This week, a letter written by English novelist Jane Austen is scheduled to be auctioned off and is expected to fetch between $80,000 and $120,000. Austen wrote this letter In 1813 to her sister Cassandra, describing an outing she took with her three nieces. The letter is unique in that it describes in detail dental practices of the early 1800s. Austen’s little group first visited a china shop and then made a trip to the dentist, for what she described as an hour of “sharp hasty screams.” Austen was not impressed by the dental care she observed. She wrote, “The poor Girls & their Teeth!” “Lizzy’s were filed & lamented over again and poor Marianne had two taken out…” Austen maligned the dentist, Mr. Spence, calling him a “Lover of Teeth & Money & Mischief.” She said, “I would not have had him look at mine for a shilling a tooth & double it.”

Of course, at this time dental techniques were still quite crude, unstandardized and potentially dangerous. The first dental college was 27 years in the future and the first successful local anesthesia was over 90 years away.

Just the other day I had my regular dental appointment and I have to admit that it was pleasant and thankfully uneventful. I’ve been lucky to have excellent dental care for the past several years. Unfortunately that has not always been the case for me. When I was child, I had a bad reaction to the Novocain that was widely used as a local anesthetic at the time. My pediatrician and dentist arranged it so that I would take a analgesic mixture before dental work. They called it my cocktail. Also their plan called for the dentist to “work slowly.” I’m not sure that “working slowly” is really what you want when it comes to drilling teeth or getting poked with sharp objects. The upshot of all this was that my earliest trips to the dentist really hurt. To deal with the discomfort, I remember pretending that I had been captured by communists and they were torturing me to get secret information. After all, this took place during the Cold War. I repeated to myself under my breath, “Name, rank, and serial number, that’s all you’re getting out of me, you commie rats.”

Years later, I was surprised to see that in the 1976 movie Marathon Man, an infamous Nazi war criminal Dr. Szell, played by Laurence Olivier, tortures Dustin Hoffman by probing a cavity with a sharp dental instrument and later by drilling into a healthy tooth, without anesthetic. It seemed kind of familiar. Unsurprisingly, this scene has been named #66 on a list of 100 Scariest Movie Moments and has also been described as one of the most frightening sequences in film history.

Dental work also figures in another Stawar family story. There was the time when my older brother Norman was scheduled to have a tooth pulled. Since the dentist was using gas, which elicits nausea, Norman wasn’t supposed to eat anything after midnight. Never one to take rules seriously, he woke up early the day of his appointment and to the dentist and his staff’s dismay, he secretly ate two large chocolate donuts. One can only imagine their subsequent surprise and horror.

I also had one other dental trauma. In high school I played football and although I admit I was a mediocre player, I once did try to block an extra point. I got kicked squarely in the mouth for my trouble. Although I was wearing a mouthpiece at the time, I still ended up with a couple of fractured teeth. It turned out that one of these teeth eventually needed to be pulled, so I was sent to an oral surgeon for the extraction. They began administering the anesthesia, when it suddenly seemed to me that they were preparing to pull the wrong tooth. I remember desperately trying to tell them, but it felt like I was rapidly descending into a deep hole, as their voices became fainter. When I woke up, sure enough I was missing the wrong tooth. Back then, however, it seemed like no one made a big fuss about such things.

Surveys reveal that the top three reasons that adults cite for avoiding the dentist are (1) cost (59%), (2) fear (22%) and (3) lack of a convenient location or time (19%). Based on personal experience I would guess that a lot of those people who say they can’t afford dental work or can’t find a convenient time or place are actually afraid. A little more than half of adults report that they see their dentist at least twice a year. Overall, however, about 100 million Americans fail to see a dentist each year, despite the importance of regular exams and cleanings.

It has been estimated that nearly 75% of people experience some degree of fear or anxiety when going to the dentist. Of that percentage, about 5-10% are fearful enough that they could be considered to have a dental phobia, also known as odontophobia, or dentophobia. For these individuals, the fear is so strong that they actively avoid the dentist. More women and younger individuals seem to be effected by such phobias.

According to dentist Peter Milgrom, from University of Washington, about two-thirds of people with dental phobias can trace their fear back to a bad experience in the dentist’s office. Occasionally an unrelated mood or anxiety disorder, a substance use disorder, post-traumatic stress, domestic violence or childhood abuse may manifest itself as a dental phobia.

Psychologist Ellen Rodino from Santa Monica, California, who has studied dental fear, believes that In addition to being afraid of possible pain or physical discomfort, many patients also fear the lack of control that they experience in the dentist’s chair. The dental experience, like many other medical procedures, tends to put people in a position of extreme vulnerability and perceived helplessness.

A negative portrayal of dentistry in the media also promotes and reinforce dental phobias. Nicknamed the “Dentist of Horror,” Dutch dentist Jacobus Van Nierop, was found guilty in 2016 of carrying out numerous unnecessary and agonizing dental procedures from 2009 to 2012. He was fined, stripped of his license, and sentenced to eight year in prison, in an international media frenzy. Such publicity, however, only reinforces the public’s fears.

While there are several approaches to treating dental phobias, developing a positive and trusting relationship with your dentist is an important first step. Various experts also have suggested that you (1) might bring along someone you trust for emotional support, (2) agree with your dentist upon a signal that you can use to stop the procedure, (3) agree upon taking some breaks during the session, (4) listen to your own music on headphones, (5) practice relaxation techniques to calm yourself before appointments, and (5) discuss with your dentist if sedatives are available or appropriate for you.

For some individuals psychotherapeutic aid may still be needed. In 2017 German researchers found that cognitive behavioral therapy generally offers the best outcomes in the treatment of dental anxiety. In this treatment approach, the therapist teaches patients to identify and modify patterns of dysfunctional thinking that cause distress or unhelpful emotions like dental anxiety.

Although it may seem odd, some people actually like going to the dentist. They may like the feeling they get after having their teeth cleaned. Others find it a quiet and restful break in their busy day and some people even like getting the goodie bag. Humorist David Sedaris has described his dental experiences and has noted a change in his attitude. He says, “I’ve gone from avoiding dentists and periodontists to practically stalking them, not in some quest for a Hollywood smile, but because I enjoy their company.”

Terry L. Stawar, Ed.D. lives in Jeffersonville and is the CEO of LifeSpring Health Systems. He can be reached at tstawar@gmail.com. Since there is now a dentist in the family, he no longer thinks of them as commie rats.

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