Fear of choking: Case study Lorraine
Nobody likes going to the dentist. But for some people, the problems run deeper and form a phobia. The causes of dental phobia can be many and varied. This case study is of a patient who couldn’t relax in the dental chair because they were afraid of choking during treatment
There are a number of reasons why a patient may suffer from a fear of choking. For some patients, it can be related to the trauma of previous abuse or violence, or perhaps even a traumatic episode such as nearly drowning. For other patients, the cause is much simpler. For example, a person with a limited diet, with food aversions or food phobias will often suffer from a gag reflex if they taste something unusual.
Some patients may have a hyper awareness of swallowing saliva generally. Though this is a natural process that most of us do without thinking about it, many people develop a phobia or gag reflex because they become conscious of swallowing. This can make it difficult to them to relax and allow dental treatment.
For Lorraine, the patient in this case study, the phobia of choking had developed after a life-threatening episode of choking on food. Even though she had never suffered a choking episode in the dental chair in the past, she was now acutely aware of the possibility of choking, especially when gauze or cotton wool was in her mouth.
The fact is that having your mouth filled with unusual and strange tools can make you feel as though you can't breathe. You also may feel that too much saliva clogs your mouth and you can't swallow.
The problem for Lorraine, therefore, was that the dental environment made her phobia of choking much worse. First and foremost, the fear of choking made her react badly to treatment. Secondly, other aspects such as the way her dentist positioned the chair made her feel uncomfortable. Because the chair was pushed so far back, she was even more conscious of how difficult it was to swallow.
Finally, her phobia was reinforced by a sense of powerlessness. The positioning of the chair and the fact that she couldn’t articulate or communicate her fears left her feeling highly vulnerable. The result was that she began avoiding visits to the dentist. While even routine check-ups were difficult, the thought of having to undergo more complex dental work was even more problematic. The thought, for example, of her mouth being numbed would immediately increase her sense of powerlessness and fear.
Obviously, in this case, Lorraine is instinctively trying to protect herself against another serious choking episode and her symptoms were both psychological and physical. An overwhelming sense of dread at the thought of visiting the dentist was followed by reactions such as an inability to swallow, eat or drink. Because these physical reactions acted as a precursor to visiting the dentist, her anxiety increased the closer she got to appointments. This made visiting the dentist, even for just a routine check-up, very difficult.
As is often the case with phobias, the more Lorraine worried about the next visit to the dentist, the more noticeable her symptoms became. This meant that, in the lead-up to a visit, the symptoms increasingly played on her mind.
For Lorraine, the solution to managing her phobia had three clear stages. Firstly, she employed some relaxation techniques and therapies to help her relax before her visit to the dentist. Secondly, she worked closely with her dentist so that he understood how she felt and what her phobia involved. Thirdly, she discussed different techniques and products that her dentist could use to make her feel more comfortable while actually undergoing treatment. In terms of relaxation techniques, there are lots available that can help with phobias and each patient may find that something different and individual works for them. For a fear of choking, some patients have found that Reflexology or Hypnotherapy is beneficial. At the same time, other patients have found that relaxing can just involve finding their own routine that suits them prior to a visit to the dentist. This could mean listening to the right sort of music, taking a long walk or going to the gym. Often, whatever helps to relax your muscles will also help to relax your mind and distract you from what is ahead.
One of the major problems for Lorraine was that her dentist did not really understand her phobia. Therefore, he was making simple mistakes such as tilting her chair too far back, which made her uncomfortable. By approaching her dentist to specifically talk about her condition, Lorraine was able to undergo a full consultation during which she discussed every aspect of her phobia. It is important to remember that a lot of the tools, such as the vacuum, are held by the dental nurse during treatment. Therefore, the nurse also needs to understand clearly the needs of the patient.
In many ways, you should view your consultation as an opportunity, not only to talk about your fears, but also to ‘interview’ your dentist. If they are not flexible enough to work differently and to give you the level of care and treatment you need, it could be that you need to look for a different type of practice. The third aspect of the solution for Lorraine was to gain more control and to feel less powerless during the treatment. For example, as she was worried about choking on her own saliva, the dentist agreed that she could hold the saliva ejector herself. During more complex dental work, her dentist recommended a ‘rubber dam’ – a thin sheet of latex that protects the throat. This gave extra reassurance during treatments, which required drilling or other types of instruments.
Therefore, there are a number of options available to patients who suffer from a fear of choking. For many patients, however, it is simply enough to know that their dentist is understanding and knowledgeable about the subject. Increasingly, many modern dentists have the benefit of training with psychologists, which enables them to understand, manage and treat phobias in the right way.
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