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Michael C Goldman DDS
Anxiety about Dental Care...
Anxiety and discomfort and how I help ease it every day
Sometimes a patient will say to me, "I must be your most nervous patient ! I get so anxious..."
I usually respond something like..."Yes, I understand how you feel, but you really aren't so bad.... you know where the really anxious people are? They're still outside. They can't get through the front door!"
Then we share a smile and for a moment the tension eases a bit. It eases because what I said in a slightly joking way acknowledges the normalcy of the nervousness and at the same time reassures my patient that I understand this is not easy for him or her at this time. It also acknowledges that I am complimenting the patient's courage to overcome his/her fear just by coming in through the front door.
"When I first came to Dr. Goldman's office five years ago, I was terrified of the dentist, due mostly to some bad experiences I had had in the past in the dentist's chair. I must say that Dr. Goldman and his incredible staff helped me work through my fears in a safe and supportive way. Not only is Dr. Goldman a great dentist from a technical point of view, he is kind, compassionate, encouraging and always very gentle." .......... Geraldine Amaral
Geraldine is a satisfied patient who offered the above unsolicited testimonial. She's a real person. You can virtually visit her at her website. She's a Tarot expert and has a beautiful website www.Tarotcelebrations.com
It's very natural to be anxious about dental care for many of us. It's a conditioned reflex to past traumatic real or vicarious experiences. Perhaps it's a reaction to something someone said to us, or even a movie we once saw...
What is really important for you to know is that dentists differ in their approach to dealing with normal anxiety. And for patients with more than a normal share of anxiety, dentists differ even more!
My hunch is that essentially all dentists want you to have a positive experience. The real issue, however, is not what the dentist wants, but what you want and how hard he or she is willing to work to try to make it a reality !
A dentist can just give you Novocain and get to work. He can rationalize that most people do just fine that way, so you should too! Or, he or she can really try to see you and know you as an individual - like no other patient he has ever worked with before - where there is a process of discovery and relationship-building leading to a kind of partnership in which the dentist and patient work together to find the necessary ingredients to make for a positive experience for you...
The truth is that every person, of course, is different and unique. Each has different needs and wants. For one person the anxiety may be about fear of physical discomfort. But for another, it may be about not being in control of a situation, or about not being able to express feelings because it's hard to talk with lots of dental "stuff" in your mouth. Another may have anxiety about anything just being placed in the mouth.
The mouth is a very emotionally charged place, and much more so for some of us than others.
In any kind of relationship it's uncomfortable to "get physical" before there is at least some sense of comfort and trust. Let's face it, dentistry is very "physical". It's a contact activity and in it's own way it is very intimate!
Many dentists would not say these things... they might prefer to pretend that dental treatment is just fine and painless for everybody. Well, that might be true for some people, but I know it is not true for many others. I feel that discussing things out in the open usually helps such anxieties seem smaller and less worrisome. It also lets you know I recognize and respect that which is hard for you as an individual.
So, the first thing I like to do to deal with anxieties is to connect! I usually ask new patients "What can I do for you?" It's a nice open-ended question that you can answer any way you want. ... No pressure.
If you choose to let me know there are some anxiety issues, then I would invite you to let me know more about them and we can discuss them a bit... or a lot, if necessary. Some people are more of a "show me" type and prefer less talk.
The "show me" type of person might get more from just reclining in my dental lounge chair than from anything I might say, because...
A TV is recessed into the ceiling right above you as you recline in the treatment chair. It can be turned off if you prefer, or as most of our patients do, you can pick from a menu of calming... even meditative... DVD's of concerts, nature, shows, etc. (some bring a favorite of their own) You control the sound level through our wireless headphones. The chair gently vibrates (or not, as you wish) for a full body relaxation massage.
Why do I provide this? Is it a gimmick? No. The idea is very simple and scientifically sound. Humans have the mixed blessing of only being able to focus our attention on one thing at a time. So, if all there is to focus on is dental treatment...you guessed it! The whole time is only dental treatment... On the other hand if your senses are pleasantly overwhelmed with positive, pleasant sensations --. your hearing, your seeing, as well as your body feeling -- then your attention is continually pulled away from the dental perceptions. So at the end of one hour's dental treatment, you may have only focused on it for five minutes....or maybe not at all !
What becomes evident to this new hypothetical patient very quickly is that a lot of thought and effort went into building the chair-audiovisual-body relaxation experience. Even if your preference is to turn most or all of it off as some of my patients do, you know I went to a lot of trouble - I worked hard - to try to make it as positive as possible. And it didn't stop there:
We use homeopathic remedies in the office for some of our patients to help them feel more centered and relaxed. Homeopathics are completely safe and without side effects and work very gently.
There are several choices available in "novocaines". Some have ingredients like adrenalin or preservatives that might give some people some unpleasant side effects. Some novocaines do not have these ingredients.
In the past, if you experienced your heart racing and a physical feeling of anxiety, it was probably the adrenalin. If you had an allergic kind of reaction, it was probably the perservatives that are needed for the adrenalin. I routinely try to use a kind of novocaine without either adrenalin or preservatives. It also has the added benefit of wearing off more quickly, often by the end of the appointment.
There are several ways of giving the Novocain injection. If you have a hard time getting numb the usual way or if it really scares you too much, some alternative way may be helpful.
Sometimes called Laughing Gas or Sweet-Air, nitrous oxide is very safe for children and adults and is pleasant for almost anybody. It does not make you unconscious; it also does not make you laugh or get silly. It just helps you relax.
Electronic stimulation of nerve pathways using little AAA penlight batteries can create a kind of numb-like distraction to minimize discomfort . Unfortunately it is not yet as effective as "Novocain", but for some people it works quite well. It does work better for some than others and it works better in some parts of the mouth than other parts even in the same person.
Some patients have a try with it and if it works well enough, great! If it's not quite enough they just signal me and I stop and give a little regular anesthetic. If they continue to use the electronic device I probably don't need to give as much anesthesia as without it.
One nice feature is that with the electronic device, when the treatment is over, just turn it off and that's it, no lingering numbness!
This is a device that looks like glasses that fit over your eyes. While you can't see through them, you can still see around them (so they're not particularly claustrophobic feeling). A light gently pulsates inside which you see through closed eyelids. The rhythm can be alpha or delta or in-between. The result is a relaxing, meditative experience that is very distracting and possibly transporting if you let yourself really get into it.
A little cordless buzzer, much like a small TV remote control, which I built and dubbed a "Speakeasy" can be held easily in your hand during treatment. Any time you need to get my attention, just press the button and you and I will hear a pleasant "buzzzzz". The beauty of it is that you don't have to worry "will I be able to say something with dental stuff in my mouth?" or "will I be able to get his attention if he's focused on my tooth?"
It's a no-brainer and it's simple and it works! The fact is most people that hold it never use it - they just feel better knowing they could use it if they need to. It really helps neutralize that not-having-any-control feeling.
And, again, it re-affirms that I care about your well-being. Not just because I say I do, but because I went to the trouble to make it so! This is not something I ordered from a catalog, I actually hand-built two of them myself because I thought it would help people feel more comfortable ... and I was right....It does help !
Although I rarely need to prescribe medication to help alleviate anxiety for my patients, it is an option that is available.
Two of my staff and I are trained Reiki practitioners. While not used often, we will sometimes incorporate a little Reiki into the treatment visit. It's not a planned thing - just sort of happens sometimes - and there's never a charge for it.
Yes, "simple" kindness. Easy to say, but harder to put into practice. In my dental practice I use the normal things other dentists use, and as indicated above, a few that not all dentists use.... Even a few that I invented and built myself that as far as I know only I use. But to be sure they are only "things"...."gadgets"
Helpful things to be sure, but still only things. I always try to stay centered in the idea that what my staff and I do has to do with a partnership, a relationship, with another real, living, feeling, human being.... and that could be you.
Michael C. Goldman, DDS
General and Cosmetic Dentistry
3815 East-West Highway
Chevy Chase, Maryland 20815 Phone (301) 656-6171
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Holism in dentistry is an approach to dental treatment, primarily caring for patients' health and safety from both a conventional as well as "alternative healthcare" point of view. It is sometimes called "biological" dentistry or "biocompatible" dentistry. In it's fullest sense, I believe it acknowledges and deals with the mind, body and spirit of the patient, not just his or her "teeth". See Topics / Info.....
Cosmetic dentistry is about doing quality , esthetic dentistry in a way that looks natural to begin with, and furthermore, can even improve one's attractiveness through techniques such as bonding, bleaching, veneers, caps, implants and more. It can be like "instant orthodontics" in correcting crooked, twisted or misplaced teeth in many instances. Dark or misshapen teeth can be restored. Smiles that lack youthful vigor or beauty can be revitalized! See Topics / Info..
Bleaching, veneers, bonding, caps, bridges, and implants are cosmetic dentistry treatments that are also discussed in Cosmetic Dentistry, and more...located in the Bethesda, Chevy Chase, Maryland 20815 area near Washington DC