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Conscious Sedation Permit,
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Academy of Periodontology
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of Anesthesiology
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Academy for Excellence in Dentistry
University of Texas, Department
of Periodontics
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Member
Recognition for Outstanding Service,
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Radio Transcription
Ep 58: Iatrosedation; Overcoming Anxiety; Live audio of anxious patient and his experience at our office
Salvador Gaytan: It's time ladies and gentlemen! SmileTalk is on the air featuring the latest news and developments in dental health, as well as other fascinating topics that make people smile. I am Salvador Gaytan, and I'm here with?
Dr. John Chao: Dr. John Chao, hi everybody. We have something very special. We actually have a recording of a live interview at my office with a very, very anxious patient and how we took him out of that mode into a situation where he was totally comfortable with dentistry.
Salvador Gaytan: That is right, and for those tuning in, we're going to get to that. You're listening to SmileTalk, and you can reach Dr. John at AlhambraDental.com or ChaoRadio.com, spelled C-H-A-O Radio, or 626-308-9104.
Dr. John Chao: You're welcome to contact me for any questions or further information.
Salvador Gaytan: Absolutely. Now, Dr. John, you're known as the friendly dentist, and also as we've talked about, you specialize in unique solutions for very difficult dental problems, isn't that right?
Dr. John Chao: Yes, including people with anxieties. I'm also recognized as a chickenologist.
Salvador Gaytan: Chickenologist, I like it.
Dr. John Chao: I treat chickens.
Salvador Gaytan: Why did you just look at me like I'm a chicken?
Dr. John Chao: Well, I'm just looking at you because I'm talking to you, but you were once a very chicken-chicken.
Salvador Gaytan: A chicken-chicken.
Dr. John Chao: But you're no longer one.
Salvador Gaytan: I'm no longer -- well, you know what, actually the thing is, I've been a patient of yours for many years, and my first experiences with you were very pleasurable. You know, I didn't have a cavity for quite a long time. I only had one, but when you gave me an injection, you told me, "You know what, all you're going to feel is a little pinching, and that's it." And I was like okay, I'm looking at this long needle, but it was true.
Dr. John Chao: Well, you didn't even feel the pinch, you felt me moving your cheek a little bit.
Salvador Gaytan: That's right.
Dr. John Chao: That was probably the movement that you thought, that felt like I pinched it, because you didn't really feel anything at all, not from a little quick movement.
Salvador Gaytan: That is right. It was totally painless, and hard to believe really, but it is true.
Dr. John Chao: It's part of our magic. Our magic meaning the kind of method that we teach at USC, that I've been teaching at USC, and that I employ at my practice.
Salvador Gaytan: That's right, and I wish I could get my doctor to give me a painless injection in my arm, that would be nice, because that's not painless.
Dr. John Chao: Or other parts of your body.
Salvador Gaytan: Yeah, other parts. Well, you know when I was a kid, I got in the rear end, but I don't like that any more either. So, but anyway…
Dr. John Chao: You know there's a reason why that hurts.
Salvador Gaytan: Why?
Dr. John Chao: You notice how they first -- where they put the injection in, they put the needle in, there's actually no pain with that, because if you do it real fast, there is no pain.
Salvador Gaytan: Are you talking the arm or the rear end?
Dr. John Chao: Wherever it is. The penetration is not what hurts, it's the sting from the injection. You felt it for a few seconds, that little sting. It's not really the needle going in, it's pushing that material out so fast.
One of the ways we can make an injection painless is a very, very slow injection. The body has the time to absorb it, and the tissue is not expanded all of a sudden, and the anesthesia has a chance to spread. And that's one of the secrets to having a painless injection. A fast injection is never painless, I can guarantee that.
Salvador Gaytan: Wow, one of your top secrets revealed right here.
Dr. John Chao: Oh I teach everybody.
Salvador Gaytan: Is that what you teach in the USC School of Dentistry?
Dr. John Chao: Yeah, that's one of the things I teach at USC Dental School, is how to make everything painless, and also how to take the patient out of the anxious state of mind.
Salvador Gaytan: Okay, so let's set up. We have a -- we're going to play it in two separate clips, a live interview of one of your patients that you recently treated here in the months of February-March, and his name is John.
Dr. John Chao: Yes, we actually had talked about him at the last show, no, two shows ago.
Salvador Gaytan: Well, it was probably -- actually, it was probably about a month ago we talked about him.
Dr. John Chao: Yeah. So, something like that. And but we found the audio taping of the interview when he first came in, and then we also have the audio taping of what he said after the procedure.
Salvador Gaytan: And obviously he consented to this, that you can use this to help other patients.
Dr. John Chao: Yes, he was so helped with this program that he has consented to allow us to use the voice taping to help other people who may be suffering the same thing as he did.
Salvador Gaytan: And I'm going to let the audience know that of course we've listened to the tape, and it is very, very introspective and interesting. Anyone who has some anxieties about the dentist, and about going, hearing his own words, very, very invigorating and hopeful to the masses, and we're going to play that in just a second, but let's set it up Dr. John.
His name is John, he's a fireman. He's about in his late 30s, a strong guy. I've seen the video, and strong guy, but he had a very bad experience which you're going to hear in his own words, but roughly what was the experience he had as a kid with the dentist?
Dr. John Chao: I'm sure he had more than just one incident, but the one he cited most emphatically was when he was getting an injection. The elbow of the dentist was…
Salvador Gaytan: Don't give it away.
Dr. John Chao: Okay. But he had a very traumatic experience.
Salvador Gaytan: Right, traumatic experience.
Dr. John Chao: And that stayed with him, even though he became a fireman and eventually was trained to be a captain. And he served as a medic, he could never get over that particular anxiety or the phobic state.
Salvador Gaytan: And that kept him from going to the dentist for how long?
Dr. John Chao: For about 20 years.
Salvador Gaytan: And he's going to tell you how he suffered with that.
Dr. John Chao: Suffered with that continuously for a long time with pain. So, he was able to withstand the pain of not having a toothache taken care of. So, that shows a lot of courage actually, but his anxiety was so strong that he could not bring himself to come to the dentist until I saw him.
Salvador Gaytan: And without further delay, let's play for the audience the first clip of John, and he's going to describe his initial fear that he had of the dentist, and also he's going to talk a little bit about what went on before the procedure was completed.
John: Well, I have not been to the dentist in about 20 to 25 years. When I was young, my parents didn't have a lot of money, and we went to a dentist. And while he went to numb my mouth, he was bumped, and the needle was driven all the way through my gum, and that caused a big phobia, which is like shocks in my mouth.
Well, it's always been a problem for me now, because I can never relax in the chair. I can never relax in the chair completely. The last time I went down to a doctor that I just didn't feel comfortable with, and I had ridden my motorcycle down there, and I sat down in the chair, and the minute he put a tool in my mouth, all of my clothes were soaking wet.
I was just sweating and just couldn't take it. And he even told me, he goes, "Hey, you better come back when you can relax."
Salvador Gaytan: Okay, now Dr. John, we just played the first clip, and it was very fascinating. He talked about his initial fear, and how the dentist -- when he was a kid, how the dentist's elbow was pushed, and the needle went through his cheek. That's not a common thing to happen, is it?
Dr. John Chao: It went through his cheek and pierced his gum.
Salvador Gaytan: His gum, right.
Dr. John Chao: That's a very traumatic experience. But I think what really made it very bad for him is that it was a threatening experience. If it was just a clear accident, such as when you fall on the floor, you hurt yourself, that's a painful experience.
But he stayed with him and actually made a very strong circuit in his brain in terms of anxiety that he could not get over for the rest of his life until he came to the office. I think that is probably generated by the feeling of helplessness.
As a little boy he was helpless, he didn't feel protected, and he had -- there was an accident, and once that was done, the work continued. And so, that added to his anxiety. His anxiety comes from a feeling of lack of control, which in my experience, has been very much involved with people getting anxieties or phobia from painful experiences.
Salvador Gaytan: Well, and especially as a child, children feel very helpless, and so many things happen to them, people, as a child, they carry that with them into their adult years.
Dr. John Chao: Especially when the protective figure, which is supposed to be the doctor or the parents are not helping the situation and making it okay for the child to have that. If you fell down and broke a tooth, the parents are going to be there for you, and say, "Oh you poor thing, let me take care of it. What can we do for you?"
But if this painful, threatening experience happened in a dental chair, the parents are not there. The parents sometimes even participate in holding the child down.
Salvador Gaytan: And says, "Hey, you have to do this, it's going to be okay," and it's not okay.
Dr. John Chao: In the young mind of a child, it's as if the child has been betrayed by those he trusted to protect him from harm, and that becomes traumatic because of the lack of control, because of the lack, because of the -- not that it's intended to be that way, but the primitive feeling, the bare feeling is that "Why didn't you protect me? Why couldn't you save me from this particularly painful experience?"
Salvador Gaytan: Now, what you did -- before we're going to setup our second sound bite here, after he had the procedure completed and was very, very happy and grateful, and we're not going to get into the details, but you used Iatrosedation as part of his procedure, which was very effective in eliminating what you're talking about, the anxiety, isn't it?
Dr. John Chao: Exactly, Iatrosedation is spelled I-A-T-R-O. That is a term for doctor, for doctor generated or doctor. Sedation just merely means, in Latin, calming. It is a term that was coined at USC Dental School back in the 60s. It's coined by a doctor who pioneered this whole procedure, called Nathan Friedman.
Dr. Nathan Friedman was a professor of periodontics at USC, and he developed this whole procedure on how to non-pharmaceutically treat a patient with high anxieties, or treat a patient with such high anxieties, that it could be classified as being phobic about dentistry.
Salvador Gaytan: Okay, and now we're getting into more of the details. We're going to setup our second clip here, and but for anyone tuning in, you're listening to SmileTalk with Dr. John Chao, spelled C-H-A-O. You can reach Dr. John at ChaoRadio.com, C-H-A-O Radio dot com, or AlhambraDental.com or 626-308-9104. Here is our second clip of Dr. John's patient, John -- you want to say something?
Dr. John Chao: Now, this is after we have given him a totally painless injection, and after we have taken out a tooth.
John: This is the best experience I've ever had with a dentist. I never had an experience like this. I really appreciate it.
Dr. John Chao: Yeah, okay.
John: I didn't feel any pain from you. It feels good to -- you made me feel comfortable with your staff, that they were just thorough, and it was kind of fluid in the way they operated. And you could tell, your office is just confident in what they're doing, that's just the most important thing to me. You changed my life. It feels really good.
Salvador Gaytan: So, Dr. John, we just heard the second clip of your patient, John, and what struck me was how he was grateful and how it changed his life, what you did for him.
Dr. John Chao: This was one of the most pleasurable and satisfying things that we do in dentistry, to take a patient who has such a debilitating condition, and then be able to help him through it, and help him not only go through it, but help him make it into a learning experience to where it impacts his own life.
Later on -- it's not in the clip, later on he said this has been an emotionally cleansing experience. He actually was able to unburden something that has been burdening him and causing him a debilitating problem that he had to struggle against, despite being quite accomplished in his life.
Salvador Gaytan: And this was just a simple cavity, wasn't it?
Dr. John Chao: Well, a simple cavity that needed extraction.
Salvador Gaytan: Yeah. I say simple cavity, because if I had a problem like that, I would think nothing of it, I'll just make the call, I go see you or if you were not available, someone has their own dentist, to see the dentist. What's the problem? One day deal, but he had such a fear in his mind, and that is what -- beyond the procedure, that is what you tackled and helped him with, was the fear in his mind.
Dr. John Chao: Yeah. And this is why at the Herman Ostrow School of Dentistry at USC, this department is called Behavioral Science, and actually what I teach in the department of Behavior Science.
We're dealing with patients' minds, we're dealing with the behavior changing techniques, and we're teaching the student doctors how to manage anxious patients such as this. And this is, like I said, a technique that has a sequence.
Salvador Gaytan: Now, we’re talking about the technique of Iatrosedation and which you talked about, makes the patient who feels helpless feel like they have maximum control. Is that right?
Dr. John Chao: That is a very, very important part of this.
Salvador Gaytan: Right.
Dr. John Chao: Whatever happened to this patient wasn’t just an accidental painful experience that could be overcome. It’s something that made him or her feel very helpless. If you cannot stop what’s hurting you and you have no control over it, it makes a very deep impression on your mind.
So this is one of the things that we deal with in this very, very effective technique that has been used at the School of Dentistry at USC for many, many years, since the 60s and 70s, so that’s 40, 50 years that this technique has been there, but it has not been made known to the public.
What we want to know, we want to show the public, through this program, is that, from the patient’s point of view, how this technique can help them and how this technique works and help them understand how they got there and what the technique is, how to get them out of it.
Salvador Gaytan: Now, you gave him a shot of Novocaine, correct?
Dr. John Chao: Yes.
Salvador Gaytan: Okay, so he got a shot of Novocain, which is what caused the trauma and the fact he felt helplessness, so, talk about – tell us, what did you do to calm his fear so that he would accept a shot of Novocain?
Dr. John Chao: Okay, number one, this is how we teach our student doctors. Number one is, the patient must be validated in his emotional state, we need to recognize and accept the fact that he has his problem, because if the doctor doesn’t accept that, neither can the patient.
It’s not bad for you to be anxious; it is not your fault. This is the first thing we do, so…
Salvador Gaytan: It’s not silly.
Dr. John Chao: It’s not silly, it’s not something you should ignore, it’s not something you have to overcome all by yourself, it’s not something you should feel ashamed about. This is something that happened to you, through no fault of your own, that you have this anxiety.
Many times the patients feel ashamed because they cannot bring themselves to go to the dentist and solve this major problem that impacts their health, impacts their self-image, because they have teeth that they can’t show. They can’t smile because they’re trying to hide their teeth all the time.
Salvador Gaytan: Right.
Dr. John Chao: So, first of all, this method calls for the doctor and the patient to recognize and accept the fact that they have this high anxiety state, you can even call this a phobic state. Once the patient – I do something like, of course I’m a chickenologist, acknowledging the fact that it’s okay for you to be scared.
Salvador Gaytan: That’s right.
Dr. John Chao: This is what I, as a doctor, treat. I say, jokingly, I specialize in it, because I want the patient to know that this is what I do, very commonly, it’s okay for the patient to feel very anxious, feel very scared, you could be a scaredy-cat you could be a coward, it’s okay. Even if you don’t want to admit to yourself that you have this anxiety state, I often say: even if you’re not a coward, I’ll still treat you like one.
Salvador Gaytan: Right.
Dr. John Chao: Because I want the patient to know that it’s going to be okay to have that, then, once the patient feels accepted, concerning his state of mind or her state of mind, then we’re going to talk about, what is it exactly that bothers the patient.
Sometimes it’s the injection; sometimes it’s the injection and the tooth not being numb enough, that’s very common or sometimes it could be the noise. I had a music teacher, she just cannot stand that noise of the drill. Yeah and it bothers the patient.
Salvador Gaytan: Yeah.
Dr. John Chao: Sometimes people don’t like the taste or don’t like the smell, so, we have to identify what is it that bothers the patient, all the specific things and then once I have a comprehension, once I have found out what specifically he’s afraid of or she’s afraid of, then I will explain to the patient that you got these specific fears as a result of past experiences. We don’t {drawl} on it too much.
We just, basically, have the patient know how he came about that this particular fear is acquired, it happened to the patient and he learned or she learned it as a child, somewhere down the line when he or she had treatment.
Salvador Gaytan: And made them feel helpless.
Dr. John Chao: Yeah, and made him feel helpless or her feel helpless, so, then I would, in different ways, show the patient that that would not happen again with me. If it’s going to be an injection problem, I will reassure the patient and if I have to explain it, I’ll explain it how I do it, to assure the patient that this is not going to happen and my staff also assures them, because we do this all day long, our injections don’t hurt, it’s painless.
Salvador Gaytan: Or if it’s a noise problem…
Dr. John Chao: Noise problem, we have them bring iPod and earphones and we can use Air Abrasion, which doesn’t require a drill to take out the decay if it’s a sound problem, we have air filters all over the place on our office, so there’s no dental’s office smell in our office.
So, we do everything we can, our apertures are open, there’s not a closed room, we have very nice partitions and with windows looking out into the garden, so we make it a very, very comfortable, warm environment for our patients.
To convince the patient that this is acquired and that through having a new experience, the patient can unlearn very quickly what has been learned from past experiences.
Salvador Gaytan: So, what was negative…
Dr. John Chao: One good experience like this, that John has, has turned his mind around totally and this is how powerful a new experience can be, if it’s done just right.
Salvador Gaytan: Yes.
Dr. John Chao: And that’s how, John – that’s how I was able to give him the injection to begin with, because we were able to help him accept the fact that he has this, it’s okay for him to have this anxiety and then we assured him that my injection will not hurt him that we can do this procedure without any sensation on his part, no pressure, nothing. Then, after he’s done, then you just heard what he said.
Salvador Gaytan: Changed his life.
Dr. John Chao: Yeah, and it changes life in different ways and how that can, well, we’ll talk about it, but I proved to him that this is a painless experience, and that he does not have to be threatened.
One thing I did with him, that I should talk about, that is the anxiety. His anxiety came from feeling helpless, so one of the main ingredients that I incorporated into my interview, my Iatrosedation interview with him is that, John, my patient has total control for this entire procedure.
He can put the stop to it, he can take a break, he can stop it any time he wants, so, unlike the child that was sitting in the chair having the needle push through his skin and his gum, John has control, because he didn’t have control before he suffered.
Salvador Gaytan: Right.
Dr. John Chao: I let him have control. I tell my patients, I didn’t tell him, but I told many of my patients that they’re the conductor, I’m the orchestra.
Salvador Gaytan: That’s right.
Dr. John Chao: They can start and stop. I told that to a patient just the other day, she said, “I like that, because I was a concert pianist”.
Salvador Gaytan: Ha-ha, very good.
Dr. John Chao: She loved that analogy and so, we actually let her play the piano in my office, but anyway, to answer your question, that’s part of the Iatrosedation technique, so that he was able to allow me to even prove the fact that this whole process will be painless.
Salvador Gaytan: A success story from start to finish, we’re down to our last, less than a minute, Dr. John.
Very fascinating, I want the people to know that if they have their own dentist, fantastic, but if they don’t and they have some fears, they need some things taken care of, they can call at you any time and you can reach Dr. John at AlhambraDental.com or ChaoRadio.com, C-H-A-O Radio.com or 626 308 9104. Dr. John, the last few seconds, what do you have to leave the audience with?
Dr. John Chao: Well, if you are a patient with high anxieties regarding dentistry, think about what caused it, it’s okay to be fearful, it’s not your fault, think about what bothers you and find a dentist that can reassure you it’s going to be okay.
Salvador Gaytan: Fantastic, we’ll talk to you next week.
[END OF AUDIO]
