Bashar Al-Naher a winner of the best care of nervous patients at the Oral Health Awards 2017 discusses the Enjoyable Dentistry Technique – a method for treating dental phobic patients successfully, effectively and predictably
The Enjoyable Dentistry Technique is able to cure lifelong dental phobics and patients with severe anxiety to dental treatment, in as little as one session.
Not only that, as the technique is reproducible and able to be repeated again and again, each time with increasing effectiveness, it has a negligible failure rate.
The Enjoyable Dentistry Technique has taken 15 years to perfect and allows patients with any type or severity of dental phobia and anxiety to dental treatment to experience dentistry in a relaxed manner, to the point where they may even positively enjoy it.
The nature of dental phobias
It is thought that dental phobias or severe anxiety to dental treatment can affect as much as 25% of the population. Such patients exhibit severe anxiety issues when it comes to dental treatment and need specialist attention and treatment in order to manage them in an ethical and humane way.
Unfortunately, because of the complexity and variety of dental phobias that present themselves, the majority of dentists have not been trained to effectively deal with such severe conditions.
In fact, attempting to deal with such patients may compound their phobias and make them worse.
Furthermore, it renders the dental practitioner open to litigation for attempting to deal with something that is beyond their scope of skills and training.
It is, therefore, a legal and moral obligation to refer phobic patients or patients with severe dental anxiety problems to specialists in this field.
Needless to say, patients who are dental phobics and those with severe dental anxieties often present with psychological traits that make them more prone to resorting to litigation, especially if things go wrong.
Dental phobics and those with severe dental anxieties can be identified in a number of ways.
Firstly, they often openly say that they have dental phobias and/or severe anxiety to dental treatment, usually on the phone as they are booking an appointment. Typically, it is not the patient themselves that calls but a relative or friend who are concerned about the patient’s dental health.
There can often be a certain degree of coercion or thinly veiled threats by concerned parties of patients who are phobics, which puts pressure on them to go for a dental appointment.
All these signs have to be identified by the reception team and passed to the principal for a decision to be made as to whether the patient can be seen or should be referred to a specialist dental phobia centre.
Secondly, patients with dental phobias will show signs of extreme anxiety or ‘fight or flight’ behaviour. They will look agitated, sweaty, restless, on edge and positively nervous.
They may show signs of being aggressive or rude either on the phone or, more likely, when they first present to the practice.
They may be anxious to be seen quickly, seem very impatient and enquire often as to when they are going to be seen and how much longer they have to wait. They may be visibly upset and even cry in reception.
On entering the dental surgery, the patient may burst into tears or be reluctant to sit on the chair. If they are able to sit on the chair, they will often be reluctant to open their mouth or display severe gag reflex if anything is placed in it. Treatment on these patients by practitioners not qualified to deal with such cases may be difficult or impossible.
The patient may show signs of extreme tensing of his or her muscles in anticipation of feeling pain that may render dental treatment impossible. They may twitch or make sudden movements at the slightest feeling of discomfort, which is greatly exaggerated, they will seem visibly distressed, sweaty and flushed. They may experience uncomfortable palpitations, which further aggravate their unease. They may dare to pull your hand away while you are giving the local anaesthetic or while drilling, which is a danger not only to themselves, but also you and your dental nurse.
They may feel faint and go through a full vasovagal attack (fainting). They may exhibit signs of a panic attack, which includes heavy breathing, breathlessness, sweating and a severe feeling of unease.
It has to be stressed that patients with dental phobias have virtually no conscious control of any of these responses.
Finally, the situation may reach a point where either the patient or the dentist decides to end the attempt at dental treatment. This unfortunate outcome serves to further compound and entrench the dental phobia and acts as an even further setback to the patient ‘proving’ that the dental phobia has taken control and that there is no hope for him or her.
Results of phobia
As a result of dental phobia, such patients often allow their dentition and oral hygiene to deteriorate to an unbelievable degree. Often, such patients will present with severe periodontal diseases and severe caries in most, if not all, of their teeth. Such patients would usually need complete rehabilitation of their dentition, which is often a prolonged and complex affair.
The state of their dentition often has a major negative effect on their life. Patients with dental phobias or with severe anxiety to dental treatment usually have low self-esteem and are either depressed or on the verge of depression as a result of the chronic pain that they experience on a regular basis, the inability to eat properly, as well as the unaesthetic nature of their dentition.
Their inability to smile and their negative perception of themselves further serves to cause a deterioration in their psychological state, and this can have a major impact on all other aspects of their lives, such as getting a job. Their social, emotional and intimate relationships are also often flawed and dysfunctional. Often as result of all this, their economic situation is also flawed, making good quality dental treatment even less likely, and making the situation even worse.
A new technique
The main driving force behind the Enjoyable Dentistry Technique was a realisation soon after qualifying in 1985 over how many dental phobic patients I was encountering in everyday practice and how ill-equipped to deal with them I found myself to be, despite qualifying from Guy’s – one of the best dental schools in the UK.
I also found that I had an aversion to seeing patients in pain and found it personally very distressing.
My quest for ways of treating dental phobics and patients with severe anxiety to dental treatment took me into the exciting and fascinating world of the psychology and bringing about a change of psychological and emotional state in people.
It led me to the most effective forms of self-change and self-development. It opened my eyes to neuro-linguistic programming (NLP), and took me into the world of hypnosis. It also showed me the field of conscious sedation – specifically, relative analgesia and sedation. My quest, over a 15-year period, involved me completing a masters in clinical hypnosis applied to dentistry from University College London, as well as a postgraduate diploma in the same field. In addition to many other courses in psychology, hypnosis and trance states, I completed full NLP training and a postgraduate diploma in conscious sedation from King’s College London, and became a clinical tutor in the department of sedation at Guy’s Hospital.
I was able to provide scientific validity for the Enjoyable Dentistry Technique by way of my MSc research project and dissertation. I had proved scientifically that the Enjoyable Dentistry Technique allows the majority of patients to eliminate their phobias as well as experience relaxing, comfortable and positively enjoyable dentistry.
The basis of the Enjoyable Dentistry Technique to cure dental phobia relies on the ability of the technique to produce a radically different experience for dental phobic patients. For most patients, these phobias usually develop at a young age after experiencing one (or more) painful and/or uncomfortable dental treatment sessions. This is then made worse every time that patient goes through another failed attempt at treatment.
The Enjoyable Dentistry Technique thus relies on bringing about a profoundly positive, radical change in the dental experience these patients had been used to feeling before.
From a state of panic-stricken terror, stress, distress and fear, we aim to take the patient to a pain-free state of peace, tranquillity, safety and security, happiness, joy and bliss.
This profound shift serves to prove to the patient that it is possible for them to not only experience totally pain-free dentistry but also relaxing, comfortable and even enjoyable treatment. This obliterates any negative previous dental experiences and becomes the dominant one in the patient’s psyche.
The patient receives a tremendous psychological boost to their confidence in dentists and dental treatment and is then well on the way of getting over the dental phobia. When this positive experience is repeated, with increasing depth and effectiveness each time, the old negative phobic pattern gets eliminated from the patient’s psyche and replaced with the new pattern. Eventually, the patient will find it hard to identify with the old pattern.
Applying the technique
The priority in treating patients with dental phobias is to get them in ‘the enjoyable dentistry state’ as soon as possible. This is a state of deep trance when the patient is in an altered state of consciousness and is in contact with the unconscious mind, which can direct the patient to be in a state of deep and profound tranquillity, safety, security, happiness, joy and bliss. This state must be maintained throughout the dental treatment.
So, after the initial consent process, the patient is administered nitrous oxide and oxygen sedation. Usually, the patient is administered 30-40% nitrous oxide and 60-70% oxygen, breathed in only through the nose. The gas mixture has to have a definite affect before the next stage is initiated. As well as feeling relaxed and comfortable, the patient will experience a floaty feeling and start to feel sleepy and drowsy. When the patient confirms that they are feeling these feelings, the next stage is initiated.
The second stage aims to guide the patient into a deep and profound state of trance. This stage requires a lot of skill and experience and involves communicating a specific series of instructions to the patient in a unique tone of voice and rhythm so as to promote this deep state of trance.
The state of trance is a hypnotic-like state – which is neither a fully conscious waking state nor sleep state – where the therapist’s voice has the power to turn words into real images and feelings within the patient, so much so that the patient
actually takes the instructions to be real. Typically, the patient is ‘taken’ to the most beautiful garden and spends his or her time there for the duration of the treatment, experiencing amazing, deep and profound feeling of peace, tranquillity, safety, security, and happiness.
This state of deep trance has to be maintained throughout the treatment sessions by skilful use of trance-inducing language patterns that maintain and even deepen the level of trance.
The patient is woken at the end of the session thinking that the length of the appointment is less than the actual treatment time; this is the magical effect of combining nitrous oxide/oxygen sedation with trance inducing language patterns.
The success rate of the Enjoyable Dentistry Technique is very high; thousands of dental phobic patients have been treated successfully.
In conclusion, the Enjoyable Dentistry Technique is a breakthrough approach in treating dental phobic patients effectively and predictably with a high degree of success.
Tips for dealing with phobic or nervous patients
• If you have any doubts as to whether you are able to manage a phobic patient then it is best to refer such a patient to a specialist centre
• If able to manage that patient, the most important qualities you need are patience, persistence and empathy
• Explain to the patient that you are aware of the nature of dental phobias and you are aware that the patient can’t help behaving in this way and that it’s okay
• Let patients behave in any way they want, provided it’s not harmful to themselves or others
• Be careful not to criticise or tell patients off or reprimand them
• Allow patients to cry if they need to. Speak to them in a calm manner and continue to persist in wanting to treat them
• Injection techniques have to be totally pain free, even ID blocks and palatal injections
• Ensure the teeth are totally numb before even thinking about starting treatment
• Try to do a small amount of treatment each time so that the patient can gradually learn to cope with dental treatment.
Bashar is the principal of The Care Dental Group: Care Dental Platinum and The Care Dental Practice.