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'Just sit back and relax'

Dentist catering to fearful patients with kinder, gentler practices

Friday, January 05, 2001

Bill Schackner, Post-Gazette Staff Writer

The whir of a drill makes them feel faint. Needles give them cold sweats.

In their mind, an instruction to "open wide" sounds like "run for your life."

These dental phobics routinely have sought relief at a most unlikely place: a building at the University of Pittsburgh where every day teeth get pulled, drills are revved and dentistry is learned.

Pitt's school of dental medicine is one of a handful of dental colleges in the United States that offers a clinic devoted to easing dental fears.

The future of the clinic, however, is in doubt.

Dr. Calvin Pierce, one of the founders who treated most of its patients, left last week after his contract was not renewed and the clinic has been referring patients elsewhere since March.

The changes at Pitt come as the dental industry as a whole tries to shed its painful image.

Fluoridated water has meant fewer cavities. Dentists competing to fill them have switched their emphasis to preventive care and have learned to make their offices less anxiety producing.

Just look at the Yellow Pages, where words like "gentle" and "no-pain dentistry" are now standard.

"Dentistry for the little chicken in all of us," promises one ad for a Regent Square dentist.

"We cater to cowards,"' reads another from a chain of outlets in and near Pittsburgh.

In 1989, national polls suggested that only 58 percent of all Americans received regular dental care, said Chris Martin, a spokesman in Chicago for the American Dental Association. He said the figure has improved to 67 percent.

Even so, millions of Americans - many with painful childhood experiences - still fear a trip to the dentist.

The industry says 6 to 12 percent of the population may have fears severe enough to keep them away.

In Seattle, the dental fears clinic at the University of Washington has 300 active patients and gets 100 new ones a year, most in their 30s or older. Its researchers found that one in 20 people avoided or canceled dental visits for fear of getting a shot.

But the outlook may be improving, said Tracy Getz, staff psychologist there. Fewer cavities have meant fewer bad dental experiences for children, who are less likely to fear dental care when they grow up.

"More and more of our children are growing up dentally healthy," he said.

Dentists are better at spotting signs of patient anxiety and use more careful language to avoid making matters worse, he said. Many skip the word pain altogether, and use discomfort in its place.

Shots are out. Injections are in.

"We stay away from any word that involves drilling or filling. If you're going to do a crown or cap a tooth, instead of saying, `I'm going to grind your tooth down,' I say, `I'm going to prepare or shape your tooth," said Dr. David Sultanov, a Regent Square dentist whose Yellow Pages display ad features a waiting room full of chickens and promises gentle dental care.

With children "it's euphemism city," he said.

"I don't use a needle, I use a pressure injector. We put sleepy juice in (them) instead of Novocain. The drill is a magic wand. The saliva ejector is Mister Thirsty," he said.

Sultanov's office is adorned with games, props and ceiling posters to soothe patients, most of whom come through fine, he said. A few go to extremes, like the man who "made a sort of Tarzan noise" to distract himself while receiving an injection.

"We would warn everybody in the office about it, that they were going to hear some noise that helps this patient get through it," Sultanov said.

"That was pretty wild."

Statistics on dental anxiety suggest that as many as 285,000 people in metropolitan Pittsburgh may have fears severe enough to keep them away from a dentist.

Yet only 100 or so patients decided - or had the gumption - to make their way to Pitt's dental fears clinic in its eight years.

Their ages ranged from 18 to 80. They had various problems - from anxiety disorders to multiple personalities - that were serious enough to complicate a dental visit or make one nearly impossible.

Some had fears about specific aspects of a dentist's office.

"With some people it's the drill. Some people it's the needle. Some people it's the alcohol smell in a dentist's office," said Pierce, an assistant professor at Pitt who joined the faculty in 1986. "I've had MDs as patients here, I've had business people, insurance salesmen, housewives."

There are the "gaggers," who could not handle being touched inside the mouth. Some break a sweat or became ill at the sight of a surgical instrument.

The first step was getting them to the dental school, a building where, if they weren't careful, they could walk into a room where the procedures they dreaded were being performed.

To avoid that, Pierce said the clinic gave patrons specific directions for reaching the third-floor clinic in Salk Hall.

A 50-minute session cost $95, Pierce said. Many patients spent their initial appointments with him in a soft brown recliner in an office far removed from the closest drill.

Depending on their progress, they received subsequent counseling in a dentist's chair and, eventually, in a clinic setting.

They learned muscle relaxation and breathing exercises. Those with severe fears about a drill or needle first became comfortable talking about one, then looking at one and eventually touching one.

"We assure them that we're not going to do any dentistry. They don't need to see a dentist's chair for whatever number of sessions until they're ready," he said.

Some needed only a few sessions, others more.

One patient, Helen Beymer, 74, of Wilkins, said she might never have gone into a dentist's chair were it not for Pierce.

Beymer had never sweated dental visits as a child or young adult. But that changed in 1989, she said, when a tiny rubber instrument was being placed around her tooth as she was about to undergo her second root canal.

"The doctor and nurse were there on each side of me. I pushed them both out of the way and I ran from the chair and over to a window. I can't explain it. I thought I was going to choke," she said. "I was so embarrassed."

Beymer said that in her three sessions with Pierce she learned relaxation exercises and listened to soothing audiotapes that Pierce made for her to take home. His assurances that he would do nothing without her permission eventually got her back into the chair.

"He said, `Just raise your hand and I'll stop.' So I knew I was in control," she said.

Beymer said Pierce remains her dentist to this day and she's not sure what she will do if he leaves Pittsburgh to find work. "It's breaking my heart," she said.

Sandy Ellifritz, 41, of Regent Square, had teeth so sensitive to pain that injections often didn't help. Routine procedures like having her teeth cleaned could take as long as two hours - more time than most dentists want to spend.

Since 1991, she has been visiting Pierce and the clinic. She said Pierce found ways to give her injections that were more effective. And he was patient with fears.

"If I say I'm starting to feel it, he'll do another shot and wait a few minutes. Other dentists would say, `You couldn't possibly be feeling that.' He listens," she said.

Standing in his half-packed office, Pierce said he had hoped the clinic would blossom into a place where research was conducted and a steady stream of new patients got help. He said he believes the scarcity of clients had more to do with internal university decisions than lack of demand.

The clinic was discouraged, he said, from marketing itself to oral surgeons who would have been in a position to send patients to the clinic as referrals.

Pitt disputed that interpretation of the clinic's lack of business.

"My sense was that he was encouraged to market this but it really never got off the ground," said Dr. Robert Weyant, a division head at the college who supervised Pierce.

Weyant said others in the dental college and at Pitt's medical center can step in to provide the services Pierce was offering, but he was less specific about plans for the clinic.

"I think there will continue to be the same level of services there has always been, but whether or not there will continue to be a formal title, I don't know," he said.


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