Hypnosis and Fear of Dentists


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Unsurprisingly for many of you, a fear of dentists and dental treatment is a very common phobia in the UK and elsewhere around the world.

  • Almost half of UK adults have a fear of the dentist.
  • 12% of these suffers from an extreme dental anxiety.
  • Women are more likely to suffer from extreme dental anxiety than men.
  • Visiting the Dentist is ranked number one (22%) for making people nervous, even more popular than heights (19%).

Direct experience is the most common way people develop dental fears. Most people report that their dental fear began after a traumatic, difficult, and/or painful dental experience. However, painful or traumatic, dental experiences alone do not explain why people develop dental phobia. The perceived manner of the dentist is an important variable. Dentists who were considered “impersonal”, “uncaring”, “uninterested” or “cold” may develop high dental fear in patients, even in the absence of painful experiences, whereas some patients who had had painful experiences failed to develop dental fear if they perceived their dentist as caring and warm.

Indirect experiences

  • Vicarious learning
  • Dental fear may develop as people hear about others’ traumatic experiences or negative views of dentistry (vicarious learning).
  • Mass media

The negative portrayal of dentistry in mass media and cartoons may also contribute to the development of dental fear. This negative portrayal may come from such films as the 1932 comedy film The Dentist, the unrelated horror film The Dentist, its sequel, the 1933 cartoon The Merry Old Soul, and Marathon Man (the antagonist, Dr. Christian Szell, is a Nazi war criminal who tortures with dental equipment).

Stimulus Generalisation

Dental fear may develop as a result of a previous traumatic experience in a non-dental context. For example, bad experiences with doctors or hospital environments may lead people to fear white coats and antiseptic smells, which is one reason why dentists nowadays often choose to wear less “threatening” apparel. People who have been sexually, physically or emotionally abused may also find the dental situation threatening.

Helplessness and Perceived Lack of Control

If a person believes that they have no means of influencing a negative event, they will experience the feeling of helplessness. Research has shown that a perception of lack of control leads to fear. The opposite belief, that one does have control, can lead to lessened fear. For example, the belief that the dentist will stop when the patient gives a stop signal lessens fear. Helplessness and lack of control may also result from direct experiences, for example an incident where a dentist wouldn’t stop even when the person was in obvious pain.

Diagnosis of Phobia
Phobia of dental care is sometimes diagnosed using a fear measurement instrument like Corah’s Dental Anxiety Scale or the Modified Dental Anxiety Scale

It would be very interesting to read your experiences of dentists and how you feel about your 6 monthly appointment. In the meantime here are some case studies and also additional references at the end.

 

Study 1: Hypnosis in Pediatric Dental Treatment Using elements of hypnosis prior to or during pediatric dental treatment.

http://www.ncbi.nlm.nih.gov/pubmed/23635894

Results: A review of the relevant research and literature shows that the advantages of using hypnotic elements and hypnosis in pediatric dentistry are evident.

Notes: Most dental practitioners are familiar with pediatric patients expressing dental fear or anxiety. Occasionally, the dentist may encounter a situation where all behavioral techniques fail, while, for some reason, premedication or general anesthesia are contraindicated or rejected by the patient or his/her parents and a different approach is required. Hypnosis may solve the problem in some cases. The purpose of this study was to review the literature about techniques that use elements of hypnosis and hypnotic techniques prior to or during pediatric dental treatment. There is a limited amount of literature regarding the use of hypnosis and hypnotic elements in pediatric dentistry. Induction techniques, reframing, distraction, imagery suggestions, and hypnosis are identified, although mostly anecdotally.

Pediatr Dent. 2013 Jan-Feb;35(1):33-6
By: B. Peretz, R. Bercovich, S. Blumer, Department of Pediatric Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel

Study 2: Hypnosis for Dental Procedure Pain
Effects of Hypnosis as an Adjunct to Intravenous Sedation for Third Molar Extraction: A Randomized, Blind, Controlled Study
http://www.tandfonline.com/doi/abs/10.1080/00207140903310782?journalCode=nhyp20#preview

Results: Intraoperative Propofol administration, patient postoperative pain ratings, and postoperative prescription pain reliever consumption were all significantly reduced in the hypnosis treatment group compared to the control group.

Notes: This study aimed to evaluate the use of hypnosis/therapeutic suggestion as an adjunct to intravenous (IV) sedation in patients having 3rd molar removal in an outpatient setting. The patients were randomly assigned to a treatment (n = 46) or control (n = 54) group. The treatment group listened to a rapid conversational induction and therapeutic suggestions via headphones throughout the entire surgical procedure along with a standard sedation dose of intravenous anesthetic. The control group listened to only music without any hypnotic intervention. Intraoperative Propofol administration, patient postoperative pain ratings, and postoperative prescription pain reliever consumption were all significantly reduced in the treatment compared to the control group. Implications of these results are discussed.

International Journal of Clinical and Experimental Hypnosis, Volume 58, Issue 1, 2009
By: Edward F. Mackey, West Chester University of Pennsylvania, West Chester, Pennsylvania, USA

Study 3: Use of Imagery to Make Easier Injection of Anesthesia for Dental Work
The use of imagery suggestions during administration of local anesthetic in pediatric dental patients.
http://www.ncbi.nlm.nih.gov/pubmed/10997242

Results: The authors of this study conclude that imaging/imagery techniques may be successfully utilized in the administration of local anesthesia to young children (from three years of age) in an effort to mitigate untoward, pain-related stress.

Notes: The aim of this study was to evaluate the effects of suggestion before and during the administration of local anesthesia to children. Eighty children between the ages of three and sixteen years and who required at least one injection of local anesthesia were monitored. Retrospective examinations of their dental records provided the information regarding the behavior and dental treatment histories of the patients. All other data were provided through observation during the dental treatment phase. During the first treatment session, before the injection, each child was asked to select a favorite, pleasant memory or image. Where children had difficulty in identifying an image, one was proposed by the dentist. After an image had been chosen, the patients were asked to concentrate on the image and to visualize it during the procedure. The majority of children had chosen their own images, and significantly visualized the same images throughout the injection procedures. Image selection and visualization had no association with gender, age, the parent’s assessment of the child’s behavior, previous dental experience, behavior (both past and present) or, management techniques (both past and present).

ASDC J Dent Child. 2000 Jul-Aug;67(4):263-7, 231
By: B. Peretz, E. Bimstein, Department of Pediatric Dentistry, Hebrew University, Hadassah School of Dental Medicine, Jerusalem, Israel

References

  1. Bracha HS, Vega EM, Vega CB (2006). “Posttraumatic dental-care anxiety (PTDA): Is “dental phobia” a misnomer?” (PDF). Hawaii Dent J. 37 (5): 17–9. PMID 17152624.
  2. Milgrom P, Weinstein P, Getz T (1995). Treating Fearful Dental Patients: A Patient Management Handbook (2nd ed.). Seattle, Wash.: University of Washington, Continuing Dental Education. doi:10.1111/j.1600-0528.1996.tb00893.x. ISBN 1-880291-01-0.
  3. Erten H, Akarslan ZZ, Bodrumlu E (April 2006). “Dental fear and anxiety levels of patients attending a dental clinic”. Quintessence Int. 37 (4): 304–10. PMID 16594362.
  4. Stabholz A, Peretz B (April 1999). “Dental anxiety among patients prior to different dental treatments”. Int Dent J. 49 (2): 90–4. doi:10.1111/j.1875-595x.1999.tb00514.x. PMID 10858738
  5. Locker D, Shapiro D, Liddell A (June 1996). “Negative dental experiences and their relationship to dental anxiety”. Community Dent Health. 13 (2): 86–92. PMID 8763138
  6. Bernstein DA, Kleinknecht RA, Alexander LD (1979). “Antecedents of dental fear”. J Public Health Dent. 39 (2): 113–24. doi:10.1111/j.1752-7325.1979.tb02932.x. PMID 287803
  7. Hilton IV, Stephen S, Barker JC, Weintraub JA (December 2007). “Cultural factors and children’s oral health care: a qualitative study of carers of young children”. Community Dent Oral Epidemiol. 35 (6): 429–38. doi:10.1111/j.1600-0528.2006.00356.x. PMID 18039284
  8. http://www.dentalfearcentral.org/abuse_survivors.html
  9. Lundgren J, Carlsson SG, Berggren U (May 2006). “Relaxation versus cognitive therapies for dental fear—a psychophysiological approach”. Health Psychol. 25 (3): 267–73. doi:10.1037/0278-6133.25.3.267. PMID 16719597

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