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American Journal of Clinical

Hypnosis
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Self-Described Reactions of a Phobic

Dental Patient during Treatment
a
Russell H. Scott Ph.D.
a
University of Pittsburgh, School of Dentistry , USA
Published online: 21 Sep 2011.

To cite this article: Russell H. Scott Ph.D. (1968) Self-Described Reactions of a Phobic
Dental Patient during Treatment, American Journal of Clinical Hypnosis, 10:4, 276-281, DOI:
10.1080/00029157.1968.10401986

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 TEEAMERICANJOURNAL OF CLINEAL HYPNOSIS
Volume X,Number 4, April 1968
Printed in U.S.A.
SELF-DESCRIBED REACTIONS O F A PHOBIC DENTAL
PATIENT DURING TREATMENT1
Russell H . Scott, Ph.D.2
A phobia, is a dread or uncontrollable
fear of some object or situation. Usually,
the object or situation which elicits the
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phobic reaction is quite well defined and the
degree to which the phobic person is in-
capacitated is determined, to a large ex-
tent, by the ubiquity of the object or situa-
tion he fears. Some phobias cause their
victims only minor distress, for example,
an uncontrollable fear of snakes is not
likely to result in severe problems under
usual circumstances. However, if circum-
stances are such that avoidance of the
feared object is impossible or leads to un-
desirable results, then the effects of the
phobia on the person’s life can be severe
and all-pervading.
Presented at the Tenth Annual ScientSc Meet-
ing of The American Society of Clinical Hypnosis,
October 1967,New York, New York.
‘University of Pittsburgh, School of Dentistry,
Assistant Professor.
m m ’ s COMMENT.The Editor is of the opinion
that the practitioner of hypnosis may learn a great
deal from subjective accounts of experiences, es-
pecially when the subject is a trained and sophie-
ticated observer who, in addition, may be ex-
perienced in the medical or psychological science
involved. In a previous issue (Vol. IX,No. 2,
October 1966) we published an article in which a
registered nurae-anesthetist, who has had a great
deal of operating room experience and who has
been a supervisor and instructor of nursing, re-
corded in great detail her subjective experiences
and her minute-by-minute reactions throughout
an extensive surgical operation in which hypnosis
waa the sole anesthesia agent. Now the Journal
has the opportunity to present a subjective ac-
count by a psychologist with a doctorate in that
field, who describes in detail his experiences and
observations under hypnotic treatment for an
extensive phobic reaction to dental treatment of
any sort. In the opinion of the Editor, physicians,
dentists and psychologiata may all find a great
deal of interest and value in this article and the
previous account of the surgical operation.
270
The purpose of this paper is to relate from
a rather unusual position as both victim
and psychologist an experience with such a
phobic reaction. I will discuss first what I
believe to be the etiology of the responses
and then, subjectively, my experience with
hypnosis both during the extinction of
these responses and during the ensuing
dental work.
My first trip to a dentist, when I was
about five or six, resulted in one bitten
finger (the dentist’s), one very upset child
(me), and no actual dental work. Suc-
ceeding visits over the next few years were
equally unsatisfactory from both my point
of view and the dentist’s. Finally, when
I was ten or eleven, my parents took me
to the dentist to have several teeth ex-
tracted under general anesthesia. There
were three people in the operatory, the
dentist, an assistant, and someone to ad-
minister the anesthetic. I was quickly un-
conscious and, I suspect, the dentist began
work. At some point prior to the completion
of the extractions I regained consciousness
and was acutely aware that the dentist had
not completed the procedure. My efforts
to get out of the chair were completely un-
successful. I punched the anesthetist, kicked
the dentist and screamed as loud as I could.
I was forced back into the chair and some-
one rammed gauze or cotton into my
mouth. A t this point I quit fighting and
feigned unconsciousness. I heard the den-
tist say “Ah ah, playing possum.” With
this remark he began working again.
I responded violently to the excruciating
pain that ensued. Accompanying the pain
I seemed to hear a distinct high-pitched
violin note being played on an extremely
taut string. As the pain increased, the
note got higher and louder. Something
 REACTIONS OF A PHOBIC DENTAL PATIENT
was clamped over my nose and mouth and
could not breathe. I thought “They’re
trying to kill me.” I fought and tried to
call for help. My last thought as I lost
consciousness was “I’m dying.” The next
thing I remember is being in the outer
office with the dentist and my parents. The
dentist told my parents never to bring
me to him again as he would not work on
me.
Following this experience all efforts to
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get me to a dentist were unsuccessful. The
mention of the word “dentist” or “teeth”
or any of a variety of such words was suf-
ficient to evoke a strong anxiety response.
Violin music recreated certain aspects of
my traumatic dental experience. For five
years I successfully avoided all contact
with dentista and dentistry. Of come, the
condition of my teeth did not improve.
Eventually, through the efforts of the
family physician, I was admitted to a hos-
pital and several extractions were per-
formed under general anesthesia. This ex-
perience did nothing to alleviate my fear
of dentistry. I still could not go to a den-
tist, the mere thought still produced dis-
ruptive anxiety.
Like most other males of my age group,
I was drafted into the army. I managed to
be someplace else when my units were
scheduled for dental examinations. At the
replacement center I dropped out of line
when my group was taken for the routine
dental check prior to overseas shipment.
I actively and successfully connived to
avoid dentists during my three-year stay
in the army.
A job, college and graduate school fol-
lowed my discharge from the service but
not a trip to the dentist. I made one
attempt to enter the office of a man I had
heard used hypnosis, but could not get
past the front door. One day three friends,
two psychologists and a dental student,
launched an all-out campaign to “help”
me. My anxiety mounted as they talked
about various aspects of dentistry, the
improved techniques of anesthesia, and
so forth. My palms were wet, my pulse
was up and, when I attempted to relate
277
the experience I described a moment ago,
I could not do so.
Approximately twenty years had passed
since the unfortunate incident and fifteen
since my last contact with a dentist,
but still the mention of dentistry as it
related to me personally evoked an acute
fear response. I was aware of my sad dental
condition, the effects it was having on my
professional and social contacts, and its
potential as a health haaard. However, I
was afraid to even look at my teeth and
had not done so, except by accident, for
several years. I always managed to find
an excuse ao I would not have to pick up
my wife after she had made a trip to her
dentist. We rarely talked about my teeth
and, being a psychologist also, she did not
bring the subject up, knowing too well what
my reaction would be if she did. All this
is not to say I had made no concrete ef-
forts to deal with this fear. After all, I
did choose psychology as a profession and
I did take a job with a dental school.
Despite the efforts I had made on my
own to cope with the problem, I had, up
until approximately seven months before
recounting my story, been unable to see a
dentist in his professional capacity rather
than my own; I had been unable to have
the necessary dentistry done.
One day while talking to a member of
the Dental School faculty in a very gen-
eral manner about my dental condition, he
mentioned the possibility of using hyp-
nosis to overcome the fear. I mentioned
that I had considered this and thought it
may have potential. He promised to men-
tion me to one of his colleagues who used
hypnosis in her practice. Arrangements
were made for me to see and talk to the
dentist on an evening when she would
be at the University teaching a class. The
appointment was for 10:45 P.M., following
the last evening class period. I went to
my ofIice that evening, having told my wife
I had some work to do, as I did not want
to talk to anyone about the impending
meeting. As I waited for the appropriate
time, I thought of various reasons for not
keeping the appointment.
 278 SCOTT
Of course, since I was on time, the
class ran over-time. As I waited I paced
the hall from one exit to the other, mak-
ing anew the decision not to leave each
time I came to one of the red signs
acutely aware of my anxiety and knew
that it must be obvious even to the two
janitors who were sweeping the hall.
Finally, after a ten-minute infinity, a head
popped around the edge of the door I was
hiding behind and a voice asked, “Are you
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Mr. Scott? I’ll be finished in a minute.”
I retired to an adjacent class room and
struggled to get control of my voice. The
comment “Well, I hear you have prob-
lems,” called my thoughts from “dentist
past” to the all too-real “dentist present.”
I stammered out a yes in a high-pitched
squeaky voice and began with some as-
pects of the story I have just related.
It was agreed that I could call and make
an appointment for the following week
with the understanding that I was not
committed to actually entering the office.
The doctor and I agreed that the waiting
room, or even some less threatening place,
might be better for the first visit.
Having made the appointment, I spent
the intervening days thinking of little else
and sincerely wondering if I could go
through with it. The day finally came and
since my highly anxious state precluded
any productive work, I left my office in
plenty of time for the appointment. I got
to town, parked the car, walked up to the
revolving doors and changed my mind. A
walk around the block dissipated the anx-
iety SufEciently to allow me to try again,
this time successfully. I made it into the
building, up the elevator and into the
waiting room with my anxiety increasing
as a direct function of my nearness to the
dental office.
The door to the inner-sanctum opened
and I was invited to come in or stay where
I was, as I preferred. I elected to go in.
This first visit was spent in the office dis-
cussing my past history and may be best
described as a “social visit.” Despite the
nature of this first appointment, it repre-
sented a major step along the road to dental
health. I had actually gotten into a dental
office and had related to a dentist as a
patient.
During the week between the first and
the second appointment my dentistry was
never far from my mind. The second trip
was easier than the first. I made it through
the revolving doors on the first attempt.
It was during this second visit that I ac-
tually sat down in a dental chair, gingerly
and apprehensively to be sure, but I sat
down. It was a real effort not to get up and
walk out. At this point the anxiety, the
fear, the twisted-up gut was still there and
I was extremely uncomfortable. My cor-
tex knew there was no real basis for such
response under the present circumstances,
but my autonomic nervous system had not
gotten the message. I was still scared.
Dentistry of even a most minor nature
would have been impossible at that time.
As I sat in the chair, the doctor explained
something about hypnosis and how it is
used in dentistry. Even though I was
familiar with the use of hypnosis in psycho-
therapy and knew something about the
experimental work involving hypnosis, I
was skeptical about what could be accom-
plished in my case. This was my first ex-
perience with hypnosis. I closed my eyes
as the doctor began the induction. Many
thoughts about hypnosis passed through
my awareness, many of them negative.
There was one point, however, that kept
coming up, I did want to get my teeth fked.
It was during this early stage of the first
induction that I had my most startling in-
sight concerning hypnosis. It suddenly
occurred to me that it may not be necessary
for me to “believe in” hypnosis in order to
profit from it. This insight was a result of
noticing that even though I was critical of
the suggestions made by the hypnotist, I
was able to institute them in my behavior.
At this point I decided to co-operate as
best I could and followed the hypnotist’s
suggestions to the best of my ability. This
decision and my ensuing vigorous co-opera-
tion quickly brought me to another, only
slightly less startling realization. As the
trance induction proceeded and I continued
 REACTIONS OF A PHOBIC DENTAL PATIENT
to co-operate, I seemed to be functioning not congruent with my knowledge of neuro-
as both participant and observer. Having anatomy. Despite violent objections to the
heard a suggestion, the participant did it
and the observer thought about and criti-
cized it.
The effects of this first hypnotic ex-
perience on my anxiety were, to me, quite
amazing. Although I was far from com-
pletely relaxed upon termination of the
trance, my anxiety level was noticeably
lower. I was moved to another operatory
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to have x-rays taken. An immediate in-
crease of anxiety was apparent when I
saw an older model unit of the type I was
familiar with in this operatory. I managed
with some effort to be seated in the chair,
and the radiographs were taken. This
ended the appointment.
During the week before the next ap-
pointment I practiced relaxing and thinking
about my teeth, the dentist, and the dental
situation. I also practiced such simple
things as opening my mouth and, while
in the shower, I tried to become familiar
with the sensation created by having water
sprayed in my mouth.
The third appointment again began with
trance induction and a demonstration of
levitation. My hand floated up to approx-
imately shoulder level and remained there.
The observer thought, “How interesting.
Wonder how long before the muscles get
tired?” The participant’s hand just hovered
in defiance of the observer’s knowledge that
the arm should be quite tired and aching.
Following this trance the teeth were scaled.
For the first time in fifteen years a dentist
was working inside my mouth. The sounds
and sensations arising from the procedure
were impressive, at least to me. Even more
impressive, it did not hurt.
It was the fourth appointment that
eliminated all doubt concerning the ex-
tinction of my anxiety responses in the
dental situation, for it was then that I
received my first fillings. Following the
induction of trance the phenomena of
“glove anesthesia” was demonstrated. Dur-
ing this demonstration the observer was
more critical than usual in view of the
fact that the attempted phenomena was
279
suggestion to “transfer the feelings of the
right hand to the left hand,” the demon-
stration was a success and the fillings were
completed with no dificulty. This appoint-
ment was particularly important in that it
firmly established, for me, that anxiety
responses were, for all practical purposes,
extinguished.
In an amazingly short time all the “easy
work” was done. “he doctor then had to
decide which of the numerous d s c u l t
tasks to tackle first. She chose the devital-
ization of two teeth, which by the way I
had been firmly convinced I would lose.
Again the induction proceeded smoothly
and rapidly. As we worked for hypno-
anesthesia the observer, in light of past
evidence, no longer raised serious objec-
tions to any of the suggestions. Of course,
I was not convinced, right up to the time
the work began, that hypno-anesthesia was
possible. Filling-yes. Devitalization-that
may be another matter. The procedures
were carried out with no pain or discom-
fort on my part, and no chemo-anesthesia.
By this time I was quite elated over the
progress, both dental and psychological,
that had occurred in the short space of
forty-nine days. I no longer became anxious
at the sound of words like “dentist,”
“teeth,” and “extraction”; I could listen
to others discuss their dentistry with no
discomfort; I even took a tour of the Uni-
versity dental clinic. As the anxiety re-
sponses to the actual dental situation
were extinguished, the generalized responses
to other stimuli were also extinguished.
At this point one may raise a question
about the generality of the extinction proc-
ess, that is, maybe my lack of anxiety in
the dental situation was specific to my
dentist. This question was soon put to an
experimental test. One of the devitaliza-
tions began causing me a great deal of
pain, the first I had experienced since the
onset of the dental treatment. Naturally,
my dentist was out of town.This emergency
was handled by another, male, dentist
with only slight recurrence of the old
 280 SCOTT
psychological responses. This was a striking
demonstration of the non-specificity of
the extinction process.
Fillings soon became routine for me. I
began thinking, maybe I would not feel
this even without hypnosis. With this in
mind I tried, upon occasion, to see if I
could feel pain associated with the drilling.
My experiments were successful, I could.
My experiences during the rather extensive
dental work done under hypno-anesthesia
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were much more those of an observer than
of a patient. Except that my presence was
required in the dental chair for the com-
pletion of the procedures I could have well
been on the observation side of a one-way
vision screen just watching curiously.
Of all the dental work I had required
there was only one procedure that had not
been undertaken by the ninth appointment,
an extraction. On this appointment the
doctor decided to remove two upper left
molars. She left the choice of anesthesia up
to me, within limits, and I chose hypno-
anesthesia. The trance induction took
longer than usual and we worked hard
for the necessary degree of numbness. I
found this a bit dficult to achieve as I
had never had chemo-anesthesia for any
dental work. As in the past I seemed to
function as both observer and participant.
Upon completion of the trance she began
work. I n addition to the two extractions, a
vital tooth in the same area remained to be
devitalized. This devitalization was carried
out under hypno-anesthesia with no difE-
culty at all. Again, I hardly seemed in-
volved in the procedure except as an inter-
ested by-stander. The first extraction was
then undertaken. The tissue was reflected
and she attempted to rotate the tooth. At
this point I became aware of sensations
in the area of the tooth and reported them.
What I did not report until the extrac-
tions were completed was the high-pitched
violin note I heard. A zygomatic block was
administered and the procedure completed.
The most impressive thing about the ex-
tractions, besides the violin note, was that
the sensations I experienced after the ad-
ministration of the chemo-anesthesia seem
to be subjectively identical to those under
the hypno-anesthesia, although I had not
previously experienced local chemo-anes-
thesia.
Post-operatively I experienced very
little bleeding, no pain and a large amount
of satisfaction.
Two months later another opportunity
arose to investigate the effects of hypno-
anesthesia. A lower left molar remained to
be extracted, which promised to be a rather
diEcult one. Trance induction went
smoothly. I now knew what chemo-anes-
thesia felt like and could work to simulate
it by means of hypnosis. It was at this
point that the observer unwittingly got the
participant in trouble during the trance
state. At one point I was not aware, as the
observer, of the hypnotist’s voice. I thought
I had gone to sleep momentarily and felt
quite guilty about it. I woke myself up
and listened to the doctor. This occurred
a total of three times during the induction.
I did not know that this is a phenomena
of deep trance. Eventually, the induction
completed, I gave the agreed-upon signal
and the doctor began the extraction. She
reflected the tissue and exposed the bi-
furcation of the root with no pain or dis-
comfort. Then she attempted to elevate the
tooth. I felt pain. After a short interval,
during which I asked for and got a good
look at what was going on, she tried again
with the same results. Two mandibular and
two buccal injections failed to produce
any change in the sensations experienced
under hypno-anesthesia. Only after an
injection in the Gasserian ganglion did
the sensation change and was it possible
to complete the extraction. Again, there
was no post-operative bleeding or pain.
This, then winds up my story, and, ex-
cept for a few remarks, the paper. The
seemingly slow progress during the early
stages of treatment as exemplified by the
meeting away from the office, the social
nature of the first visit and the simple
things attempted on the second, were
absolutely essential at the time. Had I
been pushed beyond my tolerance level,
that is, had I been exposed to strong anxiety
 REACTIONS OF A PHOBIC DENTAL PATIENT
producing stimuli at this stage, I would
have resorted to the old behavior pattern
and in addition probably conditioned new
cues to the old responses. The management
of such a situation requires that the den-
tist be sensitive to the patient's responses
and that he adjust his demands to meet
the patient's present capabilities. These
slow early step were enough to tax my
capacity a t that time.
Hypnosis served two distinct functions
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in my case. First, and most important, it
made possible the extinction of the physio-
logical response pattern previously condi-
tioned to the dental situation. The extinction
of such phobic responses under hypnosis is
281
well documented in both clinical and
experimental literature. Its importance in
dentistry should not be overlooked or
passed off lightly as the effects of such
response patterns on the patient, are not
limited to the actual dental operatory.
The second function for me was that of
anesthesia. This aspect has made, and is
making, my dentistry a pleasant, informa-
tive experience.
REFERENCE
1. h i e , M . Subjective react&
of a putient hav-
ing surgery without chemical aneethesia. This
Joun~m,1968,9,122-124.