Treatment of the agoraphobic dental patient

The dental-phobic patient is rarely motivated to seek treatment. When this type of patient does, it is difficult to perform the dental work without repeated interruptions due to the high anxiety being displayed. Many dental phobics are actually agoraphobic, and this further complicates the matter. The agoraphobic dental patient mislabels any physiologic changes that are experienced as a prelude to disaster, or horrific consequences, and something there is no control over. This type of patient looks to depend on "safe" places (like home) and "safe" people (like spouses and doctors). The physiologic changes that are perceived may be induced pharmacologically (for example, numbness and tingling from the lidocaine, imbalanced blood gases due to hyperventilation), physically (for example, tilt of the dental chair, pressure in the mouth), or cognitively (autonomic excitation due to negative thoughts). The inability to mitigate the physiologic changes or symptoms confirms the patient's irrational belief that disaster is inevitable. Two basic considerations must be given priority when treating agoraphobic dental patients. These are: (1) providing them with a sense of being in control of the situation and/or their symptoms, and (2) training them to relabel or reinterpret their symptoms objectively as nervousness, or some simple and explainable physiologic change that should be present. Therefore, teaching agoraphobic dental patients cognitive-behavioral procedures such as relaxation and cognitive-restructuring techniques works quite well. Both will help to prevent, or reduce to a manageable level, the symptoms, and result in successful dental work.