At 18, Finn James went to get a tooth removed, and the anaesthetic failed to mask the pain. “The dentist just kept going,” says James. “I didn’t go back to the dentist for decades after that.”
Dental anxiety is one of the most pervasive phobias in Britain: almost half of UK adults have a fear of the dentist and 12% of these experience extreme phobia, which often leads to avoiding the dentist altogether. For James, it meant spending two years with a potentially dangerous, searingly painful abscess. Then he came across a website advertising cognitive behavioural therapy (CBT) and neuro-linguistic programming methods for anxious patients. “That really changed my life. I just wanted someone to treat me as a person and work with my fears. The first time I saw my new dentist, we spoke for an hour and that really put my mind at ease. For a lot of people like me, the biggest struggle is the shame we feel about letting our teeth get to this state, so we need to be helped without judgment.”
Dentist Gordon Laurie says the treatment of dental anxiety has long been neglected. “I qualified in 1982 and dental anxiety wasn’t something that was taught then,” he says. “In extreme cases, we would refer people for sedation, but those referrals required a long waiting time – often when the patient was in increasing pain – and the referral centres are still few and far between.” Laurie has personal and professional experience of dental phobias. “I’ve had patients who hadn’t seen a dentist for 40 years who would take their own teeth out. My late mother-in-law was an example. She’d do anything to avoid the dentist. She used to put mustard powder into her cavities to burn out the nerves rather than get toothache. At that point, it’s just self-abuse.”
There have been numerous recent studies on the success of CBT in reducing dental anxiety – a step-by-step approach is used to explain each part of the treatment clearly; there is prior agreement of signals, if the patient needs the treatment to stop; and plans are made for follow-up appointments. Another option for anxious patients is hypnosis, although this is relatively uncharted territory.
In 2009, Emma Carey, a dental hygienist, retrained to become a hypnotherapist and now runs private clinics for anxious patients in a practice in Wetherby, West Yorkshire. She gained her qualification after a six-week diploma course at the London College of Clinical Hypnosis and charges up to £90 for an appointment. “With clinical hypnotherapy, we’re accessing the unconscious mind to bypass our critical faculty,” she says, “allowing the anxious patient to become deeply relaxed. We all go into a daydreaming state naturally several times a day, but with hypnosis it’s a much deeper level of trance that we’re trying to access. We give patients the tools to do this at home, so they can reach this deep state of relaxation easily and then take it into the treatment room.” Often Carey needs to see patients for only three or four sessions before they acquire the skills to relax themselves for treatment.
John Bailey, a full-time hypnotherapist specialising in dental anxiety, noticed that many of the phobias he sees stem from childhood. He says parents say things like, “Don’t worry, it won’t hurt”, conditioning the child to believe the dentist is something to be wary of. “The child thinks, ‘Why should it hurt?’ and that maybe then it will.”
Specialist treatments for dental anxiety are still accessible only to those who can afford them; the scarce options available on the NHS are subject to a “postcode lottery”, according to Charlotte Waite, chair of the England Community Dental Services Committee. Keerut Oberai, a recently qualified dentist, says: “While we’re much more aware of treating patients holistically, and it’s now incorporated into our university studies, in an NHS practice we’re often really pushed and it can be difficult to take the time to speak to the patient and use these different techniques. But we’re here to make sure the patient is healthy and so we need to be doing whatever we can to make sure they feel comfortable. We need to work at getting rid of the stereotype that dentists are to be feared. We’re actually all pretty normal and very nice.”