Articles

The Guilt Spiral

Last Updated (Monday, 11 October 2010 14:31) Written by Administrator Tuesday, 28 September 2010 19:52

By Dr Rob Endicott, Dental Surgeon, Phobia and Sedation Dentist in Brighton and near Croydon, UK
www.phobiadentist.com

I am a Sedation Phobia Dentist in Brighton and Croydon and the Guilt Spiral is something that seems to strike a cord with a lot of people.

I come across this a lot, people who have been "told off" by dentists or hygienists, been made to feel like idiots because they have let their teeth go.

I believe most people know that your teeth fall apart because of too much sugar and not enough brushing so when we go to a dentist because our teeth are a mess, we really know Full Well why that has happened! Why do we then get patronised?  And why should we spend money somewhere where we are made to feel like children?

This is how I believe the "Guilt Spiral" works.

1. You may be nervous of going to the dentist already - you may have had a nasty experience as a child. You get a cavity and you know about it.
2. You think, I'll just leave it a bit whilst I build my courage to book an appointment. Oddly enough, that courage never appears. so the hole worsens.
3. It then starts to hurt. You think, "i must get it sorted really soon now" but it is already starting to give you pain - if anyone goes near it, its going to hurt more. So you delay a bit longer.
4. Then the Guilt starts creeping in - If I do go to the dentist now and tell them that I've known about this for a year, it will be "Tut, Tut, Silly You! How could you let it get like this?"
5. So not only do you have pain, you have embrassement and guilt, which only gets worse as time moves on.
6. Eventually a tipping point occurs, say an Abscess, where emergency treatment is needed, you find anyone who can help, don't know if you are going to trust them etc etc.

This is the point where I get emails from people who are crying as they type - that is very common indeed.

Here is another Guilt Spiral - and I got this from a young mum I met at a Children's party last week.

She noticed her 4 year old had a small cavity - she felt awful. She put it off for a bit because she felt so bad. Eventually the boy was getting some toothache.

The sweet boy had not been to a dentist before. She went to a local Dentist who told her off, told the boy off, made him cry AND THEN ATTEMPTED A FILLING! The dentist got stroppy with the boy, telling him to keep still whilst the mum looked on in horror.

Needless to say it wasn't a successful appointment and the Dentist has now put the fear into that little boy. It is such a shame that that Dentists behaviour has actually provided a Barrier to that child getting good Dental Care. The dentist was thinking that getting the filling done was the most important thing, rather than trying to calm, reassure, not telling the mum she has been a "Bad Parent".

I am a parent, I hate being criticised by other people! How dare they!

So, how much of peoples phobias has actually been caused or exacerbated by the Dentist themselves?  We as dentists wrongly think,"Its the parents fault, they obviously mentioned the word "Pain" to the child and got them scared" or "the child is feeding off the mums phobia".

If we are going to be a force for good, We as Dentists do need to redress our attitude to Fear Management. We need to know more about the Long Term Effect of Our Behaviour on the Psychological Health of our Patients. We need to start being nice.

there - that will annoy some of my colleagues…. angry comments please to

http://www.phobiadentist.com

Top Tips for Cavity Free Kids

Last Updated (Tuesday, 28 September 2010 20:50) Written by Administrator Tuesday, 28 September 2010 09:29

By Dr Rob Endicott

Sedation and Phobia Dentist providing dental treatment in Brighton and near Croydon, UK

Further information about how Rob can help can be found at www.phobiadentist.com

I was at a Childrens Party this Summer for a fellow classmate of my 4 year old son. I was talking to one of the mums there about her little boy Charlie and his recent experiences with the Dentist. I had mentionned to her that I was a Phobia Dentist, treating people who were really nervous of going to the dentist so she explained all.

Charlie had a cavity. His mum knew about it already, she had spotted a black mark on one of his baby teeth. Charlie was complaining about this tooth every time he ate so it was obviously starting to cause him pain. Charlie hadnt been to the dentist yet, she didnt feel he was old enough to understand and probably wouldnt have kept still in the chair.

Mum was already absolutely mortified, was she being a really bad mother? Had she been feeding her child lots of sweets? Was Charlie not brushing enough? Her child was in pain and she believed it was her fault, how could she have let this go unnoticed? Was it her fault her child was suffering? The guilt was already building up and really would not be helped by what happened next.

So, she went to a local dentist. It really didnt go well. Firstly, the Dentist AND the Dental Assistant made the mum feel so small, so patronised for allowing Charlie to have sweets and fizzy drinks, not brushing enough and not having been to a dentist earlier to prevent the cavity from appearing in the first place.  Mum knew all this already, was already feeling guilty, so that guilt was absolutely confirmed by the Dentist.  Mum at this point is wondering where the exit is.

The Dentists starts to have a go at Charlie, telling him he's having too many sweets and not brushing enough. Charlie is getting worried, he's being told off by two strangers who have masks and gloves on, with a bright light shining in his face. If youve seen horror films before, isnt this sounding familiar?

Then the dentist proceeds to try to fix the problem with his drill. High pitched noises of the drill, lots of water spray, high powered suction to get rid of the water, Charlie really isnt happy, he starts crying. The Dentist isnt having it, is losing his patience, "dont be silly, lie still, it wont hurt".

Mum plucks up courage and says to the dentist "tell you what, we will leave it there, ill go somewhere else" and walks out.

The challenge now is to persuade Charlie that going to the Dentist can be nice and fun, not scary, it can be comfy and gentle, noone has to tell you off. The challenge now is to get the filling that needs doing done without making worse the dental phobia that is starting to build in Charlies head.

The dentist had been trying a very old fashionned Healthcare approach. In that one visit, he was trying to fix the problem with the tooth, prevent the problem coming back by "not so gentle" rebuking, thinking that that will improve the childs health.  Sure if it works, that will improve health in the very short term, but Charlie wont be going back to a dentist in a hurry and if he does develop further problems with his teeth its going to be a lot harder to treat. So, long term healthcare is being jeopardised by trying to improve Charlies health in just the one visit.  You still hear of stories of Dentists restraining "difficult children", although as a practice it is thankfully dying out.

So, how do we prevent our Children getting to this situation in the first place?  Fortunately it is not too complicated.

The little known Truths about Kids Cavities

Cavities in baby teeth are very common, especially in areas where there is no Flouride in the water. So if you think that you are the only mum or dad to have a child with a cavity, think again!
Cavities in baby back teeth often start without any signs at all and are difficult to spot in the early stages, even for a dentist. Often the first sign there is of a problem is an black or grey mark in top of the tooth, and probably a obvious dent where the top of the enamel has broken down.
Cavities are surprising easy to start. You dont need lots of sugar, lots of sweets or fizzy drinks, we often see children who have lots of sweets (freely admitted by parents) with no sign of cavities.  The question is WHEN rather than HOW MUCH.

Teeth are under acid attack from plaque bacteria all day, even with the best brushing in the world.  The reason why cavities arent forming all the time is that the enamel has the ability to repair itself, often called "re-mineralisation". Lets have a look what happens to the tooth from a single hit of sugar:

1. Sugar hits the teeth from most meals, sweets, cakes, drinks etc.
2. The bacteria on the teeth turn the sugar into acid
3. The acid starts to weaken the enamel
4. The sugar gets washed away over the next few hours by the saliva
5. As the sugar levels in the mouth drop, the bacteria run out of their food and stop producing acid
6. The minerals in the Saliva deposit back into the de-mineralised areas and re-hardens them.
7. The tooth returns to normal.

Any sugar, whether it is hidden in foods or milk, or pretty well "neat" has the abillity to cause a cavity.  The problem comes when the teeth dont get a chance to rest between attacks and remineralise.  Have a look at those points again but this time, insert more sugar in that two hour period of rest. When the sugar gets reintroduced in that few hours, you go back up to the top of the cycle again.  More and more de-mineralisation occurs and soon a cavity forms.

So it really isnt whether you have five biscuits or one in between meals, if you dont give the teeth a rest, a cavity will develop.

So, the best plan is to keep sugar to around mealtimes, avoiding the cheeky biscuit in between meals and make sure that no sugar hits the teeth at least on hour before bedtime.

The challenge of brushing Kids teeth!

As we said earlier, even the best brushing in the world cant rid your whole mouth of plaque bacteria, little children cant floss particularly well, kids brushing is often sporadic (it can be in my house) so you do the best you can! As dentists, we believe that one of the main reasons for brushing, apart from reducing the amount of bacteria about, is to get Flouride onto the teeth. Flouride is well proven to strenghten teeth in lots of ways, as they develop in the jaw but also as they re-mineralise, repairing teeth with stronger reinforced enamel, more resistant to acid attack.

Twice a day with a suitable level of Flouride is normally recommended but if your child is at risk of cavities, it may be sensible for your dentist to supplemement the flouride intake with drops or chewable tablets.  I would advise against the use of Non-Mint toothpaste because it is a nightmare to get kids off the fruity ones onto quite strong tasting adult mint toothpaste. Kids toothpastes come in mild mint flavours which are quite pleasant. Kids toothpastes dont contain too much flouride so it is allright for kids to suck on their brush after theyve cleaned.

The one other piece of advice is to avoid brushing immediately after high acid foods and drinks, like citrus juices and fizzy drinks. The loose enamel gets brushed away and thins the teeth. Leave it at least an hour.

Sounds obvious, but a Healthy diet is very useful

A good healthy diet is essential, including roughage. High fibre foods are very good at reducing plaque build up as they knock bits of plaque off the teeth, more liquid of soft diets allow food to push and get stuck in between the teeth. The is a whole article that could be written about Healthy diet for good teeth, there just isnt space here. Just make sure it is balanced and everything in moderation!

Regular Positive Dental Visits

Find a good dentist who is understanding, fun and patient with children. Get them in early, say around the age of two, bring them with you for your checkup, just to see you in the chair, dont hurry them to get in the chair and have a checkup, if your child is showing signs of reluctance to sit in the chair, dont force the situation, keep it light and leave it for a month or so. Any pressure early on from parent or dentist, not allowing the child to get naturally settled with the idea of showing their teeth to a stranger, can affect their confidence and slow down the amount of time it takes them to trust the "stranger" dentist.

Find a dentist who likes Preventative Dentistry, we have some great technology available to us now like the Diagnodent Laser Cavity detector, which can find cavities before xrays, without you feeling anything.

Read some stories with your child about "Going to the Dentist" a few days before their visit. There are lots of fun books out there that are great at reducing the initial scepticism that the child may have.  One tip though, read the book yourself first in the bookshop before buying, dont read them any book that introduces the words "pain", "fear", "hurt". Believe me, i've found books like that.  If you start associating a trip to the dentist with these words even slightly related, the child will wonder why.  Avoid these words at home, phrases like "it wont hurt" have the opposite intention on a child! 
Keep all your talk positive, explain what the dentist will probably be doing, the ride in the chair, the dental mirror, opening your mouth wide "like a lion roaring",  counting your teeth and the bribery of the sticker. A child who understands will be more likely to get in the chair without apprehension.

So, to summarise, it is quite easy to get cavities in kids teeth, they can be prevented by rationning sugary things to mealtimes, giving the teeth a break inbetween, the best brushing you can get with a kids Flouride toothpaste and above all, keep very positive about going to the dentist, avoiding associations with negative things like pain, fear and hurt.  That way your child will be able to have long term confidence in the dentist and dental nurse, making any future treatment easier to achieve.

The Miracle Of Sedation or Snooze Dentistry!

So if you are one of the people that dreads drills, but wants to do away with decay you should start to explore sedation dentistry.  You could be a candidate for conscious sedation if you have...

• Fear of needles
• Have had bad experiences in their past with a dentist or in a dental practice
• Have dental phobias Toothaches or Headaches
• Missing teeth
• Desire a more attractive smile
• Fear the pain of dentistry
• Hate drills or the smell of the dental practice
• Irritated with their partials or full mouth dentures
• Have children who fear the dentist
• Jaw Problems
• Are in need of a crown or bridge
• Old silver fillings that need to be replaced
• Had some SERIOUS cavities and it was affecting your overall health
• Experience Low Self-Esteem or Poor Self Confidence
• Bad Breath
• Experience Constant Oral Pain
• Trouble eating certain foods
• Can’t get numb with anesthesia
• Want to snooze through their dental care using sedation dentistry
• Or simply anyone who wants a dentist who will give an anxiety-free and comfortable dentistry experience.

That’s just to name a few.
Many patients have tried different ways to alleviate the fear of going to the dentist with little or no success. They have searched for years, using hypnosis, meditation, and even going to therapy, but never did they think they could go to an practice where Fear, Pain, and Anxiety are a thing of the past.

How It Works

Sedation dentistry allows patients to become drowsy and, in most cases, snooze right through their dental procedures. The actual process involves patients taking a fast acting sedative a few minutes before their procedure. The sedative or analgesic can sometimes be administered in a pill form, while other times it will be administered intravenously. When the medication kicks in the patient usually becomes extremely relaxed and drifts into a snooze-like state. When they become coherent after surgery most patients have no memory of their procedure at all.

Patients who opt for sedation dentistry are usually reminded to have someone around to drive them home after their dental appointments because typically sedatives will take several hours to completely wear off.

Sedation dentistry is not for everyone, but for those who have been avoiding getting their teeth fixed because of fear, paranoia or discomfort this method can be extremely beneficial.

So if you are ready to embrace healthy teeth and gums, relax, with sedation dentistry you will drift away into dreamland and wake up with a sparkling, new smile.

Local Anaesthetic

I like to make sure you dont feel what we are doing.
However, a lot people are scared of Painful Injections. I like to make mine easy. I've developed the EasyJect System

1. I warm up the anaesthetic solution so its at body temperature
2. I use very strong anaesthetic to give really deep numbing
3. I use Bubble Gum Gel to numb the area beforehand, so you dont even feel the prick of the needle
4. I inject Slowly for more comfort
5. I use the thinnest needles we can get hold of so they are really comfortable
6. I rub the gum on the roof of your mouth first so you dont feel the needle going in
7. I use lightweight, metal free Syringes for ultimate control and accuracy
8. We do not carry on with treatment if you feel it!

In fact, a recent survey we did showed that 96% of patients found our injections extremely comfortable to completely painless! A common phrase heard is "I've never had one like that before!"

Sedation

If you want the ultimate in comfort, whether you are slightly nervous, really Phobic, or just having lots of treatment done, we can offer Three Types of Dental Sedation.

Nitrous Oxide (Laughing Gas!) for gentle needle free relaxation and control of discomfort

Oral Sedative, a little white pill to take an hour before treatment to make you more relaxed

Intravenous Sedation, the deepest form of sedation we do - very comfortable, we can do a lot of work and you aren’t really aware of whats happening, you can just Snooze as we treat!

New - Intranasal sedation

if you like the idea of full sedation but can't stand the idea of the needle in the arm, then a quick mist spray up each nostril will get you extremely relaxed so that you won't care about the needle going in - email me for more details!