Michael C Goldman DDS  michael

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 throught 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 !

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A dentist can just give you novocaine 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 usualy 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...

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... video tapes of concerts, nature, shows, etc. (some bring a favorite of their own) You control the  sound level in your 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 focussed 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:

 

Homeopathics

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.

Anesthetics

There are several choices available in "novocaines".   Some have ingredients like adrenalin or preservatives that might give some people some unpleasant side effects.  Some do not have these.

There are several ways of giving  the novocaine 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.

Nitrous Oxide

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 Novocaine

Electronic stimulation of nerve pathways using little AAA penlite batteries can create a kind of numb-like distraction to minimize  discomfort .   Unfortunately it is not yet as effective as "novocaine", 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!

Biofeedback glasses

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 inbetween.  The result is a relaxing, meditative experience that is very distracting and possibly  transporting if you let yourself really get into it. 

Signal Device

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 focussed 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 !

Medication

Although I rarely need to prescribe medication to help alleviate anxiety for my patients, it is an option that is available.

Reiki

Two  of my staff and I  are trained Reiki practicioners.  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.

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Kindness

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".

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

 

      

More info about the following is available  if you select  "topics".

Holistic 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 mis-shapen teeth can be restored.   Smiles that lack youthful vigor or beauty can be revitalized! See Topics / Info..

In holistic dentistry there is an effort  to find  biocompatible materials to use to reduce toxicity for  everyone, especially the chemically sensitive.  Amalgam use is avoided   in holistic dentistry (" amalgam free" or "mercury free") due to concern about possible toxicity problems.  Amalgam removal  and replacement with natural-looking bonded materials is a common holistic dentistry treatment as well as a common cosmetic dentistry  treatment.   Detoxification, especially of residual mercury deposits in body tissues from amalgams is often done.  Root canals are controversial  in holistic dentsitry and are discussed under topics.  And much more....

Bleaching, veneers, bonding, caps, bridges, and implants  are cosmetic dentistry treatments that are also  discussed in  Cosmetic Dentistry, and more...

 

 

 

 

 

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