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What keeps millions of people from sitting in a dentist’s chair, even when modern technology has made procedures more comfortable than ever? Kaushal Shah is a general dentist and dental director managing multiple practices in the Dallas area with 15 years of clinical experience. In this episode, based on his KevinMD article “Overcoming dental anxiety for better oral health care,” he explains why dental anxiety remains the single greatest obstacle to routine oral health care and what clinicians can do about it. You will hear how anxiety starts as early as infancy, why the entire office team from receptionist to assistant plays a critical role in calming nervous patients, and how simple techniques like using epinephrine-free anesthetic or computer-guided injection systems such as STA can dramatically reduce needle fear. Shah also shares his approach to sedation options ranging from nitrous oxide to general anesthesia, including how his practice screens patients and ensures safety with a physician anesthesiologist always present. He offers a direct message to physicians whose patients avoid dental visits until infections force them into a primary care office. If you or your patients have been putting off dental care out of fear, this episode lays out a practical path forward.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Kaushal Shah. He’s a dentist, and today’s KevinMD article is “Overcoming Dental Anxiety for Better Oral Health Care.” Kaushal, welcome to the show.

Kaushal Shah: Hey Kevin, thank you for having me on the show. Myself, Kaushal Shah, as he introduced. I’m a general dentist working as a dental director in the Dallas area. I manage multiple practices and I also work as a clinician, and I’m willing to share my experience today with Kevin.

Kevin Pho: All right, perfect. Well, thank you so much for joining me, and you wrote this article, “Overcoming Dental Anxiety for Better Oral Health Care.” Why did you decide to write this article and share it on KevinMD?

Kaushal Shah: Hey Kevin. So most of the time, the biggest barrier that patients don’t come to the dental clinic is still, to this date, dental anxiety. Still, we have better technology, better material out there, very nice environment you can see nowadays in dental clinics. But still, patients don’t want to show up. They just only show up when they are in pain. They just don’t want to come for your regular checkup and all.

So that’s why I just wanted to share my experience here, that treating the patient is not only important, but managing the dental anxieties is also important as a clinician for my patients. So that’s why I just wanted to write this article to talk about this.

Kevin Pho: Now, what are some of the things that patients are anxious about going to the dentist?

Kaushal Shah: So most of the time it is the fear of needles. They thought that the instruments that we have can cause the pain for them. So that’s the biggest barrier that we see all the time.

Kevin Pho: How early do you think dental anxiety usually begins in people?

Kaushal Shah: So it’s as early as we see in six months old. So that’s why, just seeing the patient from, just taking your child to the dentist as early as possible will help to build that, to remove that anxiety and fear, and just be able to be in that environment and know that it’s not always about the pain, and we are not just here to cause the pain. We just wanted to make sure that your teeth are on the place, and it’s properly treated, and they’re growing correctly.

Kevin Pho: What do you look for when patients are in the dentist’s chair, and how do you gauge about how anxious they are?

Kaushal Shah: So you can gauge by the way that they talk, the way that they just seeing around. After being a professional for 15 years, I can just gauge that just by seeing a patient, how they are anxious about being in that environment.

So what I do is always explain to them calmly. I just want to make sure that I just, as a friend, ask them a question: are you anxious? So they just share that freely, that they know that I just try to make sure that there’s nothing to hide here. We just wanted to talk here. We just wanted to make sure that you are comfortable. So I give all these options that are available in my office.

Kevin Pho: Now during a dental procedure, sometimes it could last a little bit of time. Is there anything that you do to kind of help calm them during, in the middle of a procedure?

Kaushal Shah: Yeah. So many of the procedures that I do these days, it sometimes lasts for three to four hours. So we offer all kinds of sedation. That’s the first way to just make sure that they are relaxed. So from starting from nitrous gas to oral sedation, to IV sedation, to even, we are doing general anesthesia nowadays in my clinic. So that’s what we do.

We sometimes, when patients are not sedated, we just want to make sure to take some break. We also have them to watch the show. Like we just put the show, they like it, some music around, and just keep a normal talk. But in that area, even me and my assistant, we make sure that we talk on a day-to-day topic a little bit, just make sure that we are relaxed too. So when they see that we are relaxed and confident, they get relaxed too, a little bit more.

Kevin Pho: And you mentioned your assistant, so how important is the staff, ranging from the receptionist to the hygienist, to your assistant, in terms of managing patient’s anxiety when they come to the office?

Kaushal Shah: Oh, it’s very important. My front desk are the first person to see the patient, and they usually try to desensitize them, just to calm them down. That helps me a lot, because they see that it’s not only a doctor, but they see everything. They just even look at, what kind of paintings have we put on the waiting area, what kind of services we are providing, any kind of water or something. So everything matters. It’s not just the dentist alone, but even when they come in, the first person to check them is my assistant.

So my assistant asking them right questions. We don’t have a script, but we have the same kind of conversation with them, so they know that everybody’s on the same page. That helps a lot.

Kevin Pho: Now you mentioned earlier that a lot of this dental anxiety starts when people are very, very young. So what are some things that you and your staff do for kids when they come to the dentist’s office to make sure that that experience isn’t as bad as they think?

Kaushal Shah: Yeah. So first thing that we do when the patient comes for the first time in a clinic is the tell, show, and do. We want to show them everything that we are going to do. We just don’t want to surprise them. We just want to show them what kind of instruments we are using, what we are doing, and just using the euphemisms, not to just blow them away with the words. The words that they can correlate, like the suction that we use, we call Mr. Thirsty and all, so that helps to calm them down. There are a lot of kind of words like that.

Kevin Pho: Now, one of the things that you said patients are most anxious about is the fear of needles, right? What are some advances in technologies to manage dental pains to alleviate their fear of needles?

Kaushal Shah: Yeah, so the first thing, I don’t know there are clinicians using it, but not many of them. But the first thing, not advanced technology, but even with the regular anesthetics, you can also make it easy for my patients. So you can use anesthetics without using epinephrine, because we know that the injection pain is coming mostly from the burning sensation of epinephrine. So what I use, before I do any kind of, let’s say, lidocaine as anesthetic, I use a plain anesthetic without epinephrine. That makes it much easier for a patient to take in. So I always explain to them, I have a different kind of anesthetic that I use that will not cause the burning sensation that you used to have before. So that’s the first thing.

The other method that is available is STA, where it’s kind of a guided injection where it goes drop by drop inside. When we infiltrate it, it’s just goes very slow and patient doesn’t feel that. So there are techniques for that. And you can also, the simple technique that you can do is just to distract the patient. So my assistant just steps on the shoulder, or just tells them to wiggle the toe. These are the simple methods that can help the patient a lot.

Kevin Pho: Tell us about that technology. I’m not familiar with it. You said STA, what exactly is that?

Kaushal Shah: So STA is kind of an injection that is connected to the monitor. You just have to inject it slightly and it just, you manage the flow rate everything, and it goes by itself. And the patient doesn’t even notice that you are injecting them.

Kevin Pho: One of the options that you mentioned earlier was general anesthesia, and I know that there is some controversy about that in the medical field. Sometimes you hear horror stories about people not being adequately monitored and having a catastrophic result. So what’s your opinion in terms of the decision points a patient should make about whether they should undergo general anesthesia or not?

Kaushal Shah: So I would say that in a dental environment it’s more safer, because most of the patients that we see here as private practices, I’m just talking about the private practices side, that the patient has ASA class one, two, or max three. So we are not looking at patients with four, five, six. So we usually refer them out. So when the patient have mild to moderate kinds of issues in the body or something, and they’re completely healthy, I would say general anesthesia is perfect. It’s perfect for them. I don’t see any kind of trouble.

Just always communicate with the doctor about what kind of medication you’re taking, what kind of blood test reports and everything. So we make sure everything before, because we usually hire a team who comes and just takes all patients’ health care check, before, one week up, and they just want to make sure it pretty nice.

Kevin Pho: And for general anesthesia, who typically monitors it? You mentioned you had a team. Is it a nurse anesthetist? Is it a physician anesthesiologist who monitors that patient when they’re undergoing general anesthesia in the dental office?

Kaushal Shah: So, a physician anesthesiologist, he’s always there in my operatory when I’m treating them during the patient.

Kevin Pho: Now one of the scenarios that I get in my primary care setting, like you said, a lot of people are scared of the dentist. They don’t go, and then they have some type of infection and pain, and they come see me, their primary care doctor. Any messages that you want to share to your physician colleagues?

Kaushal Shah: Yeah, for sure. What I want to share is that, so dentistry is actually evolving rapidly, on a technology side, or if you’re talking about the patient expectation side. But the core for the dentistry hasn’t changed. Right now, communication, building a trust with the patient, and making the care accessible to the patient, those have not changed.

So just focus on that, because many of my patients, the biggest barrier, the biggest step the patient is taking in their life is just walking in a dental office. So my goal is to, I mean, as a physician or as a dentist, our goal is to make sure that patients feel comfortable. Because dentistry is not just, I want to make sure that dentist is not, I’m not just treating the teeth, but I want to change their experience about overall health care.

Kevin Pho: And for those patients who are so anxious about going to the dentist’s office that they avoid doing so, how can they overcome that anxiety? What kind of messages do you have for these patients?

Kaushal Shah: Just for the patient, it’s just like your regular health care checkup. So it doesn’t mean that when you go in a dental clinic that we are bombarding you with all these instruments and we are bombarding you with all this kind of anxious methods. Most of the time, like 90 percent of the time the patient comes, we just do a regular cleaning, just want to make sure that the teeth are healthy.

So just get it checked every six months. Go to the clinic, because if you miss at a certain point, if you don’t go to the dental clinic at a certain time, when there is a normal small cavity, you can just fix with a filling. But if you miss that time, it can turn into a big infection and abscess, which can lead to more pain, and we have to do invasive procedure. So I would definitely say that just go for regular routine care. That will help you a lot in the wrong.

Kevin Pho: We’re talking to Kaushal Shah, he’s a dentist. Today’s KevinMD article is “Overcoming Dental Anxiety for Better Oral Health Care.” Kaushal, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Kaushal Shah: Yeah, for sure. Just wanted to make sure that, just dentistry is all about, as I told you, just all about the patient’s experience. We wanted to change the patient experience and make their experience about overall health care better.

Kevin Pho: Kaushal, thank you so much for joining us, and thanks for sharing your perspective and insight.

Kaushal Shah: Thank you.