Fear of the dentist? Solutions exist!

From simple apprehension to true phobia, the fear of the dentist concerns more than half of the French. Most often, it is related to the fear of pain and a bad experience in childhood. It can, in some cases, cause the refusal of any dental care.
Also called stomatophobia in the most serious cases, the fear of the dentist can have serious consequences on the teeth and health in general. Relaxation techniques, medication, conscious sedation or general anesthesia ... help to overcome them.

The fear of the dentist, an extremely widespread fear

According to a recent survey, 54% of French people are worried about consulting their dentist. If for 35% it is only a slight apprehension, 19% see a real problem, 2% admitting never to consult because of that. In the majority of cases, this fear goes back to childhood, the older ones keeping the memory of a bad experience (pain, care under stress ...) that they transmit often to the youngest ones. All ages and all socio-cultural backgrounds are concerned.

Beyond the simple apprehension that leads to limiting consultations and can be translated once in place by sweaty hands or an acceleration of the heart rate, Dr. Daniel Banoun *, doctor-stomatologist, draws attention to stomatophobia: "Like all phobias, it is an intense and irrational fear, with patients coming with them, fainting in the waiting room," forgetting "their appointments or simply not taking it! the most severe stages, stomatophobia leads to a state of oral abandonment and can be accompanied by other phobias such as the fear of vomiting, blood, bites ... ".

When stomatophobia takes its toll

Refusing the consultations runs the risk of allowing problems to worsen. However, more than half of the people experiencing fears wait until a problem becomes serious or boring to consult. Even in severe pain, some prefer to use tricks, drugs and various drugs, rather than make an appointment.

In the absence of management, tartar accumulates, teeth are more and more painful, break and fall. "Pain and loss of teeth can prevent you from smiling, talking, eating, going out ... with serious consequences for your health and social life," notes Dr. Banoun, "but some patients remain unable to consult. They are ashamed of their fear and the state of their mouths, feel guilty for having waited and are afraid of the dentist's remarks.Stomatophobia causes terrible suffering, both physical and psychological. "

Untreated caries and periodontal diseases can also be the cause of heart diseases, ENT problems, diabetes imbalances ...

Solutions to reduce anxiety and be treated

- FIRST TO TALK!
Whatever the degree of anxiety, it is important to talk about it, if only to your dentist. "As physicians, we need to be concerned about the pain of our patients," says Dr. Armelle Laurenti-Griffiths **, a pediatric dentist, "and it's also in our best interest, first because a frightened patient will hesitate. to come back, then because we are always working more efficiently in a serene context ". The most stressed patients can request that their first consultation be limited to making contact.

If the mere fact of making an appointment seems insurmountable and / or stomatophobia is accompanied by other disorders, it may be useful to be supported by a psychotherapist. For Dr Banoun, however, nothing beats exchanges with other stomatophobic patients who have overcome their fears. Discussions can take place in a speaking group or on the Internet via blogs and discussion forums.

- NON-MEDICINAL TIPS AND METHODS

It is advisable 2 to avoid the excitants and to go to bed early the day before the consultation. Once in the waiting room, breathing more deeply, focusing your thoughts on pleasant subjects, listening to music ... avoids focusing your attention on the atmosphere of the office (noise, smells ...) and potential care.

Some dentists have specifically trained in one or more relaxation methods to reduce anxiety and the perception of pain (cognitive and behavioral therapies, sophrology, hypnosis, acupuncture ...). Their contact information is available on the Internet 3 or by word of mouth.

- THE MEDICINES AND THE CONSCIOUS SEED

Medications with anxiolytic or relaxing properties, prescribed by the dentist, can be taken the day before and / or before the consultation.

MEOPA 4 conscious sedation can supplement them or be used alone. Dr. Laurenti-Griffiths uses it regularly: "Just breathe in a mask and, five minutes later, you're totally relaxed, like on a cloud, the effects fade as soon as the mask is removed." MEOPA has no adverse effects, it is particularly useful for children, pregnant women, the elderly and disabled ...

Local anesthesia, of course, remains systematic for all acts that may be painful, as medications and MEOPA are mainly used to alleviate apprehensions and suppress the slightest pain such as anesthetic sting.

- NEUROLEPTANALGESIA AND GENERAL ANESTHESIA

Patients who are too distressed to respond to MEOPA and require significant but relatively short-term care may be offered neuroleptanalgesia, a mild anesthesia with analgesic and sedative medications given by infusion. Although it can be used as an outpatient, neuroleptanalgesia remains anesthetic, with its risks and contraindications.

As for general anesthesia, it requires hospitalization and is normally reserved for the most serious cases requiring the extraction of many teeth. The patient is intubated and usually kept for the night under observation. Some specialists perform additional care (periodontal care, implant placement ...) at the same time, but it is far from systematic. Otherwise, the continuation of the support continues in a "classic" way.

"Dealing with all the problems in one intervention is a great relief for stomatophobia patients," says Dr. Banoun, "they come out transformed and regain self-confidence, and some even agree to be followed later."