Hypnosis Applied to Dental Practice: A review

Abstract

Modern technological advances in dental professions have managed to solve problems that have existed for centuries. Yet, there is a variety of psychological and psychosomatic disorders that still challenge us because of our inefficacy to cure patients exhibiting symptoms of these disorders. Although pain management field has seen significant advance, many people nowadays keep avoiding seeing a dentist out of fear or anxiety. Clinical hypnosis seems to bring advantages to dentistry for it helps neutralize indefensible nervousness and phobia in patients. Dentists who make use of hypnosis are more able to relieve their anxious patients’ pain and fear. This article provides an insight into the advantages of hypnosis as a therapy, and explores its applications in dentistry.

Keywords: hypnosis, dentistry, clinical application

Dental News Magazine – September 2020

Emna Hidoussi Sakly – University Of Monastir, Faculty of Dental medicine, Research Laboratory of Oral Health and Rehabilitation, LR12ES11, Monastir, 5000, Tunisia

Wiem Ben Amor Jemmali – University Of Monastir, Faculty of Dental medicine, Research Laboratory of Oral Health and Rehabilitation, LR12ES11, Monastir, 5000, Tunisia

Neila Zokkar Benzarti – University Of Monastir, Faculty of Dental medicine, Research Laboratory of Oral Health and Rehabilitation, LR12ES11, Monastir, 5000, Tunisia

Faten Ben Abdallah Ben Amor (faten.benamor@yahoo.fr) – University Of Monastir, Faculty of Dental medicine, Research Laboratory of Oral Health and Rehabilitation, LR12ES11, Monastir, 5000, Tunisia

Introduction

Hypnosis is stereotypically thought of as a method of manipulation and that’s because of the myths that built misconceptions and erroneous mental representations around it ¹. In fact, the main aim of hypnotherapy is not to manipulate the patient, but to give them the tools they require to take back control of their behaviors, feelings and emotions. “Hypnosis” is originally a Greek word that means “sleep”. It represents a naturally modified conscious state. The individual gets into a hypnotic state called trance, which is not artificially induced and is different from the usual awareness state ². 

The observation of neurophysiological changes assert this altered consciousness, which differentiates it from states of meditation or relaxation. Although in a hypnotic state the subject is highly attentive to suggestion, they maintain concentration and keep the potential to make their own decisions at any time. 

Dentists who use hypnosis regularly in their clinical practices appreciate a variety of significant advantages. There are many and varied applications of clinical hypnosis in dental clinical practice. Dental applications of hypnosis include relaxation, relief from fears and anxieties, reduction in both the perception and severity of pain during procedures, control of bleeding and salivation (both for increasing and decreasing flow, as needed), control of bruxism (tooth grinding), finger-sucking, and other habits, and promotion of behavioral modifications associated with optimization of oral health ^{3, 4}. 

Amongst a lot of options for behaviour management and modifications, hypnotics is one of the oldest and non-invasive way to control dental anxiety in children, adult as well as in geriatric patients and hence get a better treatment result and a good compliance and satisfaction of the patient.

How does it work?

It’s thought that hypnosis provides direct access to a person’s subconscious mind ⁵. In essence, it is the subconscious which is mainly responsible for a lot of what we do and how we feel. Science has agreed that hypnosis involves being in a trance state, experiencing relaxation at the same time as heightening the mind’s imagination. In this state, where the subconscious is released, we observe an alteration in the composition of neural oscillations especially in Prefrontal Cortex and Right occipital EEG channels ⁶. The mind is extremely susceptible to the hypnotherapist’s suggestions, which push the subjects’ focus to their inner world to influence their perception, feelings, thinking and behaviour. But to be of effect, suggestions must be acceptable to the subject.

Use of hypnosis in the dental practice

Hypnosis can bring considerable relief to anxious patients and make it easier for the dentist to do their job but it is particularly implemented in order to help patients relax. As relaxation raises the pain threshold, requirement for local anaesthesia is reduced. And even if it is necessary, it is better tolerated. Therefore, the use of hypnosis as a general relaxation strategy is certainly possible and there are reports in the literature of its use in both adults and children ^{7, 8}.

Moreover, clinical benefits can be derived from hypnosis such as the control of dentophobia, abnormally active gag reflex, trigeminal neuralgia pain, benign chronic orofacial pain, temporomandibular joint dysfunction (TMD), adaptation to dentures, behaviour modification, like thumb sucking, bruxism. Additionally, hypnosis can control salivary flow and bleeding. Xerostomia and haemostasis can be produced through hypnotic suggestions, such as visualizing being in a desert on a hot day and noticing how dry the mouth becomes because of lack of water. Mental imagery of the ligation of a bleeding vessel can be used to decrease bleeding after soft tissue surgery. 

Hypnosis in children and adolescents is possible, but, much harder to administer than in the adults. It is also true that not everybody is susceptible to hypnosis, as it is apparent that this phenomenon has also some association with genetics and brain structure ⁹. 

Hypnotic suggestion is used in the management of paediatric patients as well. This involves the techniques of distraction, reframing and imagery suggestions. It is effective with kids aged 8–12 years, but even a four-year-old child can show responsiveness ¹. 

Furthermore, the operative use of hypnosis includes analgesia during surgery. It has been largely superseded by pharmaceutical sedation and general anaesthetics. When using hypnosis for analgesia, the patient must reach deep hypnosis, which takes time, and have an environment free from distractions and interruptions ¹⁰.

Current methods of hypnosis

A distinction arises between a deep type of hypnosis and a light one and both have different applications. Deep hypnosis takes long so it is not apt for regular dental practice; however, it is required for analgesia and behaviour modification. On the other hand, the ‘light’ state is easier and faster to attain and is used in hypnodontia on a daily basis; for instance, to relax a nervous patient in a matter of minutes ⁹. 

Dentists have to use positive suggestions managing patients. Words or actions that inspire trust in the dentist will relieve the patient’s anxiety and fear. Informal hypnotic methods include the use of utterances like “you will feel quite comfortable” or “you will like the results” and this can be a powerful technique of patient management. Suggestions can be categorized into two broad types: direct and indirect ¹¹. 

Direct suggestion involves straightforward statements that are clearly understood by the hypnotic subject. An example would be: “don’t move your head because you won’t be able to before finishing.” Indirect suggestion uses indirectness in addressing the subject in a form of covert hypnotic statements. That is to say the subject is hypnotized without their knowledge. 

The above-mentioned example would be said during a conversation in this way: “well, you might not be able to move your head before finishing.” 

Conclusion

Hypnosis has many uses within the dental field, ranging from simple relaxation of the anxious patient to complete analgesia for surgery. Clinical hypnosis can be an incredibly valuable tool in dentistry. 

References

1. Nicola A. Hypnosis in modern dentistry: Challenging misconceptions. Faculty Dental Journal 2015; 6 (4): 172-175.

2. Irina H, Barbara C, Andra C. Using Ericksonian Hypnosis Techniques at Patients with Dental Problems. Procedia-Social and behavioral Sciences 2013; 84: 356-360. 

3. Lance MR. Introducing clinical hypnosis to dentists: Special Challenges and Strategies.

American Journal of Clinical Hypnosis 2019; 61: 276-289.

4. Kroger, WS. Clinical and experimental hypnosis in medicine, dentistry, and psychology. Philadelphia, PA: Kluwer/Lippincott Williams & Wilkins. 2018

5. Lil N. The role of hypnotherapy in dental practice. Dental nursing 2013; 6 (4): 218-220.

6. Asma M. Review of clinical hypnosis in dentistry. Mod Res Dent 2017; 1(4): 59-60.

7. Patel B, Potter C, Mellor AC. The use of hypnosis in dentistry: A review. Dent Update 2000; 27: 198-202

8. Ramirez Carrasco A, Butron tellez Giron C, Sanchez Aramss O, Perdant Perez M. Effectiveness of hypnosis in combination with conventional techniques of behaviour management in anxiety/pain reduction during dental anesthetic infiltration. Pain research and management 2017; 1:1-5.

9. Singh et al. Hypnosis “A lost Art” in Dentistry A review. Rama Univ J Dent Sci 2017; 4(1):15-18.

10. Mark PJ. The neurophysiology of pain perception and hypnotic analgesia: implications for clinical practice. American Journal of clinical hypnosis 2008; 51(2): 123-148.

11. Yapko MD. Essentials of Hypnosis. New York: Brunner/Mazel Inc., 1995.

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