Dental phobia does not stop care

By Jane Elliott
Health reporter, BBC News

The surgery has a special facility to take wheelchairs

Ben Brown hates his mouth being touched and barely tolerates his teeth being brushed - so a trip to the dentist was a nightmare for the teenager from Surrey.

What made things worse for Ben and his family is that the 16-year-old is severely disabled and unable to voice his fears.

"Trips to the dentist were always an absolute trauma," said his mother Sally.

"As soon as Ben entered the waiting room, he'd realise where he was and start becoming very distressed.

'He would fight'

"Once in the surgery he would be so panicked and anxious that he would clench his mouth shut so the dentist couldn't even see his teeth.

"You would have needed to forcibly restrain him to enable any treatment, which would be very distressing

Ben's father Ian, said that his son's phobia was so great that even getting him to open his mouth long enough to brush his teeth was a challenge.

At the dentist they had to hold him down and he would cry and shout Ian Brown

"He has always been very sensitive around his mouth especially round his lips.

"He will let you brush his teeth for a while and then if you overdo it he will get more panicky and start writhing around.

"It is not clear whether he is in actual pain, although we don't think so. It is simply that he doesn't like things going in his mouth.

"At the dentist they had to hold him down and he would cry and shout.

"It did not do anyone any good. We persevered for a while but he would just get so upset. Although he was not aware of a lot of things, he was aware of the dentist's waiting room."

Dental plaque

Ben, who is in a wheelchair, has had to have three general anaesthetics during his childhood just to remove build-ups of tartar - a form of hardened dental plaque - but he would go for years in-between these examinations without any dental care.

This worried his parents, and they feared were concerned that when their son turned 16, and moved to the adult service, his care would get worse.

DENTAL FEAR Dental anxiety - a term coined in the mid-1940s to explain what is often a mild fear Dental phobia - a more extreme dread that affects about 10% of people

But then, on a trip to Guy's Dental Hospital for a routine check-up - where Ben again refused to let dentists look in his mouth - they met Dr Carole Boyle, who specialises in sedation and special care dentistry.

She suggested that, while major work would still need to be carried out under a general anaesthetic, she could do the check-ups and minor treatments by mildly sedating Ben.

Hope for Ben

Sedation is either given by inhalation or directly into a vein.

It is used to relax the patient or reduce their anxieties. Pain relief is still administered in the normal way via local anaesthetic injection.

"Sedation is much safer and can be done on a regular basis it also causes less disruption to patients lives," said Dr Boyle.

Ben would suffer from a build-up of plaque

"General anaesthetic does carry some risk to health. It is minimal, but because of the risks of mortality it is best to only do it where necessary."

The unit where she works caters for patients with all types of severe dental phobias, as well as a host of other complex conditions such as severe bleeding, latex allergy and mental illness.

"Dental phobia is a serious problem as patients can put up with severe pain from broken teeth, rather than seek treatment," said Dr Boyle.

Sally said the sedation regime had certainly worked well for her son, who has now had two successful dental appointments.

"It was such a different experience.

"Ben was less stressed as he was sedated and it meant the care could be provided easily.

"As it was sedation rather than a general anaesthetic, Ben was back to normal and off home again much more quickly."