Dentistry focus: Hypnosis in the practice

Does this ever happen to you?…
You have patients who sit waiting for their appointment, looking scared, as though they’d like to run away. They haven’t been for treatment for a long time, although you’ve sent them reminders. They come reluctantly into the treatment room, climb stiffly into the chair and sit there looking desperate, despite your attempts at being cheerful and encouraging. You look in their mouth and find their teeth and gums in a much worse state than they need to be, since they haven’t been for treatment in so long.

Your heart sinks. Now you’ll have to give them more extensive treatment, they’ll find it hard and wait even longer to come next time. The treatment takes more time than it needs to, because they ask to stop frequently, they can’t stand the vibration, they can’t stand the noise, they’re scared. Or they endure it stubbornly, but you’re a nice person – you’d rather people didn’t look like you were torturing them while you’re working.

…Or this?
Potential patients call the practice, encouraged perhaps by friends who are already patients and have said how nice and supportive you are. But these patients admit to being so scared that they don’t feel they can make themselves come to an appointment. You explain you can offer sedation and take treatments very gradually, a little at a time. They are scared of sedation. They worry that they won’t be able to drive home afterwards. They’ll need someone with them, but this is inconvenient. You politely inquire how long it is since they had dental treatment. It is more than 10 years. The only reason they are calling now is that they are in pain and their teeth look so bad they avoid smiling. If they ever do manage to turn up for an appointment, you will not look forward to that session.

The difference between a relaxed patient and a fearful patient is in their minds. Relaxed patients look ahead and imagine that you will take good care of them and they will be fine.  In their imagination, they see it all being very manageable. Fearful patients imagine the worst. Where do they get such ideas?

Bad experiences
Fears are usually acquired through bad experiences. For human beings, our relationships to other people are so important that one of the worst things that can happen is to feel let down, abandoned or mistreated by another person.  So a bad experience that is associated with any of these things makes a much more lasting impression than an experience which was painful but where we felt fairly and kindly treated.

This is what research shows about dental anxiety.  The most common origin of this fear is experience of dental treatment which was not only painful, but where the patient experienced the dental staff as unsympathetic and uncaring.1,2 This is particularly the case where the experience occurred in childhood, as children are especially vulnerable and dependent on the kindness and care of adults.

We can see how powerful the human imagination is, that experiences as a child can still terrify adults into suffering pain and unnecessary deterioration of their teeth and gums, because their imagination runs and re-runs these memories, and projects them onto the future. The Adult Dental Health Survey 2009 reported that 12% of dentate adults experience ‘extreme dental anxiety’.3

That is a lot of fear, and this does not take into account the children and teenagers who were not included in the survey.

Hypnosis works directly on the human imagination. Using carefully structured language and non-verbal cues, based on many decades of clinical experience and research, it is possible to re-direct your patients’ imagination to work for them, rather than against them. They don’t need to have the power of their minds hooked up forever to bad experiences from the past. After all, they now have you to look after their teeth, and you are not going to be unsympathetic and uncaring. You will take good care of them, and when you use hypnosis, their imaginations can get that message, and relax.

It is possible to learn hypnosis to use in the specialised dental setting, using techniques that fit easily into the usual clinical routine, quite rapidly, and those who learn it are often surprised at how quickly their patients respond. On his first day back at work after spending two days learning dental hypnosis, dentist Andrew Lane used hypnosis with great success on two fearful patients and wrote: ‘This included one lady who insisted that she was resistant to hypnosis and it had never worked before for her – she had come in feeling very stressed and left feeling fully relaxed and refreshed.’

Learning dental hypnosis skills is positive both for your patients, and for you – it is much easier to look forward to sessions with nervous patients if you know you can take care of their fears, as well as their teeth.

References
1. Locker D, Shapiro D, Liddell A (June 1996). “Negative dental experiences and their relationship to dental anxiety”. Community Dent Health 13 (2): 86–92
2. Bernstein DA, Kleinknecht RA, Alexander LD (1979). “Antecedents of dental fear”. J Public Health Dent 39 (2): 113–24
3.  Adult Dental Health Survey 2009.  Office of National Statistics March 2011.

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