Using Animals For Your Fear Of The Dentist?
Anxiety towards dental treatment and the dental profession in general still remains the main stated reason as to why around 50% of the UK population fail to seek out dental care except in an emergency situation.
Patients cite a fear of pain and yet when they present, they are already in pain. Because they are in pain, the experience is perhaps more uncomfortable than the dentist would like, they are often rushed (presenting in an unscheduled or overbooked appointment slot) and it escalates the cycle of fear. We lose these patients: bad for us, bad for them.
But is this necessary? I have become very interested in the treatment of anxious or phobic patients not only because they present a challenge but because, as a totally private dentist working in a very remote practice, We cannot afford to exclude a large number of potential patients.
Over the years we have become skilled in most anxious techniques: including conscious sedation and occasionally hypnosis.
Mostly, however, we try to revert to behavioural modification techniques as well as desensitisation techniques. However for children and late teens in particular, a good technique we have fostered is that of 'animal therapy'.
We aim to give people value for money and also give them an experience that is a little bit different.
The receptionists here are very friendly and go to great efforts to make everyone feel welcome. Patients have staff made cups of tea or coffee while they wait.
So all this helps reduce anxiety, but what about nervous teens who have ‘seen it all before’, who mistrust clinicians and who will not even make eye contact let alone open their mouth? A lot of dentists send a letter to the local General Anaesthetic department with the inevitable 18 month wait for treatment?
My response when I see negative behavior like this is to simply ask whether they “want to see the ferrets?”.
As you might imagine: not the statement they were expecting.
Initially distrustful, at least they are out of the surgery right? Well, we have a handful of ferrets (amongst other animals).
They live in a walled enclosure in the garden and they have a little tunnel they come out of when you call. They are like little meercats: tame, comical and obliging. Also not what most children are familiar with and so it opens dialogue... and that is what it is all about: getting the child to talk, open up and to give opportunity for gaining trust.
I take them out of the surgery, they look at me and think, perhaps that ‘there is that cool bloke with a ferret’, not ‘I hate all dentists’. You can see the fear and anxiety melting away. I show them the ferrets’ teeth and they are fascinated. 10 – 15 minutes and you have changed their attitude completely.
We go back into the surgery and their behaviours are completely different: they jump into the chair talking to a bemused Mum about what they had just experienced.
The examination of their mouth then, almost without exception goes well as both patient and dentist has a common point of reference: a friendship and trust has been established. A first step on the road to dental rehabilitation reinforced to discussions about them and their teeth: to which intra-oral photographs displayed on a computer screen helps greatly. Get the patient to understand, to own their problem, and motivation is increased.
Of course there are obvious downsides to this technique: I have to change my clinical top and gloves when we go out to see the animals and there are of course health and safety issues. The children aren't allowed to hold the animals but they can stroke them.
Our pigs, for example are very gentle but patients would not be allowed to see them up close unaccompanied and people are never allowed into the field with the horses. It is like everything else. You have to do health and safety risk assessments and it detracts from actual clinical time. But it can reap rewards. The next step is to take that fledgling trust and shape it: not destroy it. There is no point in carrying out these exercises if your clinical skills are not up to par, but if they are… you probably have a patient for life.
Impress Mum and Dad and you end up with full books in no time. Many of my colleagues think I am a little mad, they do not understand my wasting of clinical time but it works.
Written By Dr Mark Boulcott