When the Body Remembers the Dental Chair

One of the ideas at the heart of Bessel van der Kolk's The Body Keeps the Score is that difficult experiences do not necessarily live only in our thoughts or memories.

They can affect the way the body responds.

A person can logically understand that they are safe while their nervous system seems to be saying something completely different.

That idea stayed with me.

Because if there is one place where the difference between "I know I'm safe" and "I feel safe" becomes very visible, it may be the dental chair.

"I Know It's Fine. I Just Can't Help It."

Dentists hear versions of this all the time.

And yet the moment the patient sits in the chair, something changes.

The shoulders tighten.

The hands grip the armrests.

The heart begins beating faster.

Breathing changes.

A sound, a smell, a needle or even simply lying back can create a reaction that seems much bigger than the situation in front of them.

From the outside, it can look irrational.

But after reading van der Kolk's work, I think there is a more interesting question to ask.

The Body May Remember Differently

Most of us think of memory as a story.

Something happened. We remember it. We can describe it.

But one of the broader ideas explored in The Body Keeps the Score is that our responses to past experiences can also show themselves physically.

That made me think about patients who haven't visited a dentist for ten or twenty years.

Sometimes they remember one particular experience from childhood.

Sometimes they don't remember anything especially dramatic at all.

They simply know that being in a dental chair makes them deeply uncomfortable.

And telling someone, "There's nothing to worry about", may not change very much.

Perhaps It Isn't Always About Pain

We often assume that people who fear dentistry are afraid of pain.

Of course, many are.

But I don't think that explains everything.

Think about the position of a patient during treatment.

You are lying backwards.

Your mouth is open.

You cannot easily speak.

Someone is working only centimetres from your face.

There are unfamiliar sounds, instruments, water and sensations.

Most importantly, for a period of time, you are giving another person a remarkable amount of control.

For someone who already feels anxious, that loss of control may matter just as much as the procedure itself.

What If We Stop Asking "Why Are You Afraid?"

There is something else I've been thinking about.

When a patient is very nervous, the natural question is:

"Why are you afraid?"

But perhaps that isn't always the most useful question.

Some people know exactly why.

Others don't.

And asking someone to explain a reaction they don't completely understand can sometimes make them feel as though they need to justify it.

Maybe a better question is:

It is a small difference in language.

But it moves the conversation away from explaining fear and towards creating safety.

Feeling Safe Is Different From Being Told You're Safe

This may be the idea from the book that connects most strongly with dentistry for me.

A dentist can say:

We mean well.

But those words don't necessarily create the feeling we intend.

Trust is rarely created by simply asking someone to trust us.

It is created through small experiences.

None of these things are complicated.

But together they communicate something that words alone sometimes cannot:

Fear Can Become a Dental Problem of Its Own

Dental anxiety has another consequence.

People avoid appointments.

A small problem becomes larger.

Eventually pain forces them to come in.

By then, the treatment may be more complicated than it would have been years earlier.

That more difficult experience can reinforce the original fear.

And the cycle continues.

This is why helping someone become comfortable with dentistry can matter beyond today's filling, clean or extraction.

A good experience today may change the way that person approaches dental care for years.

Technology Helps. But It Isn't the Whole Answer.

Modern dentistry has become remarkably good at reducing discomfort.

Anaesthesia is better.

Imaging is better.

Procedures are more predictable.

Digital technology can make many parts of treatment easier.

These advances matter enormously.

But there is an interesting possibility.

We can make dentistry technically safer and more comfortable while a patient still feels frightened.

Because technical safety and emotional safety are not exactly the same thing.

Maybe We Should Stop Saying "There's Nothing to Be Afraid Of"

I understand why we say it.

We are trying to reassure someone.

But imagine being genuinely frightened and hearing:

"There's nothing to be afraid of."

The unintended message can sound like:

Your reaction doesn't make sense.

Perhaps a better response is simply:

None of that requires us to understand someone's entire history.

Nor should dentists assume that anxiety means a patient has experienced trauma.

It simply means recognising that fear is real to the person experiencing it.

The Tooth Is Only Part of the Appointment

Dentistry naturally trains us to focus on problems.

We look at the radiograph.

We examine the tooth.

We diagnose disease.

We make a treatment plan.

All of that is essential.

But the person attached to the tooth arrives with something the radiograph cannot show.

Expectations.

Fear.

Past experiences.

A sense of control - or lack of it.

And sometimes the success of the appointment depends as much on understanding those things as understanding the tooth.