Cincinnati Smiles.com | General Dentistry for Adults and Children

Interesting phrase, isn't it? Well, the truth is that sometimes dental treatment causes pain, unless you are completely asleep. In our office, we do everything we can to minimize patient discomfort. Our patients always have the right to raise their hand or hit a buzzer to stop the procedure. But we feel honesty is the best means of communication. Oral surgeons often work with complete anesthesia where the patient is put to sleep. They accomplish excellent results in this situation. However, there is always a risk involved when you are put to sleep. In general dentistry, it is more difficult to accomplish excellent results when the patient is asleep. Factors such as patient position (lying supine) and registration of certain jaw positions make detailed dental treatment very difficult.

In our office we have used a behavioral method to reduce (and often eliminate dental fear) since 1980. This is called the dental fear control program. Researchers at the University of Kentucky College of Dentistry did a scientific evaluation of this program and found that it helped 98% of patients to significantly overcome their fear and that 70% said that they would not have returned to the office if they had not gone through the program. In this method, you learn how to relax yourself naturally - without drugs - through two proven exercises: guided imagery and progressive muscle relaxation. They really work! You can also go through systematic desensitization, another psychological method, if needed.

In addition to this program, we offer nitrous oxide sedation (laughing gas), which is a vapor you breathe through a mask over your nose. Nitrous oxide works better if you have gone through the fear control program. Afterwards, there is no drowsiness so that you can drive yourself home. Some patients prefer taking oral tranquilizers. These pills can also produce deep relaxation but it is necessary to have someone take you home. Some patients wear stereo headphones to block out the noise of the drill. Many enjoy these. We also use a topical cream on the gum to make the injection more tolerable. We give the injection very slowly and very gently and many of our patients actually wonder if they received a shot at all!

Most importantly, we take the time to listen to your fears and to do whatever you require to allow you to have the necessary dental treatment successfully completed. Everybody has different needs. We are not a clinic and we are not a PPO or HMO-type office. We don't have to rush you through a procedure. If you have pain during a treatment, we take the time to stop and make sure that the tooth becomes numb before we proceed. This gives you much more control over the situation. However, it still takes a lot of courage for the phobic patient to pick up that phone. You often think you have the worst mouth in the world. Let me reassure that you don't. Look at this mouth. She had not been to the dentist in 30 years. Many fearful patients ask a friend, spouse, or relative to accompany them for moral support. This is a great strategy. You owe it to yourself to save your teeth. It's much better than wearing dentures! Give us a call at 771-2230. Stop by our office for a complimentary copy of Afraid of the Dentist and Dentist removes fear first, then cavity, two articles about Dr. Bob and his methods written by Sue MacDonald in the Cincinnati Enquirer. For more information, look at the pages below.

In 1990, Dr. Timothy Smith, a professor of psychology at the University of Kentucky, and I published a scientific research study in the Journal of the American Dental Association that described the effectiveness of the dental fear control program. For over two years we trained ten dental offices in Ohio, Kentucky, West Virginia, and Indiana to use this method. The results were very positive. In our office, over more than 20 years, more than 700 patients have gone through this program and most have been helped significantly. Many, like Susan, were able to visit a specialist and get treatment done.

"Dear Dr. Bob,
Believe it or not, I had periodontal surgery yesterday. That's right, me ... Miss Terrified. Thanks to you, my faith in dentistry has been restored. Now I can continue to do the right thing for my health. Thank you also for referring me to Dr. Lipson. He is truly wonderful and has made the entire experience as pleasant as possible." A year later, Susan was transferred. She wrote again.

"It's with mixed emotions that I'm writing to tell you I'm moving to Chicago. It's a wonderful career opportunity and ... my family still lives there. I wanted to thank you all for everything. You've been great! I promise to continue to be conscientious about my teeth, but will miss you. Thanks for everything." - Susan K.

Once a fearful patient like Susan goes through the dental fear control program, he or she becomes confident and can go to a specialist or, if relocating, to a new family dentist.

Can affect your self-image. Many dental phobics feel foolish about their problem.
Can allow dental disease to destroy teeth, gums, and bone support in the jaw. Tooth loss can lead to weakened muscles and facial wrinkles.
Can allow oral cancer to go undetected. Leukemia can be seen in the mouth in the form of bleeding gums and squamous cell carcinoma, if not treated early, can be deadly.
Can allow gum disease to cause teeth to spread and your bite might change. Bad breath can develop from gum disease.
Can affect your overall health: dental infections can spread through the blood stream or towards the neck. Inability to chew well can affect digestion of food.
Can affect your career: a good smile = powerful persuasion.
Can affect relationships. Who wants to kiss a mouthful of pus and bad breath?
Can lead to expensive dental bills. Dental neglect is more expensive than prevention.
Certain types of heart disease can worsen with dental infections.

The program consists of two sessions, although most patients only need the first one. You begin with some paperwork.

You'll complete three forms designed to find out what you're afraid of and what may have caused the fears. We will discuss these fears with you and get your feedback. Often just hearing someone listen to your concerns helps to make you feel better. You'll write about any bad experiences you may have had in dentistry. Share these with us. We'll be happy to listen.

You will then watch a videotape showing a fearful patient, just like yourself, receiving dental treatment. This tape was professionally produced by the University of Kentucky audiovisual department. It shows the patient getting a gentle injection, the use of nitrous oxide, and the patient raising his hand to stop the procedure. Control is a major concern for most dental phobics. Some have trouble watching this video ... but it helps to reduce fear.

We'll then give you an audiotape that will offer instruction in two relaxation exercises, methods proven to help you reach a deeply relaxed state. The first, guided imagery, takes you through four imaginary scenes, tranquil and happy places where you can go, in your mind's eye, to forget about the dental visit. By focusing your attention on these pleasant ideas, you'll be able to relax. Great athletes, such as Jack Nicklaus, have used mental imagery for decades. You will become skilled at achieving deep relaxation with continued practice.

The second exercise is progressive muscle relaxation. Here you will learn to alternately tense and loosen every major muscle group in the body. After 15 minutes of this, you will become deeply relaxed. Psychologists like to use this method to induce hypnosis. Again, it requires practice.

At the end of this first session, we encourage you to listen to the tape at least once a day. That way your relaxation skills will increase daily. We also give you a copy of Dr. Bob's book, How to Overcome Fear of Dentistry. Reading this book will help you to understand your fears and how to deal with them.

If you feel you need more help, we have a second session available. In this visit, we'll first review your progress. Then, while relaxed, you'll watch the videotape again. Watching the video for a second time should increase your confidence. Next, we'll use a fear desensitization ladder, a technique where we'll give you a fearful scene to imagine and then you'll relax. The scenes gradually increase in intensity. Most patients don't need this second session. But, it's OK if you do.

At the end of the dental fear control program, you can schedule an appointment for an initial exam.

We currently charge $60 for this service. However, if you choose to have dental treatment done in our office, we will credit back this fee to your account over three visits. This encourages you to have your dental work done and to save your teeth. If you don't want to schedule an appointment but would like to purchase the book ($17.95) or the audiotape ($16.95), you can charge it to your credit card by calling (513) 771-2230.

You owe it to yourself, your self-image, and those close to you to fight this fear and win! Save your teeth! Good luck. You've made it this far.

Lots of people are afraid of getting stuck. It can become a terrific phobia. Sometimes nitrous oxide, coupled with medication and natural relaxation, must be used. We pride ourselves in giving gentle injections. These take extra time and patience. We always use a topical cream to numb the gum ahead of time. Most patients don't even realize what has happened.

We also offer electronic anesthesia, which involves placement of pads onto the cheeks. A mild electric current from a TENS unit passes through the pads. This stimulates a natural body hormone, called endorphins, to produce numbness. However, the numbness is not usually as profound as with local anesthesia ('novocaine'). Used with nitrous oxide, electronic anesthesia becomes more effective.

Pain from drilling is the most feared procedure in dentistry. With profound numbness, this pain is rare. In preparing small cavities, air abrasion (a small, concentrated stream of abrasive particles) can be used instead of the conventional drill. However, air abrasion is not effective for most dental restorations.
We allow our patients to stop the procedure if pain occurs during drilling. At this point, we can use a number of methods to make the tooth more numb. It is extremely rare in or office for anyone to have discomfort during drilling. In a worst case scenario, we can always stop, place a temporary, and continue treatment some other day.
Afraid the drill will slip? Some folks are. Dentistry demands precise, exacting concentration. During drilling, the chance of slipping is minimal. In fact, the use of rubber gloves increases the grip adhesion of the fingers to the drill.
Afraid of the sound? Use headphones and listen to music or to a relaxation tape. Crank up the volume if you want it louder. Some patients pack cotton in their ear to block the sound.

The gag reflex is a beneficial protection to avoid swallowing something too large. However, if exaggerated, it can make certain dental procedures very difficult. Several things can reduce gagging. Nitrous oxide sedation can help, as can local anesthesia. Raise your foot off the chair during an impression. Breathe deeply and very slowly through your nose. Hypnosis also works.

Many young children have this fear. We reassure the patient that high-speed suction is used to evacuate particles and debris so that they won't be swallowed.

Most phobics who have avoided the dentist for a long time are embarrassed about the condition of their mouth. They don't want anyone to look in there. The mouth, you see, is a highly personal space. They feel as if they've got the worst case of decay, gum disease, and so on. But chances are good that we've seen much worse. Everyone one in our office has been trained to work with fearful patients and they have empathy with you.

As a result of prior bad experiences, a lot of people fear that the dentist or staff will criticize them or give them a lecture for neglecting their mouth. That may have happened to you. In our office, we don't criticize, rather we congratulate you for having had the courage to take a risk and visit the dental office.

Have you had a painful extraction, painful gum surgery, or a bad experience with a root canal or crown? Let us review with you what happened to you and then explain how perhaps we can make the procedure easier for you, in case you need it done.

Yes, excellent dentistry costs money. So do cars, computers, and vacations. Cars wear out soon and break down often. Computers are outdated the week following purchase. Vacations are fun but are usually forgotten soon. But, a properly restored mouth will give you chewing function, smiling power, and good oral health the rest of your life. Patients must decide on their priorities. In our office, we can help you finance your treatment.

True, dentists use tiny, sharp tools ... and for good reasons. But these are not designed to inflict pain. If you have been 'stabbed' by a dental instrument, you will be justifiably wary. If you have this fear, let us know up front. We will take extra care to avoid sensitive places during our exam, especially root surfaces that are not covered with protective enamel.

In dentistry, we have a type of local anesthetic that wears off rather quickly. We also can use a technique that numbs only one tooth at a time. Electronic anesthesia may be the answer. If this becomes a severe phobia, psychological therapy may be needed.

We have a local anesthetic that will last much longer than the average and provide hours of pain relief. This might be indicated in surgical procedures or those involving significant post-operative pain.

Some have had rough, painful experiences during a routine dental cleaning. Hence, their fears are real. However, a dental hygienist, if she or he has enough time allotted, can be gentle. In case this fear is extreme, nitrous oxide, a numbing solution, or even a local anesthetic can be used during teeth cleaning. Deep scalings or root planing, advanced periodontal treatments, should be done with profound numbness.

In these times, this fear can be real, especially in large cities where the AIDS virus is prevalent. In our office we use universal precautions on all patients - for all procedures - and we sterilize our instruments in a steam autoclave. A local hospital monitors the sterility of our autoclave every week. Except for a single incident in Florida, there have been no documented instances of patients getting AIDS in a dental office.

Yes, if you have avoided the dentist, you may need a lot of treatment. But, then again, you might not. Often it's not as bad as you might think. Many of our phobic patients are pleasantly surprised to learn their treatment will cost less than they imagined. If finances are tight for you, then treatment can be split into phases and completed as you can afford it.

There are several other fears that are related to dental treatment. They are not common and many are based on individual experiences. If these fears turn into phobias, it is often a good idea to get psychological help.

What else can you do? Talk to a friend or relative and explain your fears. Just chatting often helps. Give us a call. We'd love to see you.

Frustrated by treating fearful patients? You aren't alone. Many dentists rate the fearful patient as something they'd rather avoid. We all know what happens when a patient has uncontrolled fear:

"A long-time patient of mine who had always been fearful read How to Overcome Fear of Dentistry and then decided to let me do the three-unit bridge that he had been postponing for several years. Your book helped him to get it done. Thanks from both of us!" Dr. B.S., Cincinnati

By allowing your patients to assume responsibility for their dental fear, you will empower them to be able to be more relaxed in your chair. They will be more at ease and so will you and your staff. You can order the book, How to Overcome Fear of Dentistry ($17.95) and the audiotape, Learning the Relaxation Response ($16.95) by calling (513) 771-2230. Discounts are given for multiple copies ordered.

The book, Managing the Apprehensive Dental Patient, is also available ($44.95). Dr. Omer Reed called this book, "a remarkable aid" and Dr. Gordon Christensen labeled it "highly pragmatic and yet scientifically sound."

Here are some ideas that might help you build your practice by treating fearful patients:

Keep a copy of How to Overcome Fear of Dentistry in your reception room. This will stimulate conversation and will help to enhance your image of being a gentle dentist.
Keep a book in the treatment room. When a patient exhibits extreme fear, suggest that he or she take it home, read it, and practice the relaxation exercises. It'll make your job easier.
Design your entire office for relaxation: soft colors, quiet mood music, and friendly staff.
Take extra time with phobics. Be prepared to listen. Always stop if they request it.
Don't keep these patients waiting. The imagination has more time to run wild.
Start a dental fear control program of your own. Be creative. Get some ideas from the book.
Tell your online patient to visit this website. This information might help.
Develop friendships with a psychologist in your community in case you need to refer a difficult phobic. They'll be happy to help you.