This seems a funny statement to make on a page trying and reduce anxiety. But it is true, and a truth that most extremely anxious patients may find incomprehensible. In reality almost every patient we see is anxious to a degree, but this can vary from slight feelings of discomfort to panic attacks. There are two important differences between the patients that we see every day and treat successfully and the ones who feel too anxious to attend:
That’s right! It is not that the patients we see are not anxious, it is just that they have found ways to deal with their anxiety. We will come back to the above points in detail below. Click on the links to jump ahead. First, however, we need to touch briefly on a separate entity that is often confused with anxiety:
Phobias and anxiety are different. Anxiety is a feeling of nervousness. A tension that is in fact a normal body defence mechanism to a stressful situation. It is the preparation of the body for what is called the ‘fight or flight’ response, i.e. if the situation gets worse, you are ready to defend yourself or leg-it!
Phobias are an irrational fear, although they will be a cause of anxiety, it is theirrationality that sets it apart. It makes them difficult to justify, or sometimes even vocalise, and they are more difficult to cope with.
As an example, lots of people are afraid of flying, which is a phobia because it is irrational. There is no need to be scared of flying as it is much safer than most other forms of travel, but being scared of crashing… that is a rational fear!
Phobias can be considered like a short circuit in the brain. They are a connection between a stimulus, often harmless, like sitting in a plane, and a panic reaction. They self-feed and progress so that without any added negative input, each time the degree of panic will increase.
Phobias can be dealt with in different ways to over come the fear. The most common, and often the easiest way to try and do this is with hypnotherapy, although other techniques are used. Theresa Parnell, a qualified hypnotherapist, cognative behavioural therapist and thrive councillor, works from BPDS, please visit her site for more details of the treatments she offers
As stated above, nearly all patients are anxious when it comes to seeing the dentist. Even a person who says they do not mind will probably feel a small amount of anxiety when they actually walk in, but dismiss it out of hand.
In the middle ground we have patients who are quite put out by their visit, but they manage. They perhaps have a sleepless night, or skip lunch because they don’t feel hungry. However when the time comes, they get in the car, drive to the surgery, and they go through their appointment and are relieved when it is over. These are the patients who have coping strategies to deal with their visit, although they may not realise it. The very fact that they can come in is fantastic. There may be better ways for them to deal with their anxiety, but they are most of the way there already.
The final group of people are the ones who cannot face the dentist. Either they don’t book an appointment, in denial, or they book and then never make it into the surgery for one reason or another. Something can always crop up if needed. Surely all the people who are in this group know what I mean! These are the people who need to, AND CAN, develop coping strategies.
To add to the problems, most patients who have any significant degree of anxiety, are acutely embarrassed by this fact, confounded by the lack of rational explanation for their degree for anxiety. As already stated, the anxiety felt is normal, and dentist are used to dealing with it on a daily basis, and expect patients to be anxious and embarrassed. The realisation that these feelings are normal, and an understanding or how many thousands of people share these feelings, should help you to accept that being anxious is nothing to be embarrassed about!
There are three further points that you need to take away from this section:
There are countless different methods used to deal with the stress levels. Some better than others. But no two people are the same, so what works for one may be totally useless for another. Below are some of the common ones that we see. This is not an exhaustive list, just some known techniques.
The best methods are those that you, the individual, have control over.
These are techniques that can be used by a dentist or other professional to help an anxious patient accept treatment. Ideally it is best to find ways of helping a person cope with their anxieties and the ultimate goal of good treatment provided with sedation or hypnosis is to aid a person to accept routine treatment in the future.
Intravenous sedation uses an injection, usually placed in the back of the hand, to administer a strong sedative that can leave a patient heavily sedated, lasting normally for about 45 minutes of treatment time. Although the sedation is very profound, and has some degree of amnesia (loss of memory) with it, the sedative remains in the system for 24hrs so a patient undergoing this technique will need to be cared for over that period and have a chaperone at home.
In Monmouthshire we are unable to refer for a general anaesthetic without first trying conscious sedation on a patient.
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