Since qualification, medical doctor Eileen Sanders has been giving injections to patients in subcutaneous tissues and joints, using syringes for lumbar punctures and many other procedures requiring local anaesthesia. However, just the thought of having local anaesthetic at the dental practice fills her with dread.
RH: I understand that, despite handling syringes yourself, you have a deep-seated fear of dental injections?
ES: Yes, I put it down to childhood experience. Our family dentist was a very stern man with a dreadful chairside manner. If you were nervous or anxious, as I was, he would just tell you to 'stop being so stupid'. I remember it vividly as a terrible experience and the injections as being really painful. That memory has never really gone away. I hate going to the dentist. There's absolutely no question about it... I hate it.
RH: So, even after all this time and as a medical doctor you haven't grown out of this fear?
ES: No. If anything it's got worse. At 27 years old I had a fall and broke a front tooth. My dentist at the time recommended a veneer and I can remember that injection as if it was yesterday. It felt like it was going through the top of my head and that obviously reinforced the childhood fear. My fear is compounded by the noise of the drill and the fact that I feel vulnerable and not in control.
RH: The fact that you now professionally undertake procedures with syringes has made no difference?
ES: No. As a doctor I'm quite happy giving procedures which are probably quite uncomfortable - I often give local anaesthetics. It's being the other side of it, on the receiving end, that makes me really anxious. I'm more anxious of the dentist than anything else. I've had caesareans under epidural and spinal blocks, and more recently I had to have a lumbar puncture; it was a difficult procedure and took multiple attempts to do it, but it didn't bother me at all – I knew what they were doing. I've actually done lumbar punctures on people myself.
So it's about being frightened of the dentist – it's not about being frightened of pain. The injection is horrible, and I'm never quite certain that it's going to work - although it always does. I don't like the vulnerability of it.
RH: Has this fear ever prevented you from having dental treatment when you really ought to have done?
ES: Probably not. But if I knew I needed treatment and I happened to have a check-up coming up in a month's time, instead of booking an appointment I'd wait for the check-up. But I have had a lot of work done recently. Eventually the veneer, which lasted 20-something years, broke down and I had to have a crown – I relived the fear of that injection 20 years ago when the veneer was put on.
However, my dentist, Murray Hawkins, used a device called Vibraject and it was completely painless - which I find stunning because, due to past experience, I was fearful of the pain. I couldn't believe the difference! I could feel a vibration, but it wasn't painful. The comparison of those two experiences is amazing. I've had to have five injections in the last eight weeks – a significant number. I haven't felt any pain during a single one of them. It's incredible. I can't really understand why Vibraject isn't used more widely.
RH: At present there are at least three systems available to dentists for pain relief during injection. A couple of them are micro-processor controlled systems that control the speed and pressure at which the anaesthetic is delivered. So there's no hydraulic force expanding the tissue. They can cost several thousand pounds. Vibraject is a small battery-operated device that costs £300.
ES: I have heard from my patients who work in dental surgeries that a lot of dental patients do find injections uncomfortable, some of them to such an extent that they'd rather have the dental treatment without an injection, because in their experience the injection is so much worse than the pain of the treatment.
RH: How do you think your own injection technique holds up – are you conscious of hurting patients or causing them discomfort?
ES: Yes, I am. I was wondering whether there are uses for Vibraject in medical procedures. I do quite a lot of implants for contraception and you have to give a local anaesthetic injection for those. Inevitably that's uncomfortable. As are lumbar punctures and bone marrow aspirations.
The pain of a dental injection must be partly due to expansion – the hydraulic forces. In lots of medical injections, like an implant, you're going into skin and subcutaneous tissue so you're not really expanding a restricted space, but if you're doing things like lumbar punctures, bone marrow aspirations and lots of procedures that are done under local anaesthetics – such as surgical procedures – I could see that there could be a place in medical procedures for Vibraject.
RH: There's a regular 10-year survey, called the Adult Dental Health Survey, that looks at the state of the nation's oral health, the last one also looked at dental phobia. It found that 28 per cent of the population were so extremely anxious about dentistry they could be described as phobic and 41 per cent were anxious beyond moderately anxious, so it is a really big problem. One way of addressing this appears to be Cognitive Behavioural Therapy (CBT). At least one specialist unit has been set up, at King's College, to treat dental phobics with a CBT course.
ES: But you could have CBT and learn all the techniques and breathing and so on, but ultimately, because you don't go to the dentist that often, you're not being subjected to it enough to be able to develop a different behavioural pattern.
The majority of patients who come to my surgery for tranquilisers (diazepam) to cope with short-term anxiety do so for one of two fears – either they're terrified of flying or they're terrified of going to the dentist. I would say that every year I have patients who need something for their anxiety before they can go to the dentist. I had one lady who had a cancer of her tongue: the reason she hadn't been to the dentist for 20-plus years was fear.
The number of times people come to us for dental advice is just amazing. You say to them 'you need to go to a dentist' and they say it's too difficult to get an appointment or they don't have a dentist - but maybe they're just too scared?