Most dental practitioners put a great deal of effort into building up good dentist-patient relationship, based on the patients trust in their dentists skill and care, Yet, it is estimated that anything from 5% – 10% of the population will not go to the dentists under any circumstances, sue to an intense fear, or phobia, of dental treatment. For a larger number, they will only seek dental treatment as a last resort, when they are in severe pain or have had a tooth damaged or lost. Up to 75% of the population has had a degree of anxiety about dental treatment.
Most people who are phobic or severely anxious about dental treatment have acquired these fears in childhood. Phobias are usually considered to involve the amygdale and the hypothalamus, parts of the brain that do not respond readily to logical arguments, proofs etc. Once the connection between dentistry and danger is made(the phobia trigger), these more primitive parts of the brain override more logical reasoning in favour of the need for dental treatment. Dental phobia is most commonly acquired through painful dental treatment and where the dentist is uncaring and unsympathetic.
There are also common phobias which are not directly related to dental treatment but which may lead to patients avoiding dentistry, amongst these are claustrophobia, where the patient may be afraid of being confined in the dentist chair, and needle phobia, which is suffered by an approximately 10% of the population.
How hypnosis works
For many years it was debated whether hypnosis was a distinctive phenomenon, or whether it was only a collection of elements such as role-playing, cooperating with expectation, etc. However, more recent neurological research has indicated that hypnosis is distinct from other cognitive operations and, as such, has a particularly helpful role to play in working with problems that are resistant to reason and logical argument.
In a hypnotherapy session, skills and techniques are used to engage trust so that the patient will be willing to engage emotionally (known as rapport in a therapeutic setting) with the therapists directions. Research into neuroplasticity has indicated that an intense quality of attention is required for lasting change in the brain, which is necessary to rewire a phobic behaviour pattern. The intensity is facilitated and enabled by the trance state in which the imagination is disinhibited and focuses with a high level of power on the directions of the therapist. These directions are agreed in advance, in accordance with the patients therapeutic goals.
Most of the training required for hypnotherapists preparing to work in a general therapeutic setting involves learning how to engage the clients trust and emotional cooperation in a variety of ways adapted to the individual. Once this trust is engaged, the particular communication skills needed for dealing with the emotional and imaginative parts of the brain are used – primarily structured forms of suggestion which are more readily accepted by a patient in trance.
However, members of the dental team are in a position of special advantage in using hypnosis with their patients. The patients who will need hypnosis will be in a highly emotional state, either from fear or pain, or both. Their emotions are dominant at the time so they are highly motivated to accept relief. Research has indicated that in such a situation a rapid and effective response can be achieved by people in clear and visible roles, in a structured clinical setting.
There is a choice of levels at which hypnosis can be used in dental treatment, from providing recordings in advance of treatment for patients to practise with at home, to using trance in treatment sessions. A dental practice can chose the level to which they wish to use hypnosis, and any member of the dental team can chose the level to which they wish to train.