February 10th, 2016
ap Lüneburg. Mats Stöver is a patient as physicians wish him to be. The eight-year-old likes to go to the dentist. But he belongs to a minority. Approximately 70 percent of Germans say they are afraid of the dentist, and according to studies one in ten even suffers from a so-called dental phobia. The LZ spoke representative with three L?neburger specialists about causes, means against the fear and empiric reports. Reason was the day of the toothache (9 February).
Mats has been a patient of Dr. Rainer Köpsell since 2009 and he trusts him. Even now, when he has a hole. “That’s what happens when you don’t brush your teeth well,” says Mats. The decisive factor for the boy’s composure is the children’s consultation, which Köpsell has been offering since 2008 on a Saturday every month. Mats was two when he had his first contact with dentistry through play. He got to know suckers in disguised form: as blue frogs and pink elephants. “This is the excessive demand that stirs up fear. Smells, devices, the bright light, all are dressed in white. The children are flooded with stimuli”, Köpsell knows. “When the children get older, more courageous and more curious, they already know their surroundings. For them, a visit to the dentist does not mean pain through drilling and injections, but fun.
The patient should decide how much he can tolerate. At Köpsell, the little guest is also “master of the treatment”. He only has to raise his hand to abort the treatment. “The worst thing is being at the mercy”, knows the physician, who can remember a concrete case. He treated a young anxious patient, who had to take a lot of time for a local anaesthetic injection. “After that, the air was out, the boy simply had no strength left. Köpsell stopped the treatment. “Once I’ve lost confidence, it’s very, very hard to regain it.”
Dr. Beate Reida uses hypnosis and nitrous oxide in anxiety patients. Patients often tell me about overuse in childhood,” says the dentist, making it clear: “Humiliating statements like “Don’t be afraid, don’t be afraid”. The dentist’s area is already a special case anyway, because there the normal intimate distance between two strangers is broken. This is otherwise only the case in gynaecology. “This is like a disempowerment, all senses are stimulated.”
The 49-year-old does not always succeed in putting someone into a trance. “It depends on whether someone is sufficiently suggestible, i.e. easily influenced,” she explains. Hypnosis is about focusing the outside inwards. The patient has to block out smells, noises and light and think of something beautiful. “With children it is sometimes problematic, they must be focusable, eye contact must be possible. The doctor says: “The patient decides, but it must also feel good to me”.
Since 2009, it has also been offering nitrous oxide treatment, and demand is growing: “This is a good alternative to general anaesthesia, patients can eat normally, it is well tolerated and you are immediately roadworthy after that”. Dinitrogen monoxide mixed with oxygen is administered to the patient via a nasal mask. “This is comparable to an alcoholic intoxication, you feel drunk.” Even if the treatment was painful, the patient does not remember it afterwards – although he is awake all the time. She gives two examples: A man came after a long persuasion of a friend with ten root remains and great fear. “The day after, at the check-up, he was totally relieved. The treatment was similar for a small child with a “huge abscess on the milk tooth”. Reida had to pull it – under the influence of laughing gas. “If I had to give the child an anaesthetic there, it would have suffered a lifelong trauma,” the expert believes. Because children are by nature not anxious patients, “but they can become so”.
Dr. Nico Häusler has also had many anxious patients on the treatment chair. “The first contact is made by telephone via the practice staff, not via the doctors. So it’s important that the staff are trained accordingly,” says the 35-year-old. For patients with anxiety, longer appointments are scheduled directly so that they get the feeling that they are not “patient number 500” on that day. The practice also maintains close contacts with psychologists who support patients with serious phobias. Häusler recently had a patient who had not been to the dentist for 30 years. “He came with extreme fear on the advice of his wife,” says the 35-year-old. The patient brought his wife to the appointment – “advisable”, as Häusler finds. Familiar people are important in a strange environment. “The patient had pain due to highly inflamed gums caused by a lot of tartar. After the removal, Häusler was also surprised, because the teeth were intact. “When I told the patient that everything was fine, that I didn’t have to drill, an enormous burden fell from him. Such patients are motivated when they realize that the treatment was good for them.
In addition to classical general anaesthesia, which is always accompanied by a trained anaesthetist and anaesthesia assistant, the practice also works with so-called “shit-egal tablets” based on Valium or Tavor. “The patients report that they feel like they are in a hammock, that they are deeply relaxed but responsive. Häusler has stated that even this tablet is superfluous for most patients after two sessions, “because they then know that the syringe and the drill do not hurt”.