1. Dr Jane Boroky B.D.S. Dip Clin. Hyp.
HYPNOSIS IN DENTISTRY
Dr Jane Boroky
B.D.S. Dip Clin. Hyp.

2. My background: Graduated BDS in 1981
Country practice (mid north) 4 years
Cook Islands 4 years – remote areas and teaching
Diploma in Clinical Hypnosis – ASH 1992
Public and private practice in SA last 30 years
Currently part time clinical tutor at Dental School with continuing private practice at St Peters Dental Clinic

3. Presentation Outline
Situations in which dental hypnosis is appropriate
Examples of hypnosis use in my practice
Induction practice
Anchors and fractionation
Use of positive language

4. 1. Hypnosis in Dentistry
NOT here to teach you hypnosis in dentistry, but it is useful to be educated regarding the range of treatment and services available
Similarities and differences with use of hypnosis in other fields
Factors include :
needs of patient
expertise and confidence of practitioner

5. Common uses of hypnosis:
Anxiety control/minimisation
Comfort and relaxation
Distraction during long/boring procedures
With children
Promotion of healing
Distraction – avoid conversations between staff
Visualisation – going somewhere behind their glasses, watching DVD etc
Kids – kicking football, watching video, playing favourite computer game – find out details first!

6. More specific uses of hypnosis
Treatment of dental fears and phobias
Reduction of gag reflex
Denture coping strategies
Pain control and induction of anaesthesia
Control of haemorrhage/saliva
TMJ dysfunction or bruxism

7. Dentist referral options:
Needle phobia
Dental phobia/avoidance
Dental treatment needed as part of lifestyle change eg low self esteem, eating disorders
Dental treatment as part of rehabilitation eg torture or trauma survivor, PTSD, sexual or physical assault etc

8. Any questions?

9. 2. Examples from my own practice:
Local anaesthetic administration
Endodontics
Children
Post surgery/extraction
Progressive desensitisation
Opportunistic eg smoking cessation, ego strengthening
TMJ pain, headache and clenching
Lady who did her own – did she choose me?
Endo -

10. Local anaesthetic ‘script’:
I am going to put some numbing solution on your gum (topical gel). . .
Now I am going to let the numbing spread under the gum (administration of local anaesthetic)
It will spread up around your lip and maybe even your nose (what they may feel/notice)
It can take about an hour to wear off after you leave (a bit vague)
Just let the numbness spread – it works very quickly if you just let it spread (they have a part to play)
Show video of procedure if possible

11. Endodontics Many patient go to sleep Some probably go into trance
Always give awakening suggestions at the end of the appointment regardless of formal induction or not
Couple with suggestions for future comfort, ease of procedure, time compression, amnesia etc
Show slides here of rubber dam and ‘isolation’ ie easy to feel removed from the situation

12. Children and hypnosis
Children are ‘easy’ hypnotic subjects – good imagination and easily distracted by things that interest them, also want to please adults
Use computer games/television/movie characters or scenes
Can also use favourite toys, sport etc
Children may not appear to be in trance ie they may talk to you
Tell story of boy kicking football

13. Children and hypnosis
Distraction is useful even when no formal induction is done
Hypnosis can be combined with Nitrous oxide or Penthrox sedation
I seldom test for depth of hypnosis or use formal deepening procedures
Exception is when profound analgesia required or stressful/long procedure

14. Children and hypnosis Example: Traumatic accident
The ‘magic wand’ for pain control
Getting parents on your side
Pre-cooperative children

16. Post surgery/extraction
Always give positive suggestions for healing
Also give suggestions for post op comfort and minimal need for analgesics
Be specific – mention minor swelling and inflammation may be part of healing
Very low rate of post op complications eg infection, trismus, pain even with difficult procedures

17. Progressive desensitisation
Mouth is very sensitive part of body
Association with trauma eg torture, sexual assault
Possible association of male dentist esp as power figure
Possible unremembered ‘trauma’ eg tonsillectomy or other childhood surgery
Sometimes use hypnosis, sometimes not – depends on needs of patient for control, preconceptions, dependency

18. Progressive desensitisation
Always have consultation first – in or out of chair
Induction is usually progressive relaxation with deepening eg walking down stairs or breathing or favourite place
Find out patient preferences first – also helps develop rapport
Once relaxed introduce fearful stimuli at a distance eg noise or touching a front tooth with a soft object or examination with mouth mirror only

19. Progressive desensitisation
Sometimes give patient mirror to watch procedure
Alternatively recommend they look at reflection in my loupes or dental light
Always stop at successful stage
If anxiety develops, backtrack and concentrate on comfort eg favourite place or deepen trance

20. Progressive desensitisation
Give suggestions for ego strengthening at end of appointment
Add suggestions for easier induction, rapid relaxation, link skills learnt to other stressful situations etc
Teaching self hypnosis would probably be useful (patients sometimes resist!)

21. Progressive desensitisation
Generally takes several appointments
Patients I have seen also want treatment to be completed
At recall I have not formally used hypnosis again
Some patients lost to follow up due to public health system, lack of motivation etc

22. General ego strengthening
Often use indirect/Eriksonian techniques
Most patients come for dentistry, not hypnosis per se
Helpful for them and for me if they are less anxious, more relaxed, more confident, happier, less resistant etc
Usually tie suggestions to scientific explanations to improve self reliance

23. Bruxism and clenching Often tension related
May be habitual from childhood
Sometimes ‘busy ‘minds do not turn off at night
Only a problem if causing pain or tooth wear ie range of physiological ‘normality’.
Self hypnosis is useful

24. Useful suggestions:
Remind yourself just before you drop off to sleep that you will wake up when you grind/clench too hard
Protective mechanism (‘man in the back of your head’)
This brings the thought driving the process into conscious attention
Then no longer necessary to ‘grind on it’ (or ‘eat yourself up’
Can just turn over and go back to sleep
This may happen several times a night if your mind is very busy

25. Smoking cessation Use QUIT brief intervention program
Find out reasons and readiness to quit
Suggest give up the cigarettes which are not needed first (reduces physical dependence AND brings decision into conscious mind)
Build on information given by patient eg health effects, cost, social etc

26. Emphasize adult choice (cf common peer pressure related to smoking initiation)
Reframe in terms of benefits of being a non-smoker (natural state)
Enlist the help of the ‘man in the back of your head’ (the unconscious smoker)
I don’t use ‘aversion therapy’ as such but reinforce relevant negative effects

27. Use information they have supplied;
eg you knew all along of the real reason for your smoking . . .
eg you are now aware of how your mind has been tricking you . . .
eg your commitment and determination are strong enough to overcome habits that you no longer need . . .
eg the real you can now do what you have always wanted to/deserved to do . . .

28. Opportunistic hypnosis
There are occasional opportunities for simple interventions that are, strictly speaking, ‘non-dental’
Eg my partner agreed that he ‘did not need his wart any more’
Eg students may be surprised at how their concentration improves, study becomes more focused, energy levels go up, sleep pattern improves, relaxation becomes easier etc

29. Any questions?

30. 3. Induction practice In pairs: Chiasson or variation Computer screen
Magic wand/eye fixation
Something else the patient or client offers
Deepen using your, or patient’s favourite method
Allow a short time to enjoy
Realert including posthypnotic suggestion
Suitable for supine patient

31. 4. Anchors and Fractionation
An anchor is used as a stimulus to create a response eg trance induction
Best taught in trance or as a post hypnotic suggestion
Try it for selfhypnosis induction
Fractionation is movement in or out or trance or between different states or levels of trance
Can be useful as a deepening procedure
Often combined with an anchor

32. Any questions?

33. 5. Use of positive language
We don’t have:
‘needles’, ‘pain’, ‘hurt’, ‘injections’, ‘drills’, etc in my practice
Some of the above terms have emotional associations for some patients
There are better and more relevant descriptions (and some ‘silly’ones)

34. We do have:
‘my toys’ or ‘my gadgets’
‘numbing solution’ or ‘sleepy medicine’
‘ticklish teeth’
For kids: ‘the fire engine’ (has a light, water, noise etc), the ‘vacuum cleaner’ (suction), ‘motor bike’ or ‘jet ski’ (slow speed hand piece) etc
Questions:
I wonder whether your lip or tongue will go numb first?
Can you hear your tooth snoring?

35. Patient experiences:
It may feel like (vibration/polishing/electric toothbrush/some sort of machine etc)
You may hear (whatever sound)
There will be some pressure, but let me know if anything is uncomfortable . . .
Some people feel . . .
Your brain may invent a sensation eg rubbery, like wood, bigger than normal . . .
This may tickle – no giggling!

36. Examples of positive language
We:
‘fix teeth’
‘clean out decay’
‘make it more comfortable’
‘make your mouth feel nice and clean’
‘rebuild your tooth’
‘improve your smile’
‘get rid of left over roots/bits of tooth’
‘chase away the bugs’

37. Other positive suggestions:
It will be easier next time (or words to that effect). . .
You can feel really pleased with yourself that . . .
You may be surprised how comfortable and relaxed you are as we go on with your treatment . . .
Let’s take a few minutes for everything to dry up/ for the little blood vessels to squeeze down

38. More:
It would be interesting to see how quickly you heal Generally it only takes . . .
It’s amazing how time flies. In just an hour we have done . . .
You have been really helpful today. As you get used to the place/us/ etc we start to make really good progress . . .

39. In general: We discover, explore, find out, improve . . .
We don’t ‘try’ so we can’t really fail!
Everything is progress. Remember we are ‘inviting’ people, not dragging them into hypnosis (or dental treatment)

40. Always personalise therapy (especially with children):
‘Mr racing car driver’ (the child with the T shirt)
Should we use a blue filling? (favourite colour)
My best helper today
The first person this week who has gone to sleep/not needed a clean/ made the appointment so easy etc

41. Any questions?

42. The End
Thank you for your attention!