Soulsmile – How to Manage Dental Anxiety

Hi Aron, I thought we’d catch up on what’s new for you and for your dental office, Soulsmile.

Hi Shields. Great to talk to you and congratulations on pulling off living and working from the rainforest of Costa Rica!

Thanks. It sure has been an adventure and after two years we are really getting into our groove. So, tell me what’s new with you.

Well our daughter, Siena, will be two in the spring and is more fun that I ever imagined. Her head-back, arms-out greetings are pure joy for my wife and I. As for Soulsmile, we are almost to our four-year anniversary and grateful as ever for the continued support of the Rogue Valley community, as well as residents of towns from Yreka to the Coast.

As for what’s new, for the first part of 2019, we’ll be expanding our hours and maybe even bringing on a partner. We are – and will always – accept new patients, see them within one week, and work emergencies into our schedule on the same day.

Sounds like great growth plans. What’s new from a services standpoint?

Well, since we offer such a wide array of services, one of the biggest recent shifts in our paradigm is realizing the contribution we can make for anxious patients – a large group of Rogue Valley residents for whom dentistry really brings out fear or a feeling that they are not in control. We seem to be sought out by many individuals who feel this way and it’s been some of the most rewarding work of my career.

I hear that from people so often, they are afraid of going to the dentist, but hadn’t really thought of what it actually means for them.

Yeah, like others fears or phobias, dental anxiety hides in the shadows but really gets in the way. After all these years practicing dentistry, I’m still moved by these wonderful folks who come in and really start opening up about it and then allow us to help them on the journey to dental health and relief from dental anxiety. And I’m not talking about using drugs or sedation. I’m talking about good old-fashioned person-to-person trust and normal dental services. It really goes to the heart of why a healthcare provider does what they do.

Treating anxious patients and having a successful outcome is a big emotional deal for me, too. After treatment, there are usually hugs and glassy eyes all around. It’s impactful for everyone and a core reason that someone suffering from dental anxiety should feel confident in taking the first steps to a new beginning.

I love this topic! So tell me, what does dental anxiety look like?

Good question. Well, there is a massive barrier between patients and dental health when they have dental anxiety. It’s almost unthinkable for many. It can present as a guarded smile, sweating, pacing, overly quiet – the expressions are varied and personal, but the source is clear. I start off by congratulating them for even picking up the phone. To call, make an appointment AND show up… that takes courage! I let them know that I get it. It isn’t long into dental treatment that the smiles start to show up, the sentences become longer, the conversations fuller, the shoulders broader, this sort of thing. So I know the signs just from having seen hundreds of people show me their true personalities within days of getting started with treatment. It’s incredible.

So what happens when they are at the dentist for the first time, what should they look for? What should they say?

A patient with dental anxiety seeks trust in the entire dental team and office. The good news is that most dentists, and certainly the dentists and their teams in this town, are really good people. If at all possible, an anxious patient should try to say what it is that most causes them fear. Ideally the entire team will allow this conversation to build naturally. Just call an office and offer a hint of your fear and see how it goes! Call another office if you feel like finding just the right connection. There is nothing to lose in that and meeting the dentist for a free consultation is a great way to find out if it’s a good fit.

What if someone is afraid but feels uncomfortable or uncertain about how to express it?

It’s true that it might help to identify a fear so to get the conversation started. Anxious patients come in four big categories with some subtle variations within each.

First, some people fear pain. This usually relates to an earlier dental experience or maybe even stories of a family member who spoke of feeling discomfort while having treatment. They may also have more sensitive teeth and gums or have a fear of needles. Talking to a dental team about this fear allows them to share ways that the patient can remain in control along the entire path, including making sure they are completely numb before and during treatment.

Can you give me an example?

Sure, here’s an easy one. Many people with a square jawline report being difficult to get numb (picture Michelle Pfeiffer or google “celebrities with square jaw”) as the reason they are afraid of dental treatment. This is one of the easiest situations for a dentist to address with slight technique changes since really the nerve serving the teeth is just a little more hidden around the corner of their slightly flared out jawline. Try an appointment just to get numb if you’d like to feel reassured. Maybe try one easy filling to get started. In this case, pain is managed through technique, patience, and a patient’s ability to stop treatment at a moment’s notice by raising their hand at the slightest sensation.

I never even thought about how someone’s anatomy might change their perceived ability to get numb. Great example! How about the second category of anxious patient?

Being judged. Some people fear being judged for their dental problems. They just want to stay home and be left alone. If they tell a dental team this on the phone, or in the chair, I can assure you that everyone will respectfully discuss what relatively affordable and easy things can be done and zero about how the teeth got in this condition.

For example, I can see plenty in x-rays and may suggest to a patient that we just shoot the breeze about what they would like to accomplish and that we take our first small step on the next visit, lightly touching on our final goal of say dentures, implants, cosmetics, etc. In other words, let’s place something in front of us that feels like a small positive step and begin the practice of not looking back.

On that note, if a person has had a history of drug use that has led to their dental condition, they should know that this doesn’t really need to be discussed. You will probably feel comfortable talking to your dentist about it a couple visits down the road, but for now just focus on getting out of discomfort, saving teeth, and coming up with an affordable immediate solution to restore your self-confidence. This goes hand-in-hand with recovering from drug abuse and is one of the most rewarding type of cases I get to treat. I can tell you with certainty that no one at Soulsmile will ever talk about “how did your teeth get like this?” No way. We are totally focused on looking down the road into your future.

I like that you address that head on. I’m beginning to see how real dental anxiety can be. How about #3?

#3 was touched on earlier, but it is the fear of not being in control. For example, a patient fears that, once tipped back in the chair, it is just going to be an invasion of their personal space with a whirlwind of activity, chatter, and action that they can’t control, even if they wanted to.

The way I give space to this fear is a formula of friendly chit-chat before and after but 100% quiet focus during treatment. We always review a patient’s treatment before starting, give them an idea of the chronological order of things, explain how we will be on the lookout for their left hand to move even a twitch (I joke that they can test me with even the slightest movement of any finger, but that I prefer a “thumbs up” versus other popular single digit expressions!) and then … we shut up. From start to finish we barely say a word. The patient feels a succession of actions that feel logical, purposeful, and gentle. According to our reviews and feedback, this flow and the systems around the workspace give a patient a great deal of assurance that we are in control and they are in control.

That’s another one I hear about. It seems most people do not like being talked to while being worked on or feeling like the dental team is distracted. And #4?

The fourth is financial fear, especially when it has to do with the cost of large treatment plans. Financial fear and a related fear, that of being taken advantage of, should be remedied by trust. The first easy way to build trust is with excellent dental photographs (in addition to x-rays). Digital photographs let a patient see their teeth for themselves and lead to a very clear decision about what the patient would like to address. The second method is a very detailed treatment plan, decided on ahead of time, that shows what you will be doing all the way until the very last appointment if possible.

One recommendation I have is to work with your dental office on the treatment plan and then ask how it can be divided into the fewest appointments possible to qualify for an overall discount. Dentistry is essentially billed out according to the doctor’s time. By allowing your dentist to work efficiently, you should qualify for a discount. Just be sure to make it to those appointments.

One big challenge for a fearful patient is being able to follow through with actually showing up. That’s understandable, but if this is the case for you, let the office know and start by making short appointments for a couple simple procedures in the beginning. Soon, you will have no problem showing up.

I can understand that. When I contemplate high medical expenses it creates an anxiety that feels almost like a concern for the procedure itself.

Yes, for sure! Me too. When patients are faced with a large treatment plan, it is very easy to become overwhelmed. When combined with true anxiety, the result is postponement and a worsening condition.

This brings me to another topic. There are many ways to address the financial burden of a larger treatment plan. Here are some examples of how to make your treatment more affordable:

–       Crowns (without prior root canal treatment) generally do not require “buildups” – there you go, you just saved $300 per tooth!

–       Don’t blow your budget on one tooth with a poor prognosis and leave others with minor decay untreated (in this case, you might extract the tooth and fix the other teeth for the same cost).

–       You may be able to temporarily opt for large fillings instead of crowns, on select teeth, to save money. This is typically a better option than optimal treatment if it means halting the decay process.

–       If you’re considering dentures vs fixing teeth, you should know that full upper dentures can look and feel great. If at all possible, try to keep as many lower teeth as possible to support a lower partial denture.

–       Don’t suffer because of the price tag of implant-supported dentures, if that’s your ideal treatment. You can always do regular dentures for now and get implants to support those dentures in the future if you choose to.

–       When missing teeth, get your self esteem back by wearing an inexpensive “flipper,” “stay plate,” or “Nesbit” in areas where you are missing teeth and can’t afford dental implants.

–       There are many dental financing options offering 0% financing.

–       Modern dental offices have their own membership plans now that cover all your preventative services (exams, x-rays and cleanings) for a low monthly cost.

–       If you are a longstanding patient with an office, they will most likely extend to you a monthly payment plan on your word. This is great motivation to establish a dental home and let them get to know you.

–       Don’t be afraid to ask an office to barter dental services for your services or wares.

–      Ask to be put on a “short call list” so the office can slide you into the schedule on short notice if they have an opening pop up. This convenience of filling an opening in their schedule may afford you a discount on your treatment.

So it seems sedation or laughing gas isn’t the magic ingredient in handling dental fear.

Right! Forms of sedation are great and certainly indicated for emergency situations or surgery, but in fact, it can be another barrier to long-term dental health. The real benefit of overcoming fear without sedation or gas is that a patient becomes free of fear and able to have routine cleanings and dentistry with no problem. This dental confidence is also a gift given to one’s child, as dental fear seems contagious.

Whether or not a person is a patient of Soulsmile, I hope they can live free of dental anxiety and achieve the dental health of their dreams.

Thanks for dedicating this interview to helping folks with dental fear.

My pleasure. Thank you, Shields.


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Aron Kivel, DDS
1144 Iowa St., Ashland


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