A case study of a dental phobic.   Dr Mandy Kent BDS

 Mr AL (55yrs old) works in the film industry and loves films. He is an extrovert man with a friendly personality but terrified of dental treatment. He is a self-confessed dental phobic and gagger and he was shaking like a leaf when he first attended. His last dental visit had been over 25 years before and he only came this time because he was in severe pain from an abscess on his upper front tooth. He is also a heavy smoker and had 25 years’ worth of tartar on his teeth, several cavities and several missing teeth. Not a pretty sight! He was successfully wearing a very small denture that a dental technician had made for him, replacing two upper incisors. It was loose but he could manage it without gagging.

 I talked to him about using hypnosis to calm his nerves…he wasn’t keen on the idea so I proposed that we just did some deep breathing and relaxation….which he agreed to. I used the old trick of some salt on the tip of his tongue and managed to take a radiograph of his painful front tooth without him gagging. I sent him off with some antibiotics to clear the infection and an appointment for extraction the following week.

 He attended and was still shaking but with lots of calming words and TLC the extraction was straight forward. His main fear was of having the impression taken, needed to add a tooth to his denture. He revealed that years ago he had choked on a sandwich and had a very bad experience which made him panic. This had started the strong gag reflex… for self-protection. I explained that if he leaned forward this would help him to breath. I asked him to imagine the scene in the film Titanic, with Leo DiCaprio and Kate Winslet at the front of the ship, in that iconic scene. I asked him to picture himself as a figurehead at the prow of the ship. leaning forward into the fresh air.

A dab of topical anaesthetic cream, self-applied on his palate and a dab of salt on his tongue, served to distract him and to help him imagine the salt air of the sea, and I asked him to breathe slowly and deeply. I took the impression with him sitting up and leaning slightly forward as described. He did not gag or attempt to gag! He was very pleased afterwards. And he has been able to tolerate the new slightly larger denture without gagging.

Since then, he has become a more regular attender, wants to get his mouth healthy again, has stopped shaking every time he comes and is much calmer.

So, this Titanic experience was by no means a disaster.