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Q. Is fear of dentists common? 
A. Very! Almost all patients who are fearful think they are the only ones who fear going to the dentist. The truth is that dental fear is more common than even dentists think. It is estimated that as many as 50% of the U.S. population does not get regular dental care, most of which is due to fear.

Q. What causes dental fear?
A. The most common cause is a traumatic dental experience at an early age. This is why regular preventive dental care to prevent dental problems is so important. Other causes include childhood sexual abuse, claustrophobia, agoraphobia, cross phobias (where patients exhibit a number of phobic disorders), panic disorders, anxiety disorders and what I call phobia by association. Phobia by association happens when a patient learns to fear something without any direct experience. An example would be when peers try to scare a child by telling him the dentist is going to hurt him. 

Q. Can I be put to sleep for my dentistry?
A. You can but there are some negatives. Although general anesthesia has a great safety record none the less there is a small chance of complications, the most serious of which is death. You may also have to be hospitalized and most insurance policies won't cover this. There are a few specialists called dental anesthesiologists who will be willing to work in your dentist's office to put you to sleep. Because the dentist is under time constraints when using general anesthesia the quality of the dentistry is compromised. Patients who have their dentistry done under general anesthesia are encouraged to have their teeth cleaned frequently, as often as every other month. By doing so these patients will prevent future problems and reduce their fear of the dental office as they become accustomed to dental visits.

Q. What are some safe and affordable alternatives?
A. Intravenous sedation, oral sedation and nitrous oxide conscious sedation have all been used with great success.

Q. Do I have to go to a hospital for any of those procedures?
A. Absolutely not if you are in good health. Qualified dentists with the ability and equipment to monitor the patient's vital signs can safely do these procedures in the office. 

Q. I've heard about laughing gas. What is it?
A. Laughing gas is another name for nitrous oxide conscious sedation. It is an excellent and safe way to relax a fearful patient. Nitrous oxide mixed with oxygen is delivered to the patient through a nose piece. The dentist can regulate how much the patient gets and the patient can control the effect with his breathing. The patient is awake but relaxed and responsive. 

Q. Do I still have to get Novacain if I use the gas?
A. For minor procedures relaxing gas is excellent as a pain eliminator. However, it should never be used as a substitute for adequate anesthesia. 

Q. I am pregnant.  Is it safe to use a low dose of laughing gas at the dentist for a filling?
A. No, it is not.  There is a much higher risk of miscarriage with laughing gas.  I would also recommend delaying any dental fillings until your second trimester.  If it's something that can wait until you deliver; that's even better.  Don't skip your cleanings however.  That's very important.

Q. I'm so worried about my appointment that I can't sleep the night before. By the time I get to the dental office I'm a basket case. Can anything be done about that?
A. Absolutely. The dentist can prescribe a sleeping pill so you can get a good night's sleep. He or she can also prescribe a sedative that you take an hour before your appointment to keep you calm. Someone will have to drive you to the office if you are sedated.

Q. My teeth are in such bad condition that I'm afraid the dentist will yell at me or make me feel foolish
A. Dentists who are trained in dealing with dental phobias never criticize their patients. Instead, they encourage and help them to improve their dental health and appearance.

Q. I'm deathly afraid of needles. Can they be avoided?
A. In some cases, yes. Some dentists use air abraders that use fine abrasive particles to remove decay. Most of the time this is painless and doesn't require Novocain. However, air abraders cannot remove old silver fillings and have limitations. Lasers are another new development that shows great promise in eliminating all discomfort. Like air abraders, lasers cannot remove old silver fillings. There are many techniques dentists can use to make the Novocain injection painless. The dentist can use topical anesthetics, anesthetic mouth rinses, Novocain adhesive patches and other techniques to insure that you experience no discomfort when getting Novocain. There is even a computerized injection device that delivers the Novocain with little discomfort.

Q. How do I go about finding a dentist who treats people with dental fear?
A. Rely on the recommendation of friends, neighbors and relatives rather than on yellow page ads. When you call an office be up front about your fears; don't try to hide them. Good offices have good telephone receptionists who identify themselves by name and ask how they can be of help. Request that the doctor meet with you without doing any treatment for the first visit. You should expect to pay for the doctor's time. At the very least try to get the doctor to return your call and answer your questions. If you encounter resistance to this then you have called the wrong office. At your first visit you should get to meet the doctor privately to discuss your problem. Try to meet the staff as well since they are an important part of the office. Get a tour of the office if you are comfortable with doing so. At least check to see if steps have been taken to eliminate some of the scary things you might expect to see in a dental office. You want to note if the office is clean, tidy and up to date. Dental offices that treat dental phobias exclusively don't look like dental offices. You want to note if the doctor has taken the trouble to avoid a clinical look in the office. Is the equipment out in the open or is it out of sight? Do the doctor and his staff look like operating room personnel or are they dressed in a non-threatening manner? Most importantly, are you being treated in a warm, caring manner or do you feel like an emergency room patient? Be patient; it may take several calls and visits before you find the office that is right for you.

Q. Can the fear itself be treated?
Absolutely. There are psychologists who treat fears such as fear of flying, fear of driving and fear of dentists. Through a process called desensitization you can learn how to relax and overcome your fears. We hope to offer you more specific information in the future about therapists in your area who treat phobias.

Q. Can You tell me what a DDS is versus a DMD? 
A. A DDS degree stands for "Doctor of Dental Surgery." A DMD degree stands for "Doctor of Dental Medicine." There is absolutely no difference in the degrees. Because of tradition, some schools grant DDS degrees and others DMD degrees. But there is no difference in the training.

Q. I have a terrible fear of dentists. I have been going to my dentist for 30 years. Because of my fear I didn't get dental care until I was an adult, so I do have poor teeth with bridges etc. Somewhere along the line he has forgotten my fears and is reluctent to give me gas. The last time I asked for it he said "Oh, you haven't had that in a while. You don't need it." Well I do. What do I say to remind him of my fear. I am not a very assertive person.
A. Because you have such a long relationship with him it would be worthwhile to save it for your sake. My suggestion is to write him a nice letter reminding him of your fears and thanking him for all that he has done for you in the past. Be very clear that you do expect to receive gas and if that is a problem for him then you would appreciate hearing from him before you schedule another appointment. Send the letter with personal and confidential marked on the envelope. That should do the trick.