DEAR DOCTOR K:

I'm a rational person, but I have a deep fear of the dentist that I just can't overcome. Any suggestions?

DEAR READER:

I don't know too many people who enjoy a trip to the dentist. But the health of our teeth and gums are an important part of maintaining our dental and overall wellness. So we do it.

Some of my patients have such a fear of dentists that they avoid making dental appointments at all, or cancel appointments they do make. Almost to a person, they tell me they've "always" been afraid of dentists. Almost surely the fear began with a visit to the dentist -- maybe their first -- when they were a child.

Regardless of why you have this fear, there are several things you can try to get yourself into a dentist's chair. Medications such as diazepam (Valium) and lorazepam (Ativan) may help reduce anxiety. But they are best used in combination with the following cognitive and behavioral strategies:

-- Breathing techniques. Physical tension and emotional stress can make pain feel worse. Deep breathing can counter physical and mental tension. Breathe in slowly and count to five. Then exhale to another count of five.

-- Muscle relaxation. Progressive muscle relaxation involves tensing and then releasing one group of muscles at a time. It can help to slow heart rate and promote calmness. Just a few minutes of progressive muscle relaxation may help during an appointment.

-- Desensitization. This approach combines deep breathing and relaxation with gradual exposure to the thing that triggers your fear. If you're afraid of needles, for example, you may look at pictures of a dentist's needle in a safe environment such as at home, while practicing relaxation and breathing techniques. The goal is to help you learn to relax while confronting a trigger of your fear.

-- Distraction. Focusing your mind elsewhere is another way to lessen anxiety and pain. The more complicated the task, the better. Listening to music may help. But counting tiles on the ceiling or slats on a window blind may be even more effective.

I know that this all may sound silly. If you're tilted back in a dental chair, and a person wearing a mask is approaching your molars with a drill, is counting the tiles on the ceiling really going to make you relax? Yes: A combination of multiple relaxation techniques really can help. I've seen it happen, repeatedly.

Relaxation techniques have been used by people in Asia for thousands of years. On occasion, true nonsense can be perpetuated for thousands of years, but usually things that have lasted that long have proven their value. Recent research at Harvard Medical School has even shown that relaxation techniques literally change body chemistry. They alter which genes are turned on and off. So consider this approach to your fear of the dentist. It really could work.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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