeat fear in large things. A patient who was previously embarrassed to go to a urologist or proctologist, and then stopped, will most likely accept the dentist calmly. Fear is normal. Doctors see fearful patients every day. We don’t laugh at this, this is the patient’s usual state. The fact that you came is very good, and it is a sign of respect for us, because you were not afraid to come to us. This is not a legend for patients; doctors really have respect for those who simply sincerely explain what is wrong with them. Without playing detective, as often happens.

Fear is easier to bear in a good physiological state. It’s better to get enough sleep, come in the morning (before you’re tired), and not be very hungry (unless your stomach is “twirling”). If you have something important to do after the doctor, it’s better to reschedule either the appointment or the case.

If you are afraid to tell your doctor something or don’t want to share your fears with him, this is a sign of not the most professional doctor. The doctor must recognize the patient's condition and ask him to tell him what is bothering him. The dentist does not start treatment right away, but tells what will be done and how (if this is appropriate, that is, if it is not dental phobia in certain forms), talks about the equipment, shows sterilization and talks about other safety aspects. In our application, when making an appointment, the protocols of each future intervention are automatically uploaded: you can read in advance what exactly the doctor will do and in what order, so that you can ask questions on the spot.

Really dangerous situations

In fact, the most dangerous thing you can do in a doctor's office is touch an instrument or the hand that holds the instrument, or try to throw the doctor off balance by grabbing his leg.
If at this moment you have a diamond disk in your mouth (like an angle grinder, only small), you can get hurt. We won’t cut through to the brain, of course, but it won’t be much fun, because bleeding in the sublingual space is difficult to stop. Fortunately, in 2021 these discs are probably used only in regional compulsory medical insurance clinics. But if you do this with a drill, you will very quickly end up with a new unplanned hole in your gum or cheek. We really don't like it. In my youth, I had a situation where I damaged a patient’s lip with an old polishing instrument, but visually it seemed that she was walking around with herpes while it was healing. It was extremely embarrassing, and this was my first negative review - it is still hanging out on the Internet. Therefore, believe me, I would not want my doctors to do the same, even by accident. I have the opportunity to purchase a tool for clinics that has protection against going beyond the designed axis: you can configure the drill to automatically turn off when the doctor’s grip changes (for example, if someone is afraid that the doctor will simply drop the drill in his mouth) and if resistance arises along the axis of rotation (this is when soft tissue or hair gets wrapped up and slows down the tool, usually the first millimeters of error). That is, in our case, the gum can only be drilled purposefully at a calculated angle; if the patient gets hurt or the doctor has a heart attack during the drilling iteration, the device will turn off. But not everyone is like that.