Many patients with dental phobia visit the dentist's practise to have their teeth fixed under anaesthesia. Some of the patients believe that afterwards their fear will be gone forever. But they forget that some treatments cannot always be done by one anaesthetic session. Although aesthesia may be right for some patients, it doesn’t mean that the affected patient thereby loses his/her dental phobia.
For this reason we offer the patient different alternatives during the treatment. For some patients anaesthetic may be the right decision, another patient feels better when conscious with just a slight sedation of suitable drugs administered. Again other patients only want their minds to be taken off the noise of the drill by watching video films or listening to music. You see, there is a whole arsenal to defeat phobias of our patients. Our Therapy Centre against dental phobia tested and decided to offer a special service called “one-session-treatment” which consists of different parts:
In order to not feel completely at the mercy of dental fear, you can learn to actively use a relaxation method. Together with your psychotherapist / psychologist you can learn a method called “the progressive muscle relaxation according to Jacobson”. With this procedure you train how to put your body into a state of relaxation.
You can use this method during any situation of anxiety at your dentist’s visit. The vicious circle is thereby interrupted and you can learn in such a way as to reduce your fear. This requires that you learn the relaxation exercises properly and exercise them daily. Afterwards you and your dentist and can work out a treatment plan together, which will allow you to use your relaxation exercises during the treatment.
In order to replace the negative thoughts you associate with a dental treatment by positive and more realistic pictures, the psychotherapist / psychologist develops, together with you, reassuring affirmations. Whenever you think of the forthcoming dental treatment and anxiety arises, you should repeat these affirmations aloud to yourself (self-verbalisation).
Only in the early seventies an increasing number of case reports (Gale in 1969, Klepac in 1975), as well as controlled studies proved that the use of behaviour-therapeutic interventions like the systematic desensitisation can lead to a continual reduction of dental phobia (Gatchel in 1980, Mathews in 1977). The first reports on a successful behaviour modification had already been derived from 1924. Mark Clever Jones reported on the modified behaviour of a small child who was afraid of a rabbit.
The rabbit could slowly be brought closer and closer to the child, while the child was busy eating his favourite dish (cit. Ingersoll1987). This technique of replacing a nervous reaction was developed by Joseph Wolpe (1958) in the 60s. In the following years Wolpe’s method was successfully used for several different irrational phobias. With this technique, impressive results have been achieved, especially in the reduction of phobias related to animals, queues, insects, syringes, water, crowds of people and flying, to mention only a few.
Other procedures, as for example cognitive attempts (Ellis in 1974, Corah in 1979, baker in 1981), model learning (Melamed1975) and pure relaxation therapies (Öst in 1987), have been used in single therapy as well as in combination with reducing fear in phobias and were examined in various clinically controlled studies for their efficacy. The aim has always been to create a short therapy with the best long-term effects. This recently led to the development of so-called one session treatments, which De Jongh successfully used for the first time in 1995 for the treatment of dental phobias. Nearly all methods are based on the following principles:
The patient is informed extensively about the upcoming treatment. Patients learn by the treatment that their fear disorder is not an exception and that they do not need to be ashamed of the situation. Patients will gradually be brought forward to the treatment (in vivo or in sensu), until they have learned that they dominate the situation and can control their fear.
The application of these psychotherapeutic procedures only makes sense, when they are used in close cooperation with a psychologist or psychotherapist trained in this method. This requires the contacting of appropriate institutions close to the dentist’s rooms and the definition of a joint therapy draught. Our experience is, that we noticed that some patients go back to their old behaviour of avoidance and never come back to the dentist although they made an appointment with a therapist.
In addition, a successful therapy depends strongly on the compliance and cooperation of the patient. Lindsay (1987) recommends letting the patient participate in the choice of the anxiolytic method. Incidentally the patient needs to be informed that after a failure it is always possible to continue the treatment under general anaesthetic. Despite -the above mentioned methods, some patients with dental phobia cannot be treated without full anaesthetic.
Therefore, the following chapter will be confined exclusively to the indication, contraindication and execution of a dental therapy under general anaesthetic.
