Chairside Trauma

Dentistry is so hard on us because we are constantly engaging with our patient’s trauma triggers and deep-rooted fears. If you’re an empath like me, it can be challenging to not take it personally or to not feel their pain. 

My first patient after lunch one day was a petite 22-year-old female. She came in with her boyfriend who held her hand as she lay in the chair, crying. She’d been added to the schedule at the last minute under an appointment block that read “Emergency, in pain.” 

The source of her pain was no mystery; she had a decayed and broken premolar that couldn’t be saved. She knew this before she came in, and was willing and ready to go ahead and get it extracted. While the assistants obtained consent and set up for the procedure, she appeared relieved to have a solution.

I sat down next to her, adjusted my loupes, and put on my gloves. Before I even touched her, she began to shake. Her body vibrated from head to toe in small, violent waves. Tears started flowing again, and her breath became shallow and rapid. It sounded like she was gasping for air.

I took my loupes off and removed any instruments that were around. I then realized she was having a panic attack. I wasn’t a stranger to panic attacks, I’d seen them before, and have even had them myself. 

But we hadn’t even started – there were no sounds or smells, and no physical sensations to trigger her. I was taken completely off guard and felt the adrenaline ramping up in my own body.

“Breathe,” I instructed her. “Slow and deep, I’ll do it with you.”  We breathed in for three counts and out for three, then slowly made our way up to five. Her body slowed down as she focused on the numbers.

“Is there something you’re afraid of or worried about?” I asked her.

She started shaking again, and sobbing, “My friend. One of my friends died getting his wisdom tooth taken out,” she explained. Her breathing was erratic, and she clenched her chest. “My chest is tight,” she said, almost in a whisper.

At this point, I knew I had to call the EMTs. I was confident that she wasn’t having a heart attack, but it wasn’t a risk I was able to take. I shared with her that her loss was tragic and rare, and assured her that the risks involved with her tooth were significantly lower than her friend.’ She listened, but in her fight-or-flight state, I wasn’t sure she could hear me. 

While we waited, I just talked to her. All I could do was keep her present and take her mind off of her fear. The conversation kept me present too. “Tell me something that makes you happy,” I said. So she told me about her children. “How many do you have?” I asked. She had four. “What are they going to be for Halloween?” I continued.

As she spoke about her kids, she lit up, and she laughed. While distracted, she was more at ease, although her body was still pumping with adrenaline. After I handed her off to the EMTs, her boyfriend told me that she was prone to anxiety attacks. She didn’t take medication or seek therapy because they didn’t have health insurance. 

He said she was in the ER just last week for a panic attack. I couldn’t even imagine their growing hospital bills. The irony.

Though this story is an extreme case of dental phobia, it’s not uncommon. We see a lot of patients who sit in our chairs and share their fear of needles, of dental work, of the drill sound, of the loss of control, etc. 

Some of these patients, like the one I shared with you, walk into our offices and relive a trauma completely unrelated to their experience with us. They associate their past trauma with the roles we play and the titles we carry. 

My patient linked an extraction to a friend’s wisdom tooth experience, which brought up the grief of her loss and the fear of losing her own life. The threat of danger was real to her and had nothing to do with me.

But this threat of danger becomes real to us. 

Patients who cry in the chair because they’re scared can trigger us to question if we’re hurting them. A patient in the middle of a panic attack may lead us to think they’re having a heart attack or worry that they may pass out. Then there we are, in fight or flight mode right with them.

We see so many patients a day, and we are so frequently exposed to this environment of fear, and anxiety. And THAT in itself is stressful. THAT is why dentistry can be so draining. What we need to do is learn how to take care of ourselves, how to see these triggers, and manage the stress that comes along with them.

The only way to help a patient is to co-regulate, and those tools were certainly not in our textbooks.

Let’s talk about it. 

Have you ever had a patient reaction you feel you were unprepared for?