Fear of anaesthesia
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 stemmed from fear of being anaesthetised.
The fear of being anaesthetised has a number of causes. The fact that a very small number of people are allergic to anaesthetics often makes people nervous when they are being anaesthetised for the first time. For other people, it is the fact that they will be numb, unable to move and communicate with their dentist that is the most distressing thought. For other patients, the phobia revolves around the thought of waking up too soon during the procedure, and starting to feel pain.
The patient in this case was Pablo, a teenager who required a number of tooth extractions while under general anaesthetic. In the past, he has complained of not being numb while under local anaesthetic, and was understandably nervous about undergoing a full procedure under general anaesthetic.
At the same time, the dentist was also concerned about treating this individual. If the patient was allergic or non-responsive to the anaesthetic, then the dentist has to make an important decision about how to proceed. While there are other, more advanced anaesthetic techniques available, not all dentists have the facilities, support or training to administer them. So the patient may need to be referred elsewhere.
Part of the challenge in this scenario is to separate the fact from the myth. As with many other teenagers, Pablo is thoroughly conversant with the internet and uses message boards, blogs and social networking sites to keep in touch. However, many of these sites are not necessarily factually accurate. They often rely on the ‘a friend of a friend’ style of rumour that the internet is so good at sustaining.
Therefore, while Pablo complains of not being numb under local anaesthetic, there could be a number of reasons. First and most obviously, he could be right. Maybe the anaesthetic did not work so well. What most patients do not realise is that it is relatively straightforward for a dentist to ‘top up’ their local anaesthetic if they can still feel some pain during the treatment. In fact, good dentists will usually stop and ask the patient whether they can feel any pain and whether they want the treatment to continue.
The other aspect of anaesthesia is that some people are allergic or immune to it, or that some people wake up early. While it would be wrong to say that this has never happened, it is a phenomenally rare occurrence. The problem is that, if you have a phobia, a dentist who gives you statistics isn’t usually what you need.
What is clearly important in this case is that Pablo has jumped from a previous experience, which is not uncommon, to assuming another experience is also likely to happen. But the two are not linked at all. The fact that he didn’t feel numb enough during an earlier treatment probably meant he just needed a top up. It probably didn’t mean that he was allergic to all types of anaesthetic.
But that, unfortunately, is the nature of phobias. We tend to escalate our fears and focus on the worst-case scenario possible. For Pablo, the mythology surrounding anaesthesia, an unsystematic approach to learning more about the subject – and a vivid imagination – had developed into a phobia.
The primary symptoms in this case were panic attacks. Pablo was unable to relax in the dentist chair and usually suffered breathing problems, rapid heart rate and an overwhelming sense of panic.
Sometimes, if a phobia is particularly deep-seated, counseling is required. However, as in this case, phobias are often created by not having access to the right information. This could be because a patient has not spent enough time discussing the treatment with their dentist. Alternatively, it could be because you and your dentist just don’t ‘click’. There’s nothing wrong with that. It’s simply a case of shopping around until you find a dentist that is right for you.
The most important point to remember about the anaesthetic process is that it is surrounded by lots of poor information and factually incorrect stories. The fact is that local anaesthetic is always effective if it is injected in the right way and given time to work. If you don’t feel numb, that will more than likely be because everybody has anatomical variations in their mouth and jaw which mean getting the injection right can sometimes be difficult. As we mentioned above, most dentists will be happy to ‘top up’ if you are not feeling comfortable.
Another reason why the local anaesthetic may not work is – and this is particularly relevant for people suffering from a phobia of any kind – if the patient is highly stressed or anxious. Once again, this only happens in a small number of cases, but anxiety can make the local anaesthetic have a reduced effect.
We could discuss the merits of and alternatives to anaesthetic all day. But at the heart of the issue is usually whether a patient has confidence in their dentist. In this case, the doubts first emerged when the patient did not feel numb in a previous treatment. Rather than being able to discuss that with his dentist at the time, stop the procedure or ask for a ‘top up’, he let doubts creep in and has worried ever since.
Normally, your dentist should be your first source of information and reassurance if you are worried about a procedure. They should have both the technical expertise and the patient skills to help you make the right decision about what to do next.