I’ve asked around and I’m a bit shocked. There’s a really big question that many really good therapists don’t ask when somebody comes to them with a fear of going to the dentist. The question they don’t ask is: ‘Well, is your dentist any good?’ They completely ignore the fact that you really should be very scared of some dentists. There are some really bad ones out there and I think it would be negligent of me to send a client to one of these clinics with a smile on their face. All dentists are not the same. I’m all for getting rid of irrational fears but not the rational ones.
But this post is not about how to find the right dentist for you; this post is about phobias in general and dental phobias in particular. As a therapist, I understand the structure of phobias, how they start, how they develop and what needs to happen to make them go away. Phobias are great examples of ‘one trial learning’. Something bad happens, it’s highly emotional, threatening and painful; our unconscious mind takes a snap-shot of what’s going so we can avoid this situation in the future. It’s a useful mechanism, it helps to keep us alive, it keeps us away from edges and stops us playing with fire. This mechanism is really old as well, part of the limbic system which we’ve had since we were birds. Unfortunately there’s far more evolutionary pressure on things that don’t scare us enough as opposed to being scared more often than necessary. The result is that we’re stuck with this primitive, somewhat over-protective, yet extremely useful mechanism.
Because the limbic system is pre-conceptual and outside of our conscious awareness or control, we don’t get much say in how it operates. Phobias and the whole fight and flight mechanism actually kicks in before the information gets to higher level of consciousness where the danger can be assessed more objectively. In fact, when this extreme fear is triggered, one of the first things to happen is the inhibition of the frontal lobe, the modern part of our brain, that helps us to deliberate and make decisions. Evolution has decided that it’s unnecessary for us to deliberate over the best action when faced with a predator; in this instance our attention it riveted to these intense feelings of wanting to run away. Control is ceded to our bird-brain.
So we have this mechanism and once triggered it’s in total control. As to what events the mechanism responds to – these are learnt. We’re not born with a fear of dentists, lifts, planes, etc. So what typically happens is the young child, who will be more sensitive to discomfort than an adult, is taken out of his usual routine and dragged to the dentists. This is an unfamiliar and scary environment for most children. A good dentist takes time to ensure the child is calm and comfortable before beginning. The other dentist, with his eye on the clock, exudes frustration and irritation toward the child that won’t sit still and this sets-up a sensitivity to be scared and hurt. If the dentist is clumsy and doesn’t use modern pain control methods, the pain or discomfort triggers the child’s fight or flight mechanism. A mental snap-shot is taken and stored in the child’s memory. Typically, the child will store ‘this dentist is a danger to me’, ‘dentists are a danger to me’ or ‘whirring, grinding noises are a danger to me’. Any part of the memory can be a stimulus for the phobic response. The adult and rational response would be, ‘I’m never going back to this dentist again.’ But in the future, the primitive brain is in control any time the stimulus from this snap-shot is triggered; the fear response closes down any rational response until the person is away from the stimulus.
Cognitive Behavioural Therapy (CBT) has many ways of dealing with phobias, such as gradual desensitisation where the client is encouraged to face their fear a little bit more each session – sitting outside the dentist’s clinic one week, inside the clinic the next week, in the chair the next if they are able. They might learn breathing exercises to help control the fear as it starts to get out of control but that doesn’t sound like a lot of fun to me. This approach can easily take several months and often only leaves the person coping and (less) afraid.
Cognitive Hypnotherapy, on the other hand, takes a different approach to phobias. By understanding how these early, traumatic, memories are encoded, we can recode these early memories in a way that no longer trips the fight or flight mechanism in the brain. Many simple phobias (those having a single stimulus) can be treated with as little as a single session.
Some dentists and doctors are actually trained in hypnosis so as to ensure their clients remain stress-free through treatments. In fact, shortly before modern anaesthesia was developed it was quite common for both dentists and doctors to train in hypnosis for the purpose of pain control. The introduction of cheap, safe and effective anaesthetics effectively ended this development for decades. I’m delighted that trainee doctors in the UK now have an option to learn about hypnosis in their early training. Many dentists are also beginning to re-discover the benefits.
If you suffer from a dental phobia or know somebody that does, I highly recommend getting this treated. It’s not necessary to be scared of your dentist. The second step is to seek out a dentist that will offer an un-hurried service, one that understand your needs and that can incorporate relaxation techniques into any clinic visit. (Unfortunately, the NHS does not offer un-hurried treatments. You get what you pay for.) I would also recommend that you choose a dentist that uses modern pain control methods, such as topical numbing treatments prior to injections, or the use of modern equipment that can numb individual teeth. Treatments might still be uncomfortable but there’s no reason you should experience pain from a modern dental exam or procedure.
And if you’re London-based, I highly recommend my own dentist, Covent Garden Dental Practice (www.cgdp.com). I’ve been sending people to these wonderful dentists for well over a decade and you’ll be in very good hands.