Needle Phobia

Rita had a badly broken down tooth that was giving her pain. She knew she needed it out. She had come to her first appointment prepared for an extraction, with James, her boyfriend, for support. We agreed the tooth was too decayed to save and that an extraction would be wise, the sooner the better, before the pain and infection worsened.

Rita was relieved and grateful to find a dentist (me) willing to offer an emergency appointment and fix the problem. There was just one even bigger problem.

“I hate needles”, Rita said.

Rita was absolutely phobic about dental injections. At the age of 8 years, she had had an unexpectedly painful dental injection that had gone on for an excruciatingly long time. The dentist had continued despite her obvious shock and pain, and her mother had told her to “Get on with it”.

As an adult, Rita had all her previous dentistry carried out with general anaesthetic, where she could be ‘put to sleep’. We discussed all the options for treatment this time, weighing up the risks and benefits of each, including referral for similar support with sedation or general anaesthetic.

But Rita wanted her tooth out today. She had seen my website, and she wanted to improve her ability to receive dental care while conscious, an experience she trusted me to provide.

“Sure”, I said.

Rita, James, my nurse and myself, all trooped into the treatment room. Rita sat herself in the dental chair. She was literally shaking with fear. I deployed ‘Lambie’, one of the soft toys I use for just such occasions. With Rita holding Lambie tightly, my nurse patting Rita’s arm and James stroking her hair, I applied ‘magic jelly’, a topical anaesthetic gel to numb the gum before injection.

Building trust is a delicate and crucial process. Fear of prolonged or unexpected pain was a significant factor in Rita’s phobia. I asked Rita to indicate to me with a raised hand if she wanted me to stop, and promised to do so immediately, even if she just wanted to “rest, cough, swallow, or comment on the weather”.

I used the ‘tell, show, do’ technique to avoid surprises, informing and demonstrating to Rita at every stage what I was about to do. Some people prefer not to know or see what is being done for them, and that is respected. Other people like the reassurance of explanation and advance notice, and Rita clearly benefited from this.

Rita was encouraged to breathe, focus on wriggling her toes, and to feel a deepening relaxation spreading from her toes, up her legs, and throughout her body as she relaxed and breathed ever more deeply during her care.

Rita stopped shaking, and relaxed her rigid hold on Lambie. With the support of my team, I gently and slowly numbed Rita’s jaw with a local anaesthetic injection in her mouth. I spoke soothingly and hypnotically to Rita. The offending tooth was carefully delivered in two sections while James and my nurse held their posts supportively.

Once finished, I congratulated Rita and assured her that she would not miss the tooth at all, which we then examined carefully. Rita noticed how much bigger and more rotten it was than she had imagined. Rita also took the opportunity to look at and touch the anaesthetic needle, which she declared was much smaller and finer than she had thought. She was delighted to have coped so well with treatment, and said she now felt confident to have future treatment with local anaesthetic only, a great step forward in practical and emotional terms.

“I’m such a coward. I should have come much sooner”, Rita chastised herself.

I reminded Rita that her fear and avoidance was the result of the childhood trauma over which she had been powerless, not because of any weakness on her part, and that a phobia is a logical way to protect oneself until a sense of safety is assured.

Then I reminded Rita that she was not, in fact, afraid of needles. She looked at me, puzzled.

“A picture paints a thousand words”, I said, pointing to several beautifully wrought tattoos on her arms, silent tributes to her courage and determination.

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Please note that I have made changes to protect the identity of my client but this is a true story. I thank my client, who kindly consented to her story being shared.