Why don't more people go to the dentist? RA (Inhalation Sedation)

The Anxiety Angle

Without quoting specific studies, I think most of us that have anything to do with

the dental profession would say that one or more of these factors would cover most of the reasons that most people delay or put off attending for dental care:

Fear, anxiety or phobia                  
Perceived high cost                        
Embarrassment                             
An embarrassing gag reflex 
Fear of being told off for:
  

·       Poor Oral Hygiene or diet

·       Non-attendance / erratic attendance 

·       Allowing dental health to deteriorate.

For the moment, I would like to look at the first of these. 

Dental Fear, Anxiety and Phobia. (DFAP)A very recent Canadian study[1] by Campbell J, (a third-year resident in the Dental Anaesthesia program at the University of Toronto, Faculty of Dentistry) summarises what I have been aware of and writing about for many years.

"patient demand for sedation and anaesthesia services is not being addressed fully by dentists".   

“Dentists perceptions for the need and demand for sedation and anaesthesia is clearly not corresponding to what patients would like, however, patients are leading us to believe they are attracted to these services"[1]

Given that in the UK, anaesthesia services will be reserved for the most difficult cases by referral, the larger proportion of those with DFAP are managed outside the hospital setting.

So for a general dental practice, the decision is whether to offer many of those patients who need or ask for sedation, the help that they need and what are the consequences of failing to provide that option? What of those who don't ask for sedation but would be very grateful if it were offered?

I understand full well that sedation is not the only way to manage DFAP.  My own experience (yes, anecdote) over 38 years in busy general dental practice settings, of utilising conscious sedation techniques, has been that without doubt it has helped a large number of patients, transforming their dental experience and often "curing" their DFAP in the process.

Again my own experience with the same cross-section of people that would attend most dental practices, is that Inhalation Sedation ("RA" if you prefer) should be far more widely available, as it will successfully manage about 90-95% of these anxiety cases. The others may not be suitable for this technique or have expressed a specific preference for say, IV sedation.

I have deliberately excluded true phobics here, as their irrational level of anxiety and sometimes acute panic, will need other, sometimes combined approaches for successful management including Hypnotherapy, hypnosis , possibly NLP or CBT for example.

Here is another quote from the Canadian study mentioned.

"We now know that there is significant fear and anxiety towards dental care within our population….. Within Canada, the most recent study shows that 5.5 % are very afraid, and 9.8% are somewhat afraid" [1]

 So that is 15%+ or to spell it out, 1 in 6 people.

In the UK, the situation is worse. The last Adult Dental Health Survey 2009,[2] stated that 36% of attenders had moderate anxiety and 12% had extreme anxiety – higher figures than in Canada.  So 50% of attenders.  

I accept also that those working in practices with specific interests, ortho, cosmetics for example, will attract patients generally seeking elective care but they may still see those with strong gag reflexes or who want that smile makeover but are anxious nevertheless.

Also the survey is taken amongst NHS patients only and so socio-economic factors may be having an effect.

The Canadian study goes on to say :

" ...in Ontario, where numerous fear and anxiety studies surrounding dental treatment have been conducted, the literature displays a higher value at roughly 10-17%This situation has serious negative-cycle effects that are evident in patients’ behaviour, including failed or postponed dental visits, lack of preventative care, and overall poor oral health."

" Dentists sometimes fail to perceive their patients’ desires for methods to reduce their anxiety when seeking dental care." 

"In contrast, patients want to have more dental procedures completed with sedation or anaesthesia." [1]

Again for the purposes of this item, aimed at General Dental Practitioners and Specialists too, we need to refer those who can only be treated with a GA, though most people with dental anxiety, seen in general practice, can be treated with sedation techniques. Again my own experience was that for every case treated with IV Midazolam, 20 were successfully treated with "RA".

Plenty of food for thought here but just imagine walking back to the reception area with a patient who has just completed treatment with Inhalation Sedation and for that patient to turn to you and say "Thank you so much, you have fixed a broken part of my personality".

I am not alone in believing that being a dental professional involves more that fillings, whitening, implants and STO - important though these are to our businesses and to satisfying patient demand today.

So if you wish to 

• Learn more about how to achieve success with this technique, 
• Attract more patients to your practices, perhaps retain others who might seek sedation elsewhere 
• Increase take-up and acceptance for treatment plans offered
• Make your own working days less stressful and/or
• Wish to arrange one-to -one mentoring to attain a certificate of competency then please contact me richard@the-ra-coach.co.uk now.

You will find much more information at www.the-ra-coach.co.uk

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[1] Jonathan Campbell, DDS, (Dental Anaesthesia MSc candidate)

Dental Anxiety What Are We Missing? Feb 1st. 2015: http://www.oralhealthgroup.com/news/dental-anxiety-what-are-we-missing/1003462744/?&er=NA
[
2] Adult Dental Health Survey 2009 - Summary report and thematic series [NS]: March 24, 2011: Page 19 Access and Barriers to Care -8.3 Dental Anxiety Copyright © 2011, The Health and Social Care Information Centre. All Rights Reserved: The NHS Information Centre for health and social care. Part of the Government Statistical Service ISBN 978-1-84636-531-7