Treatment for anxious patients

Anxiety is caused primarily by negative experiences, a feeling of helplessness and a lack of communication.We understand that few people enjoy a visit to the dentist. We will therefore try to tell you what we are going to do in advance and try to reassure you as much as possible.

If certain procedures are too painful, we can use a local anaesthetic. We can also use pre-anaesthesia in the form of an ointment or spray (so you don’t feel the anaesthetic).

Afraid of the dentist?

Fear of dental treatments is a well-known, deeply rooted phenomenon. About 800,000 Dutch people are so afraid of the dentist they refuse to seek treatment. However, postponing visits could lead to tooth and gum problems. This fear can be caused by a variety of different causes, which mostly find their origin in childhood. In many cases, the person had a hard time at the (school) dentist. In other cases, the fear was ‘copied’ from parents or comes from grossly exaggerated ‘horror stories’ at school. Most people who fear going to the dentist eventually do go. The fear then often focuses on (the sound of) the drill. Other people are afraid of pain and think that nerves or their tongue will be pierced.


Tips to prevent fear at an early stage

  • Anxiety prevention starts during childhood. It is therefore wise to take your children to the dentist as soon as you can. Research proves that the sooner a child gets used to the dentist, the smaller the chance he or she will develop a fear of the dentist.
  • When taking your children to the dentist, it is a good idea for one or both parents to stay in the room during the check-up or treatment. Older children can try and stay by themselves to boost their confidence.
  • If, as a parent, you stay in the room, leave as much as possible to the dentist. Do not make any promises you cannot keep, such as “You will feel absolutely nothing”. If it hurts anyway, your child might feel betrayed.
  • There is nothing against giving your child a reward for bravery. Think of something small, like postponing bedtime for once.


Tips for people who are afraid, but do go

  • It is important to realise that dentists’ techniques have improved a lot over the past few years. Horror stories from your childhood are all in the past. Nowadays, virtually all treatments can be done pain-free.
  • No matter what the cause of your fear is, it is important to know that there is mutual respect and trust between you and your dentist.
  • If you are afraid to have treatment, please discuss this with your dentist, who is most probably prepared for this and can take extra time for you if needed.
  • Seek information on the type of treatment you are going to have, make sure you know what is going to happen and why. Consider if looking in the mirror during your treatment might help.
  • Are you afraid of pain? Demand anaesthesia.
  • Agree on some kind of sign, like raising your hand, for the dentist to interrupt the treatment. This will allow you to feel in control.
  • Give relaxation and breathing exercises a try. Distraction can also be helpful. If possible, ask your dentist to put on some music. After all, the less you focus on your treatment, the higher the chances your fear will decrease.
  • If your dentist does not take your anxiety seriously, look for another dentist. Find someone who explains everything, shows compassion and considers your wishes.


Tips for people who are afraid, but don’t go

  • If you refuse to go to the dentist for a long time, your dental problems will get worse and worse. Bad teeth have a negative effect on your self-esteem and social life. You will eventually need to get them checked. So, where do you start?
  • Talk about your fear with others. They can support you in taking an important step – the start of the restoration of your teeth and the end of your misery.
  • Ask others to share their experiences with their dentist. A nice dentist takes the time to comfort patients and makes children feel comfortable. That’s the type of doctor you should be looking for!
  • Make an appointment to get your teeth checked, but agree with your dentist that nothing is going to be treated straight away. The first visit is an opportunity to meet and see if it feels right.
  • If your anxiety runs too deep, contact your GP for a referral to an ‘anxiety dentist’ or a centre for specialised dental care. In the Netherlands, there are about 40 dentists who specialise in treating people with an extreme fear of dental work.


Ivoren Kruis, the Dutch Society for the Promotion of Oral Health, gives the following tips in its leaflets titled ‘Afraid of the dentist?’ and ‘What can you do to conquer your fears?’

  • Look for a dentist who is good at dealing with anxious patients. Maybe someone in your environment knows of such a dentist. If not, don’t hesitate to ask your GP or insurer.
  • Tell your dentist you are afraid and when this fear started. Dentists are generally aware of such problems and can do a lot of things to reduce your anxiety.
  • If you don’t feel comfortable around your dentist, discuss it with him or her.
  • Do some breathing exercises or count to 500 whenever you feel overcome with fear.
  • If you want to take something to relax you or calm you down, discuss it with your dentist first.


What can you ask your dentist to limit your anxiety?

  • To take more time for you than he/she usually does.
  • To only check your teeth or take an X-ray on your first visit.
  • To explain everything in advance so you know what to expect.
  • To show you all the instruments and explain what they are used for.
  • To tell you exactly what he/she is going to do during your treatment and how long it is going to take.
  • To let you watch everything with a mirror (or not, if you prefer not to).
  • To stop the treatment as soon as you raise your hand.
  • To allow you to listen to music during your treatment.
  • To have you hold on to something (favourite teddy bear, shawl, etc.).
  • To propose other solutions to decrease your anxiety.


Anaesthesia and calming down
If the dentist has to do something that could be painful, he will generally first offer you anaesthesia. The anaesthesia, which is provided with a small needle, generally reduces pain or even numbs it completely. Please tell your dentist if you still feel pain. He or she can then give you some extra anaesthesia. As soon as the anaesthetic starts working, your cheek or lip will feel a little swollen and you will feel it is hard to talk, eat and drink. This feeling will disappear once the anaesthesia has worn off, mostly one or several hours following your treatment. The dentist can also use an ointment to make the place where the anaesthesia is going to be injected a little less sensitive. Some dentists work with nitrous oxide, which causes a feeling of relaxation and therefore takes away your anxiety. Nitrous oxide is administered with a mask. You then have to breathe in and out through your nose. Please take into account that you cannot use nitrous oxide in the first three months of pregnancy and that you are not allowed to participate in traffic until half an hour after your treatment. If your dentist does not use nitrous oxide, you could ask if he/she is willing to refer you to a dentist who does. The dentist could also prescribe calming medicines, which is called premedication, with Valium being the drug of choice. This will not only ensure that you feel less pain during your treatment, but it will also make you remember less. Despite all these options, some people are still scared. If you are one of them, you have the possibility of getting narco-anaesthesia, which allows you to have treatment without noticing anything at all. This type of anaesthesia is available at hospitals, but some dental clinics also use a variant of narco-anaesthesia called intravenous sedation.


Leaflet about dental fear
© Author: Prof Dr A. De Jongh



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