The key to good oral health is prevention - stopping problems before they arise. Unfortunately, people who suffer from dental anxiety often fail to visit the dentist for routine care. When they finally do go, often a small

preventable problem has turned into a problem which will require major intervention.

In my years of successfully treating dental phobics, I have used a number of techniques. Some even involve the use of mild sedatives but most techniques involve face to face communication, answering of the patient's questions, and a lot of listening.

Most dental phobics have had very negative experiences with either unskilled, uncaring, or incompetent dentists.

The most important step to overcoming dental anxiety is finding a good dentist. A good dentist is one who:

• is patient
• is highly competent
• endeavors to make each meeting pain free
• genuinely cares about you
• has the ability to nurture you through past traumas

Ask friends and family for dentists they recommend. Feel free to ask any potential dentist about his practice, practice philosophy, and the steps he or she takes to make dentistry pain free and anxiety free. Remember, do not be intimidated. You are the consumer and it is the dentist who should be selling you on his or her service.

It takes a true partnership between the patient and the dentist, a growing trust, and a growing relationship that cannot nor should not be pushed faster than the patient can accept.

In my practice, I have used this no pressure approach with great success. Usually the first appointment is a 'get to know you visit' where we take a complete medical and dental history and have a discussion with the patient.

I have found that by clearly explaining any planned procedures (what they are and why we plan to do them) and by answering all of the patient's questions, much of the anxiety can be eliminated. If all goes well, we may do an intraoral examination using a special camera that lets us see, on a monitor, the inside of the patient's mouth .

The second visit includes discussion on what is the most stressful thing about dentistry for the patient and ways we can reduce if not eliminate that stress. We perform an examination, take X-rays and develop a treatment plan.

If the patient is ready for a cleaning of the teeth, we may proceed. The progress made in each visit is controlled by the patient and their readiness to continue. No pressure at all.

During future visits, we following through with the necessary procedures. I have dozens of patients who have been helped with this no pressure approach. A person can also reduce their anxiety by bringing a friend or loved one along with them for support.

I often advise people not to schedule appointments during stressful times. Don't, for example, schedule an appointment before a major business meeting or in the middle of the day if you know you have several tasks to do after the appointment.

Also, during the procedure, I tell patients exactly what I am doing - when they are going to feel pressure and when they are going to feel coldness. I use all the techniques available to minimize pain. In the few cases where the patient will feel discomfort, I tell them. Surprisingly anxiety is reduced if a patient knows exactly what to expect.

I can not stress enough how important it is to find a dentist you can trust and who is willing to do what it takes to relieve your anxiety. Many dentists will use a technique known as guided imagery where they will tell you to think about pleasant experiences (such as sunbathing on a beach in the Bahamas) while the procedure is going on.

Some dentists may go over relaxation techniques with you. Others will play soothing music in the background or allow the patient to bring in a walkman and headphones. Some dentists even have virtual reality goggles which the patient can wear during the procedure.

If your dentist is unwilling to discuss your anxiety or try things to help reduce your anxiety it is time to get a new dentist.

Remember that an educated consumer is a less anxious consumer. Make sure your dentist explains each and every procedure you undergo. Good dentists usually have videos, pamphlets, or books explaining the procedures they perform. A good dentist will answer the questions you have thus lessening your anxiety.

With a good dentist-patient relationship and with good communication, dental anxiety can be overcome. You should feel comfortable discussing your anxieties with your dentist and should be confident that he or she will do everything possible to reduce your anxiety. If not find a new dentist who is willing to do what it takes to overcome your anxiety.

This article was written by Dr. Eric Spieler. Dr. Spieler is a practicing physician in Philadelphia, Pa.

For more information on overcoming dental anxiety visit the Dental Phobia and Anxiety website.