A fear of needles : case study Derek
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 whose dental phobia was based around a fear of needles.
Derek is a middle-aged man who has suffered from needle phobia throughout his adult life. It not only affects him during dental appointments. The situation had become so extreme that it was affecting many different aspects of his lifestyle. For example, his phobia was so strong that he chose his holiday destinations so that he would not need vaccination injections. In the past, he had required some straightforward dental work that required injections. This had mainly been achieved through sedation to reduce his anxiety. The problem now was that his phobia was becoming very disruptive to the dental practice where he was registered as a patient. The more time they spent with a single patient, the more difficult it was to manage their schedule and give other patients the level of treatment that they deserve.
People who suffer from a phobia often find it difficult to see the dentist’s point of view and to appreciate how hard it is to treat them within a normal practice environment. The more the phobia impacts on their behaviour and their willingness to be treated, the harder it often is for the dentist to provide the right standard of care – not only to the individual with the phobia but to their other patients too.
For this reason, needlephobia is now recognised as a very real condition that patients and medical professionals should be able to tackle together. The level of fear varies from person to person, and some people are afraid of dental injections in particular, while others are phobic about any sort of needle. Between 1 and 3% of the UK population has some kind of phobia about needles (aichmophobia) or, subtly different, injections (tryanophobia). Some people are phobic to the point of avoiding injections at all costs – even in life-threatening situations.
With modern medicine more and more reliant upon the use of needles for blood tests and the administration of drugs, the issue of needlephobia is becoming an increasingly important one for doctors, nurses, carers and patients. In the past, there have been very few options for people suffering from needlephobia. Now, as the extent of the problem is becoming increasingly understood, there are more solutions and products emerging that can help people to cope with their phobia. For example, microscission techniques now allow some vaccinations to be given without the use of needles.
In the field of dentistry, new products such as The Wand™ offer patients an alternative to the traditional anaesthetic techniques. The Wand™ is a computer-controlled device that administers anaesthetic smoothly, painlessly and with less force than you would expect with conventional methods of administering anaesthetics.
In an ideal world, of course, a new product would emerge that made needle phobia a thing of the past. But it is never going to be that easy. As any person who suffers from a phobia will tell you, their phobia is a very complex set of personal reactions that vary from individual to individual. While a pain-free needle might help some sufferers, it may not be the right sort of solution for others. Therefore, each patient really needs to work with their dentist to understand their personal symptoms so that they can be addressed in an individual way.
In Derek’s case, the main symptoms were anxiety at the thought of injections and avoidance of injections. In addition, his anxiety would bring on other involuntary reactions such as a dry mouth, palpitations, sweating, trembling, over-breathing, feeling dizzy and light-headed, feeling sick and even fainting. All of these additional symptoms are common for phobia sufferers and all contribute to making a patient difficult to treat unless their dentist can help them to manage their phobia.
For the majority of patients, the most straightforward way to manage your needles phobia is by working with your dentist to understand the situation and grow your confidence in their skills. In the past, needles and injections were much more painful because of the problem of blunt needles. In modern practices, most needles are brand new for each patient. Simple details like this, explained by a dental professional, can help a lot of people to relax much more.
Needlephobia is more common in children than in adults. In these cases, explaining the technical issues may not help too much. Therefore, many dentists deploy coping strategies and distraction techniques. For example, you could take along a child's favourite toy, teddy or dolly. Reading a book can help (musical books or pop-ups work especially well with young children). Finally, dentists also have a number of ‘magic creams’ at their disposal which, when applied directly to the skin or the gum, have a numbing effect. Topical anaesthetic preparations (to give them their proper name) numb the nerves before needle procedures. Most dentists will be happy to discuss the different types of numbing agents available. For example, Ametop Gel® contains the anaesthetic tetracaine. It is licensed for children over one month of age, put in place 30 to 45 minutes beforehand and numbs the skin or gum for four to six hours.
For some patients, the phobia of needles, however, is not necessarily related to the pain a needle may cause. Rather, it is related to the whole experience surrounding the injection. In these cases, products such as numbing agents or The Wand™ may be no use, because while the pain is removed, the fear of the injection remains. In these cases, counselling or hypnosis by a registered professional may be more helpful. In the first instance, though, a full consultation with your dentist should be able to help you determine the most appropriate course of action.
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