What we learned from research among Habrowers about fear of dentists

Thank you very much for this.

Let me clarify right away that this is a qualitative study, not a quantitative one. We looked for patterns and identified a course of action in order to further build hypotheses and conduct quantitative experiments.

The second feature is that we do not have raw data, except for notes in a notebook, because all interviews took place without recording and anonymously, this was the main condition for participation for many.

Now let's move on to the conclusions themselves.

What we researched

One of the biggest problems in medicine is the fear of doctors. In dentistry, it is very powerful, because many people saw the Soviet punitive drill, which, with the whistling sound of a turbine, penetrated pain directly into your brain. And it also smelled like burnt human bones. The children remembered this very well, and the adults who grew up from such children preferred to endure, but not surrender to these sadists in white coats.

When we first entered the market in Moscow, patients were very surprised that nothing hurt us at all. No channels, no implantation, nothing. Just come, the doctor does something a little longer than usual, and it doesn’t hurt. Technology was not even perceived at that time as a point of choice, microscopes, applications, openness of data for the patient, cross-review of doctors – all this was not as important as the fact that we gathered the best specialists and they did not hurt.

Dental phobes endanger themselves by not going to the doctor until it gets too bad. And the worse they get, the more afraid they are of the hike. As a result, they are usually delivered by ambulance and not to us, and maxillofacial surgeons pump out pus from the cellular spaces of the skull far beyond the mouth and teeth.

A bad tooth opened the gate to a wonderful new world closer to the brain, here details

These are still good situations, because there it is possible to intervene, so to speak, not directly to the morgue. The story is worse with chronic dental diseases. Everyone is crying there – cardiologists because of the constant inflammatory process in the body, which generates plaques of cholesterol that carefully heals inflammation in all vessels without exception, infectious disease specialists simply laugh hysterically, and psychiatrists remind that bad teeth dramatically increase the chances of meeting an elderly German with Alzheimer's. Every time you ask us these studies: Here And Here .

So, it was important for us to understand the following:

Is there anything that can be changed in the process so that dental phobes are treated more or less on time.

Is there anything that we and doctors in general around the world are doing wrong now?

Are all dental phobes exactly dental phobes, and not other phobes, for example, those who are afraid of a discovery or those who are afraid of losing control?

Not all dentists are true

People who considered themselves dental phobes came to the study. The good news is that there were quite a few true dentists among them.

A true dentist is unable to control his reaction when approaching the dentist or the dentist's chair. In general, it is normal to be afraid of the doctor. The difference is whether you can continue to control the body or whether the body controls you. In an ordinary person, with strong controlled fear, the “fight or flight” or “freeze and hide” reaction is activated, or he simply cries or loses consciousness (rarely). Dentophobe falls into the same reactions, but at the same time loses conscious control. That is, the memory is written, but there is no control anymore. Usually this leads to the fact that either treatment is impossible, or in the process the same heart rate goes off scale beyond dangerous limits.

The solution is very simple – for short interventions, daytime tranquilizers (before major operations, patients are often prescribed phenazepam for courage), for long ones – propofol, that is, treatment under sedation. Sedation is like anesthesia, only the patient is partially conscious, feels everything, but does not personally participate in the process and does not remember the process. Sedation is usually accompanied by either local conduction anesthesia (switching off the nerve in the intermediate section), or the patient is taken even deeper into sevoran anesthesia during long interventions.

So here it is. True dental phobes are happy to receive a tranquilizer or lose consciousness, for them this is happiness. But a significant category of patients are categorically against this.

“Pilots”

As the study progressed, a lot of patients emerged who were afraid of losing control, not the doctors themselves.

That is, the situation in the dentist’s office is humiliating and frightening for them, not because there is a doctor with a needle or a knife, but because they cannot control the process and do not understand what is happening.

This choice is described in psychology reference books: if a person boards an airplane, where will he prefer to turn – into the cabin, where he can spend the entire flight in comfort, but without any control, or into the cockpit, where the situation will be in his hands.

Dentophobes want to lose consciousness.

“Pilots” categorically against this.

Dentophobes do not want to know the details of the intervention.

“Pilots” want to know all the details and principles of decision-making.

Dentophobes will be horrified at the sight of a root canal needle.

“Pilot” He will examine it with interest and ask how it fits in a person and how it is protected from going beyond the calculated axis.

Dentophobes afraid of the dental chair.

“Pilot” adjusts the chair to suit himself so that his back does not sag.

Dentophobes In general, he reacts normally to the medical bill.

“Pilot” wants to see the bill before the appointment and a guarantee that it will not increase.

Dentophobes he gets scared already from the counter at the entrance to the clinic.

“Pilot” wants to see not only the counter, but also how the instruments are sterilized behind the transparent wall behind it.

In general, for dental phobes, we did everything wrong

It so happened that we developed our clinics for those who were considered dentists. Judging by preliminary data, these are people for whom something else is important. I guess it's the fear of making a mistake or the fear of losing control.

The ideal world for a dentist looks like this:

The doctor conducts a preliminary conversation not in the clinic. Ideally, in a restaurant with classical music and a glass of wine.

There is nothing openly showing medicine in the clinic; the clinic itself does not look like a library or an English club of the nineteenth century. The chair doesn't look like a dentist's chair.

The light is dim, the treatment is in the spirit of all sorts of alternative practices, with aromatic oils and bells ringing (this distracts from the progress of the treatment).

It is better not to know the details of the treatment and not watch videos before surgery. “Just do what you have to do, I trust you” is the ideal scenario.

It is better to treat without consciousness and all at once. If the patient is conscious – as quickly as possible.

Solutions should be such that the patient never comes to the clinic if possible.

There's a lot about this scenario that's realistic. For some patients, we organize consultations in a restaurant near the clinic or near the patient's office or home (this is almost three times more expensive than a regular consultation, but for some it is important). We know how to treat in your sleep, and we have very good anesthesiologists. But everything else is terribly unsuitable.

First, we treat to the optimal medical outcome. That is, doctors fight for quality, durability, beauty and the maximum possible within the chosen treatment plan. This means that we do not know how to finish work as quickly as possible and do not compromise on quality. Speed is important to dentists, and we can provide it in our sleep. However, if the treatment is carried out “in reality”, then speed competes with quality and here we choose the latter, alas, by reducing the appointment time (how long our dental phobe will endure, so as not to disappear again for a long time) while increasing the number of visits.

Secondly, we are very open. Our clinics have transparent walls, patients see technical rooms, laboratories, and sterilization. The chairs are similar to medical chairs. There are thousands of things in the medical staff’s protocols like “be sure to rustle a sealed bag with thermal stickers in the patient’s field of vision so that he can see that a sterile instrument is being unpacked.” We send intervention protocols before the intervention so that the patient knows step by step what we will do today. We agree on the bill before interventions, and it never changes. We discuss treatment plans in detail, show pictures, show equipment, and so on.

In general, we work for “pilots”, not for dentists. This is clearly visible in this situation with a patient in whom these fears were brought to an extreme stage.

Openness of data is incredibly good for such people, but very scary for essential dentists.

That is, our processes are not architecturally suitable for this type of patient, but at the same time they are ideally tailored for a different psychotype of people who are ready to make responsible decisions consciously.

What is the fear of decision-making?

If you've read this far, you're definitely not a dentist. Otherwise you would have been even more scared when I showed the picture.

If you think that you are afraid of doctors, then it is very likely that the fear does not concern the doctors themselves, the vulnerability of your body, or something else. The fear of making a mistake or making the wrong choice in an important area comes into play.

Important decisions are choosing a job, choosing a life partner, buying an apartment, and so on. That is, these are fears before any fairly responsible decision.

What came as a surprise in our study was that for many, teeth were involved in important life decisions. This is the fear of spending quite a lot of resources in the wrong way or with an error.

And it turned out that it is precisely for such an audience that our principles work perfectly. Medicine has long ceased to be a wardrobe that can be assembled at home, where anyone can figure it out according to the instructions. Different clinics say different things, but no one tries to give the patient all the information. And then suddenly he’ll figure it out! And we give. People are gradually regaining their trust through this kind of data.

Total

Most likely, we will not be able to do anything quickly for essential dentophobes. There are standard things like sedation and sedative pills during the appointment, there are patient doctors, and so on – but our capacity for such patients is approximately 1:20. That is, every twentieth person can receive such care without breaking processes. We simulated possible situations and realized that if the ratio changes to approximately 1:5, then we as a clinic will no longer be able to withstand it.

Therefore, we focus on those who trust open information, and not on those who are scared by it. To the great relief of many doctors (especially surgeons), I can say that we will continue to very politely, a little cynically and very accurately tell the patient what he has, what we can do with him and what results this will lead to in the short and long term.