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I have a secret ambition to host the gameshow 'Family Feud,' except I'd make all the questions dental related. I've done this before when we asked 2 dentists to name something you wish everyone would put on their New Year's resolution list and then talked about the top 7 answers on the board in this dental resolutions article.

The one question I hear myself ask patients virtually every day is, "How come you waited so long to go to the dentist?"

Today I thought I'd share the most common answers I get in response along with some notes on how we work every day to combat them.

The 5 most common reasons for avoiding the dentist, according to my daily patient interactions:

  1. There's a Pandemic
  2. I'm Just Scared
  3. I Once Had a Bad Experience
  4. It's Too Expensive
  5. I Don't Want to Get Ripped Off

Let's delve into these reasons and talk about how I can help alleviate those concerns for you!

1. Um, There's a Pandemic!

upset woman with her hands on her hips wearing an orange pandemic mask over her mouth and nose

A survey back in March 2021, commissioned by the American Association of Endodontists, revealed that more than 50% of Americans said the COVID-19 pandemic has caused them to put off general dental check-ups. We get it, ours is an office of pre-pandemic germaphobes and the very nature of performing a dental procedure in someone's mouth has always meant prioritizing the health and safety for staff and patients above all else. During a pandemic, everyone gains a heightened awareness of just how often we all encounter germs as we interact day-to-day in our everyday lives and start to think of how we can guard against exposure.

Skipping routine visits to the dentist for a bit in 2020 made sense given the transmission dynamics, but be careful you don't fall too far behind and run into trouble. That same survey I mentioned above also revealed that 60% of Americans say experiencing tooth pain that won't go away would lead them to make a dental appointment. Don't let missing regular routine visits put you in that predicament. In fact, I wrote about Covid cavities and why foregoing your dental visit is bad a while ago.

And, don't forget, oral health is essential to your overall general health and well-being. (See this Surgeon General's report and my post about recent research that suggests link between gum disease and Alzheimer's.)

medical grade air purifier
purifying the air

How We Can Help

We have been practicing infection control and strictly maintaining sterilization and cross contamination processes to conform to rigorous standards in accordance with the ADA, OSHA, and CDC guidelines since I settled here in Lewiston in 2008. We also invested in significant upgrades when we moved into our new office in September of 2015.

Since Covid, we've continued to maintain and continually update the important safety features put in place as a way to ensure all of our patients that the only thing we'll ever pass on to you will be a few bad jokes.

We wrote all about practicing dentistry during a pandemic, and we are here to answer any questions you might have. Don't suffer in silence! If your dental anxiety is heightened because of the pandemic, we'll be happy to speak to how we are devoted to keeping our patients and our staff safe. Technology changes, infectious diseases mutate, but prioritizing your safety does not.

2. I'm just scared, man.

frightened woman

Dental anxiety is a real thing and it's pretty prevalent, with several studies agreeing there's a large portion of the general population that suffers from some level of anxious nervousness (from mild to severe) when it comes to visiting the dentist. The phrase, dental anxiety, was coined by an American psychiatrist and neurologist named Isador Henry Coriat, who defined it as "an excessive dread of anything being done to the teeth" and suggested the fear is an "anticipatory anxiety" because it stemmed from a fear of real danger and anticipated unknown danger. (source

the vicious cycle of dental anxiety drawn out
getting caught in the dfa cycle

The problem is, knowing that doesn't help you feel any less scared and the most common way of dealing with those nerves is to simply put off going to the dentist at all. And worse yet, DFA (dental fear and anxiety) which keeps you from regular routine dental visits often results in a vicious cycle. First described by Berggren (a Swedish dentist and researcher) in 1984, the vicious cycle goes like this: " . . . DFA leads to avoidance of dental care, which results in neglect of dental treatment and subsequently poor oral health. This is compounded by feelings of embarrassment and shame, as well as by the likelihood that when a dentally anxious patient attends after a long period of avoidance they will need more invasive treatment which has the potential to reinforce DFA and further, future avoidance."

How We Can Help

Actually, we completely relate to this. Believe it or not, there are quite a few folks on staff here who struggled with a fear of the dentist, too. It really is a universal human condition. Our goal is to recognize and respect your anxiety and work to help you feel as pleasant and as comfortable as possible. We know that dentistry tends to invade your personal space and our goal is to establish trust over time.

While sometimes we can just tell a patient is pretty anxious (a racing heartbeat, sweating, crying, or my personal favorite - using humor to mask your anxiety), telling us is one of the best ways to combat your anxiety.

If your dentist doesn't take your fear seriously, find another dentist!

3. I had a really bad experience once.

worried woman about to cry

This is way more common than it should be and I honestly hope it's on the decline with improvements in the field and patients having more information available at their fingertips.

While this reason is also anxiety/fear based, there's a past experience that drives it home in the patient's mind. "I once had this horrific experience at a dentist's office; ergo dentist offices must be avoided at all costs!" It really is kind of like a PTSD situation, where the sights, sounds and smells of simply being in the office triggers an extreme emotional and sometimes even physical response.

cartoon with a rabbit on the couch and a therapist telling the rabbit it goes back to being pulled out of a hat
recalling past experiences

In fact, this article in the Hawaii Dental Journal (2006) suggests "the vast majority of dental-care anxiety (DA) cases stem from aversive dental experiences." The authors further proposed that the condition be classified as Posttraumatic Dental-Care Anxiety (PTDA) and classified as part of the PTSD spectrum in the 5th edition of the American Psychiatric Association's DSM-V (the Diagnostic and Statistical Manual of Mental Disorders).

Furthermore, any trauma exposure can affect dental anxiety. According to a questionnaire-based study cited in this article, the "highly anxious individuals reported a significantly higher number of traumatic events, both within and outside the dental or medical setting, than those in the reference group (73% vs. 21%)."

How We Can Help

If you let us know you've had a bad experience and give us some information, we'll work with you to help alleviate your specific worries about coming to the office and sitting in the dental chair. For example, we can have secret hand signals if you fear not being heard during a procedure. Or maybe you need to leave one foot on the floor or have a blanket barrier (they really do work to help provide comfort).

As I said above, we know that dentistry invades your personal space, we take your fear and anxiety seriously, and our goal is to earn your trust over time as a patient in our care.

4. It's Too Expensive.

confused woman holding her hands up in the air with dollar signs

Dentistry just sounds expensive, right?

It sometimes is expensive, even with dental insurance (which often covers preventative procedures but starts to dwindle when it comes to oral surgery and restorative procedures and rarely covers any cosmetic procedures).

Although, expensive compared to what?

A pure bred puppy?

man with sleeve tattoos holding an adorable puppy
getting a sleeve tattoo and a puppy or fixing a tooth

A full arm tattoo?

Four new tires for your car?

At least you can tell when you need new tires; the wear and tear on the treads is a pretty obvious indication. It also doesn't take four years of higher education to be aware of the deadly consequences that come with continuing to drive on bald tires.

Recognizing the wear and tear on your teeth is a little harder without any dental training and a fancy x-ray machine. Pain and breaks are usually the first indicator of when it's time to call your dental office, but that often means a bigger problem (and potentially a more expensive solution).

I'd also love you to remember that dentistry is a professional service and running a modern, patient-centric dental office with all of the best technology and equipment is an expensive endeavor and, at the end of the day, the quality of the service you receive is based on those investments and on the education and skill of the individuals at the office. Think of your teeth and overall oral health as a lifetime investment.

However, I will agree that it is definitely way more fun to spend money on a sleeve tattoo and a new puppy than it is a new grill (for your mouth or your car) or four new tires.

How We Can Help

We try to help you understand exactly what we see, and then prioritize any issues based on what will be in your best interest to handle now (and avoid further cost) versus what can wait. Our treatment plans are divided into what we consider to be elective and necessary treatment options.

We also make sure you remember it's your mouth and that the final decision on treatment is your choice! We're just here to advise you of your current condition and options.

5. I don't want to get ripped off!

angry woman with a scowl on her face

So why should you go to a dentist when there is no problem (at least from your perspective) only to have them tell you, "you have a problem." Makes it hard to believe them, right?

Aren't they just trying to upsell you a root canal like those used car dealerships with the gigantic gorilla balloon and cheesy TV commercial where the owner is dressed in a stars and stripes gorilla suit? No, not at all. Although, if I could wear a gorilla suit to work it would definitely make for a more entertaining (to me, anyway) day.

giant balloon gorilla holding a car that says sale
seeing a giant gorilla sale

The "feeling like you're at a car dealership problem" is basically a "TRUST" problem! Fortunately, we all have personal experience on how to build trust, as well as recognizing when it's been broken (for the most part). The good news is that fraudulent dentistry doesn't happen in the majority of offices (although it does occur). Most dentists really are honest, because building a successful practice is not a short-term project; the risk is just too high.

In a chaotic world where we want the security and comfort of a black and white answer, I am here to tell you the reality of whether or not you need dental treatment can be a gray area. One dentist may recommend a certain course of action while another provider will treatment plan something quite different. This is normal and doesn't automatically mean anyone is trying to take advantage of you. While a diagnosis may be the same, there are some dentists that have a more conservative philosophy to approaching treatment interventions.

The key is that you are informed of the diagnosis and provided options (and a rationale for them) as well as an explanation of what could happen if you opt to do nothing (don't do that).

How We Can Help . . .

We work hard to provide the best possible information to each and every patient and remind you that it's your mouth and we're here to help you. My goal is always to educate and then provide options and answer questions. I can also give you some red flags to look for and advice to keep in mind if you're worried about getting taken for a ride!

Confusion Red Flag: When you're sitting back up in the dental chair, eyes (and brain) glazed over by the x-rays while the doctor is talking about a subperiostal diastema in the dentition of the alveolar interproximal periradicularacute requiring an immediate autogenous graft and cantilever extension, and saying something about how they first need to take a cephalometric image . . . (these are all actual dental words, they just don't mean anything in this sentence). My point is, if a dentist starts talking to you using language you don't understand, and then doesn't try to find a way to explain it so that you do understand - yet still expects you to 'accept treatment' - that's a red flag and it might be time for a second opinion/explanation!

Pressure and Panic Red Flag: "Because I Am the Doctor in the White Coat and I Said So" is not a good enough reason.

Urgency with no supporting details is another red flag. Details should include an explanation to support both the diagnosis and the recommended course of treatment. This comes in the form of reviewing the x-rays with you, relating it to models or images in the operatory for examples of what could happen if left untreated.

You should never feel like you're at Valvoline when you're sitting in the dental chair- although my undergrad is in Mechanical Engineering and I really like cars - what I mean is that if you've ever been to Valvoline and the technician starts holding up the internal organs of your car's engine, pointing out how filthy and disgusting they are and that they need to be replaced RIGHT NOW (with something they just happen to be having a "special" on THAT WEEK) and then begin telling you you'll have to replace your ENTIRE ENGINE which could be REALLY expensive, then perhaps you need to find a provider who doesn't use the "pressure and panic" approach.

Timeshare Dentistry Red Flag: A (dental) deal that sounds too good to be true probably is (or has a catch). Be aware that a lot of heavily advertised, deeply discounted or free services (see previous section about Valvoline) exist to get you in the door. You tend to see this more in the corporate-owned chains. A franchise based practice tends to rely on a quota based work model. This sort of 'incentive' can result in overtreatment planning. If you are presented with a lengthy to-do list when you've been consistently following up with dental care and good oral hygiene practices at home; trust your gut, you'll know if you feel like you're sitting in a sales meeting!

Woman pointing to the words HOW TO BE IN THE DENTAL DRIVER'S SEAT

Ask trusted (there's that word again) friends, family, or other providers (your eye doctor or dermatologist) who they go to (and why). Also ask your dentist for a second opinion. Even just watching your provider's response to that question will indicate whether or not there could be an issue. I've had many patients come to me in search of a second opinion. Sometimes they don't like the news they've been given and are hoping I'll tell them they don't need a bunch of shots and drilling work. Sometimes I can do that, but sometimes I can't. It's okay to ask for a second opinion!

Look at online reviews to see what you can learn, but keep this in mind: It doesn't matter whether you are a Yelper, Googler, or Facebooker, there is a universal law to reviews that transcends whatever it is that's being reviewed. Whether it's a six-person tent on Amazon, the vista at the Grand Canyon, or the drive-thru barista at your local Starbucks, someone is always going to be disappointed, maybe even downright mad enough to rant about it for five or six paragraphs. It's usually pretty easy to spot these reviewers and scroll past (or linger on them for entertainment if you have the time). We are all human and we all make mistakes, (or don't have the best day) for a myriad of reasons, but the key is to look at the overall rating and what course of action happens after a mistake. Feel free to check out some of our Google reviews and see how we measure up.

Your dentist can make an enormous impact on your life (positive or negative). The wrong dentist can cause permanent damage in your mouth, (with too much work you don't need), as well as your check book. The right dentist is a partner who collaborates with you to optimize your health and prevent disease.

If you are feeling overwhelmed, confused, skeptical or fearful of the dental office, give us a call and allow us the opportunity to build trust with a new dental home. I promise I'll save the gorilla suit for Halloween . . . .

peter's signature

Our thanks goes out to Robin Higgins for her fun images!

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