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For Most People, Twice-a-Year Dentist VisitsAre Simply Routine,but Others Panic Just Making the Appointment.
Dr. Martin Seif Helps Bob Morris Confront His Dental Demons

From Elle Magazine
March, 2006 No. 247
BY BOB MORRIS

I am a dentophobe. I blame a hygienist. She would scold me as if I were a child for not flossing well. Then without a hint of sympathy, she'd chip and scrape away, making me yelp and wince. One day, I overheard her tell the dentist that she had made me cry. I heard him chuckle. It was absolutely humiliating, and I avoided dental checkups for years. When finally I returned, it was to a new dentist. I had high hopes for a hygienist with a kinder touch, but this one's shabby and antiquated office and equipment made me even more nervous. I had no cavities, but my plaque situation had worsened to the point that the dentist referred me to a periodontist. After a friend described the procedure I was to have (scaling) as painful and arduous--requiring four visits-I simply ignored the periodontist who kept calling to schedule the work.

I had developed a full-blown case of dental fear, a condition that only in recent years has started to emerge as a real medical concern. According to the American Dental Association, nearly 22 percent of us are so afraid of pain that we won't visit the dentist, which exacerbates problems in the mouth and is even linked by some studies to arteriosclerosis and heart disease caused by plaque in arteries. (Hormonal changes make pregnant women or those on the pill especially vulnerable to gum disease.) Signs of dental phobia include uneasiness the evening before a visit, anxiousness in the waiting room, in the chair, and at the sight of dental instruments, concern that a dentist will say something negative or embarrassing about your teeth, and an uncontrollable feeling of panic when instruments are placed inside your mouth.

"I've had women unafraid of plastic surgery who hid from the dentist for years," says Louis Siegelman, DDS, a Manhattan dentist who specializes in phobic patients. "Some tell me stories of kicking or punching their dentists. Many patients break into tears each time I start talking about teeth."

Siegelman chalks all this mouth anxiety up to a number of causes. Claustrophobia or fear of embarrassment for not taking better care of one's teeth could aggravate anxiety; he also points to studies that have linked dental phobia to childhood abuse,which can lead victims to feel too vulnerable lying back and constrained in a dental chair. It can trigger a fight or flight response in some and irrational belligerence in others.

"Our front desk staff is trained to recognize anger as a defense mechanism. We try to kill our patients with kindness," says dentist Jack Byne, DMD, who is president of Dentalfear.com, a website that offers special training to dentists and, for nervous subjects, a list of phobia-attuned experts across the country. Bynes' office, near Hartford, Connecticut, is a cozy converted mill full of natural light and comfy furnishings designed to not resemble that of a dentist. The staff doesn't wear uniforms, the equipment is hidden, and the scent of disinfectant is masked by candles. Before Bynes (a kindly, white-haired, bow tie-wearer) does any work, he escorts you into his homey office with cedar-paneled walls and a waterfall view for a relaxed chat.

"I don't give people a hard time for neglecting their teeth. I tell them if they want to stop in the middle of a procedure and go home, they can," says Bynes, who employs everything from hugs to drugs to minimize patient discomfort.

"It isn't coddling people," Bynes continues."I think of it as letting them have some control. That is often what phobic people need: control." Bynes lets patients choose from a number of aids to make treatment easier. Some like the giddiness of laughing gas; others prefer distractions such as DVD-viewing goggles or noise-reducing headphones so that they don't hear the drill. And if patients want to know nothing at all, there's a full menu of sedatives. The drawback to anesthetics? Knocking patients out doesn't treat anxiety.

"Drugs only mask phobias," says Michael Krochak, DMD, a high-end Manhattan dentist with a tightly wound clientele, whose office has a juice bar, feng shui fountain, aromatherapy candles, and assistants who keep asking, "are you okay?" as they take X-rays and clean teeth. Although he provides all the "bells and whistles" available for phobic patients----from the most sophisticated drugs administered through a wand he helped invent for people who hate needles to reflexology, music, neck pillows, and visual distractions---Krochak believes that the best cure is straight talk. "The most important thing I can do is listen carefully and pay attention to the needs of a patient," he says. He doesn't rush through his explanations, preferring to show patients X-rays, photos, and the tools of his trade (such as drills and scrapers) that might intimidate. Even the close-up pictures of my rotting fillings (a Krochak discovery) and his demonstration on a mouth model became less disturbing as we talked. This "desensitizing" process is a form of the exposure therapy used by psychologists to treat all kinds of fears; it is clearly what I need. But alas, like so many phobic-oriented dentists, Krochak isn't in my HMO.

So thanks to my insurance, am I doomed to a life of avoidance and dental fear? Martin Seif doesn't necessarily think so. Seif, a New York City-based psychologist and the associate director of the Anxiety and Phobia Treatment Center at White Plains Hospital in New York, reassures me that he has seen patients in far worse shape than me---patients whose anxieties have kept them from the dentist for decades. Like the people he treats who are deathly afraid of flying, they don't think about the fact that the scenarios they envision--getting cut with a drill or being exposed to unbearable pain--rarely happen.

"Anxiety loves ignorance," Seif says, "so it's important to get some information. And when you learn more, you'll feel you have some control."

Then Seif says something very simple that resonates deeply: "Anticipatory anxiety is almost always more painful than the experience itself. And anticipatory anxiety stops escalating once you've made a commitment."

Before I leave, he gives me a list of anxiety-management techniques ("Anchor yourself in the present; catch your disturbing thoughts as they occur; don't plan your escape") that phobic-friendly dentists recommend to patients. He lists some books about controlling anxiety (Jon Kabat-Zinn's Wherever You Go There You Are [Hyperion] and Don't Panic by R. Reid Wilson [Harper Collins]) and hands me a tape of relaxation exercises. He also assures me that once I take control of the situation and find a periodontist who inspires my confidence (and takes my insurance), it will be easier to move forward. "You have to break it down into manageable steps," Seif says. The best thing he does for me is ask a favor. "Will you call me when you finally make your appointment with the periodontist?" he asks.

I hesitate for a moment and laugh. But he is serious. I tell him I will. And the following week, I do.

I guess I've gone from phobic to anxious. Not perfect, but it's a good start.