John C. Chao, D.D.S.

Research Associate Professor, University at Buffalo, SUNY
Adjunct Assistant Professor, Ostrow School of Dentistry, USC

(626) 308-9104

News & Press



How to Overcome Dental Phobia
Through a Non-Pharmaceutical Method:
"Iatrosedation"

Without use of drugs, a tried-and-true method developed and used at the Herman Ostrow School of Dentistry of USC since the late 1960’s can predictably help patients overcome high anxiety or phobia associated with dental treatment. This non-pharmaceutical method is called “iatrosedation.”  It is defined as “an interpersonal-cognitive (doctor-patient) process by which patient suffering from dental phobia/high anxiety are calmed by the behaviors, attitudes, communicative and  “painless” skills of the doctor.  In other words, this method calls for the doctor to use his/her verbal and “painless” skills in a particular way to help the patient dissolve dental phobia or anxieties.  “Iatro-“refers to the doctor and “sedation” means, in this instance, to mean “calm.”  Doctor calming the patient, without the use of drugs, is therefore called “iatrosedation.”

What then is dental phobia and why is it necessary for this condition to be treated in such a special way?  A phobia is an intense fear of certain situations, activities, things, animals, or people.  The main symptom of this disorder is the excessive and unreasonable desire to avoid the feared subject.  Dental phobia may be described as excessive and unreasonable fear of dental treatment.

In contrast to other phobias, dental patients suffering from dental phobia generally cannot avoid repeated exposure to the threatening stimuli, but yet be expected to do so.  Continued avoidance leads to significant consequences, such as dental emergencies. For the truly phobic individual it is common for a vicious cycle to develop in which fear leads to avoidance of dentists, results in neglected dental care, increased awareness of unmet needs, and likely feelings of shame and inadequacy.

It is estimated that 5-10 % of adults in the U.S. suffer from this condition.  This means over 10 million people suffer from this debilitating condition.  More often than not highly anxious patients are treated with pharmaceuticals, such as oral sedatives, nitrous oxide, IV sedation and general anesthesia.  However, often after extensive dental treatment, these patients do not return for maintenance care and their dental conditions continue to deteriorate over time.  This may be because the root of the problem is not addressed, i.e., resolution of the phobia.

Doctors trained in the “iatrosedative” approach recognize that fear of dental treatment generally arises from past dental/medical procedures which gave rise to a “conditioned response” that manifests as unreasonable fear of dental treatment.  The role of the doctor consists of helping the patient recognize how the fear developed and that through positive experiences this “learned” fear response can be “un-learned.”  Through an empathetic process the doctor ferrets out what specific conditions trigger the fear.  With the specific fears identified the doctor maps out a plan of treatment that would reassure the patient that each specific fear is addressed and the patient can expect to have a comfortable, secure treatment experience.  For instance, if the patient is afraid that “novacaine” would not completely numb up the tooth, the doctor can use new anesthetics that are more potent than those in the years past, give the area plenty of time to numb up, and encourage the patient to raise a hand whenever something bothers the patient. Through this kind of “iatrosedative” process trust is developed between the doctor and patient, and thereby the fears are dissolved.

The iatrosedation approach has been successfully taught and used at USC School of Dentistry for over 50 years, during which time thousands of patients with high anxieties have seen their conditions resolved and their lives changed for the better.


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