Dental anxiety affects upto 50% of the UK adult population. As such, anxiety managment is a routine challenge dentists face and one we should be well equipped to manage.
Patients with significant anxiety are often managed using concious sedation. However, in this article, Dr Munir Ravalia discusses the non-pharmacological alternatives to consider when treating this cohort of patients.
Lecturer in Conscious Sedation, Medical & Clinical Hypnotherapist
Royal London Hospital
Munir qualified from The Royal London Hospital in 2002. He completed training as a Senior House Officer in Oral & Maxillofacial Surgery.
He is currently a Trust Dentist and Clinical Lecturer in Conscious Sedation at The Royal London Hospital and provides a peripatetic sedation service for dental practices.
In addition to his formal training, Munir has been trained in acupuncture for the head and neck region and obtained a Medical Diploma in Clinical Hypnosis. He is leading the clinical team at the hospital with a new psychology team, utilising techniques such as CBT, and Cognitive Hypnotherapy, to revolutionise the patient journey and placing at the forefront non pharmacological techniques for the management of those with severe dental anxiety and phobia.
Anxiety towards dental treatment is widespread in the population, it is a global phenomenon. The adult dental health survey in the UK figures report between 36%- 50% of participating adults had moderate dental anxiety and 12% extreme dental phobia. It is evident that much severe anxiety goes unreported as sufferers may not attend the dentist due to their fear.
Dental anxiety is unpleasant for sufferers. There are physical, psychological and behavioural consequences of anxiety and it may lead to neglect of the dentition.
For dental care professional’s anxious patients are an important cause of stress as it is often difficult to provide treatment for such individuals. In addition, anxiety may lead patients to cancel their appointments or simply fail to attend their appointments on the day.
Both pharmacological and psychological approaches to overcoming fear of dental treatment are widely reported in the literature, but no one approach is applicable to all. Behavioural methods have been shown to be effective and there is some evidence that long term improvement is more likely in patients who receive such methods compared to those who receive pharmacological interventions.
1) Non-pharmacological – CBT, Clinical Hypnotherapy
2) Pharmacological – Conscious Sedation – Inhalation, IHS and GA
So, what is clinical hypnotherapy and CBT? Clinical Hypnotherapy can simply be defined as a heightened state of awareness, whereby the therapist assists you to go into a deep state of relaxation, and is then able to give the patient the relevant suggestions for the changes they wish to make, it is known as the medicine of the imagination. CBT is a type of talking therapy, which focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour, and teaches coping skills for dealing with different problems.
A key question to ask is why do some patients fail even under conscious sedation. Well the answer may lie in the fact that the mind is divided into the conscious and subconscious. The most commonly used sedative can make people react in two ways- some become well sedated and cooperate under sedation and some react the total opposite way and become more agitate and angry, whereby you cannot provide the treatment safely. There are of course some key pharmacological issues at play, but a lot of those patients with a ‘failed sedation’, will likely have significant life events, which have now shaped the way their brain reacts.
As such mind therapies are key in healing these patients not only move forward in their dental journey but also helps them in their life.
Various pathways are available, from traditional university recognised certificates and diplomas. There are also many accredited CBT, Clinical Hypnotherapy institute’s that offer training for dentists and other allied health care professionals.
My advice is, if this is an area you are interested in, to have a chat with someone in this field who can then advise you and you can tailor your learning to what suits you, as you may wish to pursue such avenue in general practice or in the hospital setting.