Dr. Siegelman is a Dentist Anesthesiologist, practicing in midtown Manhattan. Dr. Siegelman is Assistant Director of the Dental Anesthesiology Residency Program at Lutheran Medical Center in Brooklyn. His practice and career has been devoted to patients with dental phobia and special needs. The following is an interview with Dr. Louis Siegelman on Dental Phobia by Byron Cordero from MetroSource.
Byron: Let me just say, getting off the L train I came across your dental anxiety poster, and it really caught my eye! I immediately scanned to see who the genius behind this was. A few seconds later, an online search brought me to dentalphobia.com and I found you! Tell me a little bit more about how you came to be the special midtown dentist you are.
Dr. Louis Siegelman, DDS: I’m a dentist, but I also trained as an anesthesiologist. Initially, I didn’t understand the fears, traumas and difficulties people encounter in going to the dentist. It took time to understand the people who needed some form of sedation or special anesthesia for their dental care. Many of my patients suffered with generalized anxiety, or panic attacks at the dentist. Others had traumatic life experiences which had left deep emotional scars. Some were victims of abuse by an alcoholic or bipolar parent. If a person’s fear level is astronomical — there is probably a good reason, and history of abuse or trauma may be the cause. The bottom line is that people come to me for help with their teeth, and not for all these other issues. I have to really listen to determine how I can best help them.
Can you describe some cases that have come up over and over for our readers?
An extremely common scenario is a child held down for a dental or medical procedure. Another is an accident with some facial trauma, with blood and pain where the child is terrified. The common denominator is a real sense of danger at the time of the original trauma.
Another scenario is a childhood with a parent with their own psychological, drug or alcohol issues. The child may grow up in an environment of uncertainty and fear, never knowing what to expect. These people may emerge as adults with issues of chronic pain, anxiety or depression.
A painful past, a bad experience in the dental chair or being a victim of abuse are common problems that can make it difficult to go to the dentist. In addition to needle phobia and a strong gag reflex. I also see patients with sensory issues, autism, autoimmune, fibromyalgia, and other medical issues that can make dental work difficult for them.
Ok, so I’m a new patient. What should I expect?
When a new patient calls the office, I’ll generally speak to them first on the phone. I want to understand where a patient is coming from. Regardless of a patient’s personal history with dental care, I want to help. I want patients’ to know before they even walk into our office that their comfort is the first priority and we will do our best to create a positive dental experience. A lot of people feel ashamed when they avoid the dentist. It can trickle through in other aspects of life and some find that it affects their ability to be intimate with others.
Describe to me what your waiting room environment is like at 119 W. 57th St.
I want people to feel safe and secure, because I don’t want to stimulate any of that fear we previously discussed. I try to make it homey. The dental treatment rooms are designed with things to the side of the patient and not over them. We’ll be sensitive to things that would make the patient feel more secure like a blanket and even ice cream after the treatment.
We’re all embarrassed of our teeth on some level. It’s a very personal area.
What kind of sedation techniques do you use?
I use all different types. Everything from making a patient very numb through local anesthesia; what people call Novocain, to oral sedation with a pill or an elixir, to intravenous anesthesia. It depends on the needs of the person. I listen to the patient, and then design a plan that will address their needs.
Who takes these types of meds?
People who have speaker’s anxiety take a beta blocker, which blocks stress without drowsiness, unlike valium. I use medications like that frequently for my patients. When you block someone’s stress in another place, you don’t need them to sleep. I can communicate with them and keep the personal connection going. In the future maybe we can select an area in the brain that quiets that.
Let’s role-play, I’m a horrified patient; no clue where my fear is derived from. How would you help me?
Let’s think about what the problem could be. A lot of us associate certain fears with dental offices. Fears can be generated through instinctive responses. Claustrophobia is a huge one. For example, mouth breathers have a hard time breathing—a primal need for our bodies. Then here comes a dentist with their hands in your mouth, you may feel you can’t inhale properly and then you panic! There are certain things that trigger a primal fight or flight response; worst possible feeling in world.
On your first appointment I’d meet with you in my private office. This provides a non-threatening environment. I only give them (the patients) what they’re ready for. Some just come in and meet me. I don’t even look in their mouth until they go to sleep because they can’t tolerate that. I take them along in a process of things they can handle. I don’t overwhelm them with procedures, and information. I do it at a pace they can handle.
I try to bring it down to a personal level. I try to read people and give them what they need at a pace they can handle. The important things are being approached in a step-wise fashion and building that trust. This enables me to develop life-long relationships with my patients. My goal is to give my apprehensive patients a place to go to get their teeth taken care of just like everyone else.
Coming to the dentist and being approached in a step-wise fashion, using medications, and building that trust has really helped my line of work and keep life-long relationships with my patients. Not to say that all of them will be rid of their fear, but they will always have a place to go to get their teeth taken care of by a doctor who cares.