RESEARCH FINDINGS USING GUIDED IMAGERY FOR
Dental Procedures

July, 2006

Dental Procedures – Scope and Purpose
About 78% of Americans say they saw a dentist between six months and a year ago (ADA, 2000). American Dental Association surveys found that there were approximately 150,000 professionally active dentists in the U.S. in 1996, with the average dentist seeing about 3,900 patients per year (ADA, 1997).

Dental procedures include cleaning, repair, and pulling (extraction) of teeth, treating infection of teeth and gums, replacing damaged teeth, and sometimes cleaning, treatment, and repair of underlying bone. Dental procedures have significant medical value because dental infections can spread to other parts of the body, including the heart valves.

Dental infections can challenge the immune system even when they remain confined to the teeth and gums. In addition to pain and suffering, dental infections can cause tooth loss, impair patient nutrition, and contribute to high blood sugar and atherosclerosis (“hardening of the arteries”). Thus, timely, effective treatment of dental problems can prevent more expensive and damaging problems.


Problems with Dental Procedures
Unfortunately, 15 – 25% of all patients have dental anxiety severe enough to cause them to delay needed treatment (Toal and Samra, 2001). As many as 15% can be classified as dental phobic, meaning they have strong anxiety at even the thought of going to a dentist.

Dental phobia can lead to spread of infection and premature loss of teeth. Dental anxiety can cause longer, more difficult dental procedures, requiring some kinds of sedation or anesthesia (Miles, 1986). Sedation and anesthesia both add to the difficulty and cost of procedures.


The Role of Relaxation and Imagery
Many studies have shown that relaxation using guided imagery or hypnosis can reduce patient anxiety, increase the ability to tolerate procedures, improve patient satisfaction, speed healing, and reduce the need for analgesic medication and sedation in patients undergoing many medical procedures (Bampton and Draper, 1997; Lang, Benotsch, et al, 2000; Lang, Joyce, et al, 1996). Similar results have been shown in dental procedures (Carlsson, Linde, and Ohman, 1980; Enqvist and Fischer, 1997; Enqvist, von Konow, et al, 1999).

The prestigious Cleveland Clinic lists many mind-body approaches to effective pain management during and after dental procedures: distraction, relaxation and progressive relaxation, guided imagery, deep breathing, hypnosis, and cognitive behavioral therapy (Controlling Dental Pain, 2003). Cognitive behavioral therapy both and relaxation techniques improved dental fear, with relaxation providing more relief from fear than nitrous oxide (Willumsen, Vassend, et al, 2001).

In a recent study, hypnosis was shown to positively affect neurophysiologic parameters during dental implant surgery (Eitner, Schultze-Mosgau, et al, 2006). Hypnosis significantly reduced intraoperative anxiety in oral and maxillofacial patients (Hermes, Gerdes, et al, 2004).

A 2004 review of the literature confirmed relaxation’s effectiveness in cases of dental anxiety (Jorm, Christensen, et al, 2004). In another study, an impressive 93% of the dental surgery patients using hypnosis showed “remarkable improvements in treatment conditions” both for patients and for surgeons (Hermes, Truebger, et al, 2005). A combination of hypnosis and acupuncture can effectively control distinctive gag reflex, thus facilitating procedures (Eitner, Wichmann, and Holst 2005).

Reduced sedation decreases complications and cuts the need for expensive monitoring, as well as allowing patients and their caregivers a more rapid return to their daily lives. Increased patient satisfaction also improves patient willingness to have other follow-up procedures.


Conclusion
Guided imagery can reduce anxiety and medication use in dental patients, leading to increased patient satisfaction. This can result in shorter procedures, lower costs, and more regular dental visits.


References
1997 Survey of Dental Practice, ADA Survey Center. American Dental Association (ADA). 1997.

2000 Public Opinion Survey: Oral Health of the US Population. 2000 American Dental Association (ADA).

Bampton P, Draper B. Effect of relaxation music on patient tolerance of gastrointestinal endoscopic procedures. Journal of Clinical Gastroenterology. 1997 :343-5.

Carlsson SG, Linde A, Ohman A. Reduction of tension in fearful dental patients. J Am Dent Assoc.1980 Oct;101(4):638-41.

[no authors] Controlling Dental Pain. WebMD in collaboration with The Cleveland Clinic. Feb, 2003.
http://www.webmd.com/content/article/66/79596.htm#techniques
Accessed July, 2006.

Eitner S, Schultze-Mosgau S, Heckmann J, Wichmann M, Holst S. Changes in neurophysiologic parameters in a patient with dental anxiety by hypnosis during surgical treatment. J Oral Rehabil. 2006 Jul;33(7):496-500.

Eitner S, Wichmann M, Holst S. A long-term therapeutic treatment for patients with a severe gag reflex. Int J Clin Exp Hypn. 2005 Jan;53(1):74-86.

Enqvist B, Fischer K. Preoperative hypnotic techniques reduce consumption of analgesics after surgical removal of third mandibular molars: a brief communication. Int J Clin Exp Hypn. 1997 Apr;45(2):102-8.

Enqvist B, von Konow L, Bystedt H. Pre- and perioperative suggestion in maxillofacial surgery: effects on blood loss and recovery. Int J Clin Exp Hypn.1995 Jul;43(3):284-94.

Hermes D, Truebger D, Hakim SG, Sieg P. Tape recorded hypnosis in oral and maxillofacial surgery--basics and first clinical experience. J Craniomaxillofac Surg. 2005 Apr;33(2):123-9. Epub 2005 Jan 26.

Hermes D, Gerdes V, Trubger D, Hakim SG, Sieg P. [Evaluation of intraoperative standardized hypnosis with the State-Trait Anxiety Inventory] [Article in German] Mund Kiefer Gesichtschir. 2004 Mar;8(2):111-7. Epub 2004 Feb 6.

Jorm AF, Christensen H, Griffiths KM, Parslow RA, Rodgers B, Blewitt KA. Effectiveness of complementary and self-help treatments for anxiety disorders. Med J Aust. 2004 Oct 4;181(7 Suppl):S29-46.

Lang EV, Benotsch EG, Fick LJ, Lutgendorf S, Berbaum ML, Berbaum KS, Logan H, Spiegel D. Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet. 2000 355:1486-1490.

Lang EV, Joyce JS, Spiegel D, Hamilton D, Lee KK. Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use. Int J Clin Exp Hypn. 1996 4(2):106-19.

Miles L. Practice Dynamics. Penwell Publishing Co. Tulsa, OK, 1986 p. 54-58.

Toal M, Samra J. Dental Stress. 2001 http://thestressoflife.com/dental_stress.htm
Accessed July, 2006.

Willumsen T, Vassend O, Hoffart A. One-year follow-up of patients treated for dental fear: effects of cognitive therapy, applied relaxation, and nitrous oxide sedation. Acta Odontol Scand. 2001 Dec;59(6):335-40.`