A middle-aged patient timidly shows her bulging and bleeding gums to a dentist, gripping the reclined chair and shutting her eyes, trying to distract herself from the reality of being at the dentist.
Such patients have not visited dentists for many years due to their extreme dental phobia.
They fabricate excuses such as lack of money and time, said Nilou Nouri, a fourth-year student at the UCLA School of Dentistry.
Dental phobia can range in severity from person to person, said Raphael Rose, an assistant clinical professor in the UCLA Department of Psychology.
Dental phobia can become an acute psychological condition to the extent that it is impossible for a patient to receive proper dental care without psychological therapy, said Craig Woods, an adjunct professor of the UCLA School of Dentistry.
Positive relationships between the dentist and the patient are important in the treatment of dental phobia. Also, the very first appointment is an essential time for the patient to establish trust in the dentist.
Patient-dentist relationships are very fragile as one small mistake can ruin the relationship, said Dr. Ronald Mito, professor of clinical dentistry and associate dean of clinical dental sciences at the UCLA School of Dentistry.
“You not only have to establish it (the relationship). You have to monitor and maintain it,” he said.
Woods said there is no need for him to try to lessen anxiety to the patients he has had for 20 years as they do not have any. They undergo dental procedures without hesitation, he said.
“Once they trust you, they are okay,” he said.
In addition to strong relationships, UCLA psychologists and dentists say patients can overcome cases of dental phobia with treatment and coping skills.
Mito established The UCLA Dental Fear and Anxiety Center to help dental phobic patients. The program existed in the mid-1980s, but had to be cut because of Mito’s increasing administrative responsibilities.
Mito said he would have patients rank certain actions associated with dental appointments, creating a dental fear hierarchy, to assess the specific fears of the patient. He would then expose the patient to the certain fear in gradual amounts, he said.
In psychiatric appointments, exposure therapy can be practiced by having the phobic patient see and handle a big needle, for example, if the patient is afraid of injection, Rose said.
Experts also say specific physical techniques during the appointment may help ease anxiety.
In addition to positive inner dialogue, slow breathing could calm the nervous system, said Kenneth Mazey, a professor of clinical psychology at UCLA and a private clinical practitioner. Mazey worked in the UCLA Dental Fear and Anxiety Center during its existence.
He currently helps dental phobic patients in his private practice.
The UCLA School of Dentistry teaches students how to calm the anxiety of dental phobic patients, and this instruction is important in order to succeed as a dentist, Mito said.
Dentists use a variety of strategies to help ease patients depending on the circumstances.
Adults may use mental and physical coping strategies while children might be easily distracted from story telling or watching movies during dental procedures, Nouri said
Examples of real-life applications are a great way to sidetrack some child patients from their fears. For example, Nouri said she tells child patients that fairies are going down their teeth and to be quiet so their teeth could fall asleep, Nouri said.
But UCLA dentists say that no one, including children, are primary victims of dental phobia.
“I never noticed any age group more or less anxious,” he said, adding that he has not seen any trends in dental phobic patients since the beginning of his practice 26 years ago. “I really don’t think children are more anxious than adults,” he added.
To help better psychological needs of patients, Woods said he teaches his dental students how to psychologically calm the patient in a dentist-patient relationship course.
Telling the patients what is going to happen and the procedures of the dental care is important, Woods said.
Nouri, one of Woods’s students, said she agrees that it is essential to tell what is going to happen to the patient to the patients themselves.
“Patients do not like surprises,” she said.