By: Sarah Steward, MS
It’s important for adults and kids to establish good dental health habits early. Many links exist between oral health and other aspects of your well-being. Oral health can even impact Force readiness. But fears of a dentist visit can sometimes get in the way of keeping up this aspect of fitness. Luckily, you and your family can do many things to get on the path to healthy teeth and gums.
HPRC interviewed Dr. Tania Faruqi McConville, DDS—General Dentist and military spouse—to get her take on good dental habits.
Dr. Faruqi McConville completed a General Practice Dental Residency in Seattle, where she trained in sedation, specialty procedures, surgery, and hospital dentistry. Her residency allowed her to work at a hospital and a private practice that specialized in treatment of dental phobias, special needs, and medically complex patients. She attended dental school at the LSU School of Dentistry in New Orleans. Dr. McConville has a private practice off-post in Clarksville, Tennessee, that often treats military families. Throughout her training, she was in a long-distance relationship with her husband because of their careers and several deployments. The move to Clarksville was their opportunity to finally be together as he completes aviation training at Fort Campbell.
Can you share the importance of dental health and how it affects other areas of well-being and Total Force Fitness?
Every day, there is more research to support the mouth-body connection. From a physiological aspect, not only can oral bacteria cause dental decay, gum disease, and facial abscesses, but it has also been linked to endocarditis, cardiovascular disease, pregnancy and birth complications, and respiratory illnesses. Patients with other comorbidities (the presence of two or more diseases at the same time)—or any form of immunosuppression—are more susceptible to these types of infections.
Systemic infection risks are why I often had to complete “dental clearances”—treatment of all high infection-risk teeth—for patients undergoing cardiac surgery, radiation, chemotherapy, or organ-transplant treatment. Dental exams are also part of hospital work-ups for patients with sepsis (a potentially life-threatening condition that occurs when the body’s response to an infection damages its own tissues).
Regular dental treatment helps prevent dental pain, infection, and tooth loss, which influences our ability to eat and perform daily functions. A toothache is frequently cited as one of the most profound experiences of pain, right up there with childbirth! Regular oral-cancer screenings and gingival-health evaluations are important for those who use tobacco and nicotine products. Keeping Military Service Members and their families from developing poor oral health is definitely important for Total Force Fitness.
Many people have dental anxiety. How common is this, and what are the different types of anxieties?
In my experience, dental phobias—or anxieties—are fairly common, but their severity can vary from patient to patient. Some of my patients have told me they just need someone to hold their hand during injections, while others can’t even sit in the chair without an IV (intravenous infusion) or GA (general anesthesia) sedation.
A lot of these phobias are based off previous bad dental experiences. Many patients tell me their anxiety stems from a procedure that was completed on them when they felt they weren’t numb or when force was applied to improve their cooperation as a child.
Other common reasons are needle phobias or just the perceived lack of control when they sit in the chair. The mouth and face are very personal spaces to have worked on while awake, especially since you can’t see what someone is doing. In Seattle, our office provided sedation options for adult and special-needs patients who fell into four main categories:
- Nitrous oxide (laughing gas) provides a mild level of anxiolysis. This is a minimal level of sedation. It’s completely reversible after administration of 100% oxygen once the dental treatment is completed.
- Oral sedation involves prescription of an anti-anxiety medication—such as a benzodiazepine—for the patient to take about an hour before the procedure to relax them. This is a moderate level of sedation. Because this is given orally, there is a little less precision and predictability to the effect of the medication and dosing. This level of sedation and higher also requires the patient to have someone drive them to and from the appointment.
- IV sedation involves starting an IV and gives the patient a controlled combination of anti-anxiety and pain medications throughout the appointment. This option is a “conscious sedation”—the patient breathes on their own and can be woken up with stimulation if they fall asleep.
- General anesthesia. Our office in Seattle was unique because we worked with an anesthesiologist who provided GA to the very medically complex or complex special needs and pediatric cases. These cases required high volumes of dentistry that needed more time than could be safely covered with an IV sedation appointment. This is the most profound form of sedation in which the patient is completely unconscious, just like when one goes into surgery.
Dentists are required to have additional certifications and training in emergency management in order to administer the high levels of oral sedation and IV sedation.
What about for children? Can you share a little bit about the dental fears or phobias kids tend to have?
A lot of young patients who have never been to the dentist model their perception of dental care off of their parents. If the parents discuss the dentist in a negative light or even use it as a punishment—“I’m going to tell the dentist on you!” “If you don’t _____, I’m going to take you back to the dentist!”—it can start the phobia from a young age. Alternatively, my pediatric patients whose parents love going to the dentist seem to have a lot less modeled anxiety with their visits. If both the child and their parents are patients, I have the parent sit for their exam first, allow the child to watch or participate, and then switch places, which has really worked well.
It’s best to get a child acclimatized to the dental office environment early so they can get used to the flow, the tools, and the people as they mature. It's recommended by the ADA (American Dental Association) and AAPD (American Association of Pediatric Dentistry) that children receive their first dental visit by age one. First infant exams—important for noting early dental development issues—can be full of tears, but it’s a key to start the acclimatization or desensitization strategy. It's important for parents to frame the visit in a positive light.
The most famous pediatric dental strategy taught is called “tell-show-do.” I use this strategy every day. You tell the child what you are doing to do, model the action—either on yourself or on their finger—and then perform it. When you say, “I’m going to use this soft toothbrush to brush your teeth,” brush the bristles against their finger to show them how soft it is, modeling the action, and then perform it. Make kids feel as if they have some control over the visit, but not so much that they prevent you from performing treatment. Have them choose their toothpaste flavor or the color of their toothbrush. But let the child know that brushing is going to have to be part of the procedure.
In pediatric patients—who are especially resistant to treatment—there are also the options of different levels of sedation or protective stabilization. This usually means the dentist will refer the patient to a pediatric dental specialist for care.
What strategies can you share to help folks manage or overcome dental fear?
For adults:
- Remember that every office and provider is different. A past negative experience does not guarantee all future procedures and offices will be that way. Don’t psych yourself out before you start any procedure. Ask for help when you need it, and don’t think we expect you to sit through something if you’re not numb. Tell us immediately if you’re uncomfortable so we can help you.
- If you are phobic or anxious about the dentist, it’s probably helpful to break down what you are afraid of into its core elements and treat those factors. If it’s the sound of the drill that makes you tense, bring in your headphones. If it’s needles, try to close your eyes and ask your provider for distraction methods.
- Plan with your dentist before any procedure for communication cues to let them know that you are in pain or have discomfort mid-procedure. Before every procedure, I explain every step I take before I do it so that a patient has an opportunity to express a concern beforehand. As I numb them, I ask patients to close their eyes, breathe through their nose, and wiggle their toes while my assistant pats their shoulder or holds their hand. I also tell all my patients to raise their left hand during the procedure if they need me to stop for any reason. Bottom line is that good patient-provider communication, trust, and mental preparation are key.
For parents:
- I would focus on the importance of parents modeling a dental visit or the dentist as a positive experience (especially not as a punishment). Try to incorporate as much familiarity with dental exams and hygiene at home so that things seem “normal” when they are in the chair. If your child has never seen floss at home, they won’t know what to do when we floss them in the chair. If you never have your child open their mouth and check on their teeth from time to time—perhaps while helping them brush—they won’t know how to react when a stranger decides to look in there.
What kinds of questions or conversations should people have with their dentist or dental hygienist?
It’s important to give us a heads-up in your first visit on what level of anxiety or phobia you have, what particular fears, phobias, or limitations to treatment you have, and what you feel has been done well or done poorly in the past to address these fears. If you’ve been sedated in the past, let us know that. If you’re “hard to get numb” or you’ve had bad reactions to any anti-anxiety medications or anesthesia, definitely discuss that too. Ask your dentist what levels of sedation they offer if it interests you, and be as detailed with your medical history as possible if you plan on pursuing sedation. Don’t psych yourself out about a procedure before it happens. And find a dentist you trust.
Thank you so much for sharing your experience with us. It’s clear there are so many ways that open communications with healthcare professionals and dental providers, shifting our mindset, and being understanding and patient with our kids can make a big difference in our oral health.
About the Author
Sarah Steward, of the Henry M. Jackson Foundation, is a Social Health Scientist for the Consortium for Health and Military Performance (CHAMP) at the Uniformed Services University of the Health Sciences (USU).
* The opinions and assertions expressed herein are those of the author and do not reflect the official policy or position of USU or DoD. The contents of this publication are the sole responsibility of the author and do not necessarily reflect the views, opinions, or policies of The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. The author has no financial interests or relationships to disclose.
