As I was giving a patient some Novocain the other day (which is technically Procaine, with Novocain being a trade name, but that's for another post), she asked me about hypnosis for dental pain instead. I had heard about hypnosis for a lot of things, but dental pain? This was somewhat new to me, so I wrote it down, vowing to take a look at it (which was all I could do at the moment -- since I'm not a hypnotherapist, I told my patient that for now, the needle would have to suffice).
Anyway, a little digging, and yes, I found out that hypnosis and dentistry (amongst other medical practices) does have a connection.
To start, let's discuss hypnosis and hypnotism. What is it? The Mayo Clinic defines it as such: (1)
Hypnosis, also referred to as hypnotherapy or hypnotic suggestion, is a trance-like state in which you have heightened focus, concentration and inner absorption. When you're under hypnosis, you usually feel calm and relaxed, and you can concentrate intensely on a specific thought, memory, feeling or sensation while blocking out distractions. Under hypnosis, you're more open than usual to suggestions, and this can be used to modify your perceptions, behavior, sensations and emotions. Therapeutic hypnosis is used to improve your health and well-being and is different from so-called stage hypnosis used by entertainers. Although you're more open to suggestion during therapeutic hypnosis, your free will remains intact and you don't lose control over your behavior.
Fair enough. That's pretty much what we all kind-of / sort-of know about hypnosis. So in a nutshell, you get hypnotized (brought into that trance-like state they mention) and then are more open to suggestion. If you're watching a hypnosis show at the county fair, the suggestion might be "bark like a dog." But for medical / life-improvement purposes, the suggestions might be more practical, like "stop smoking" or "eat less" or maybe even "the dentist's drill won't hurt." That last one is essentially the connection that I am interested in -- using a hypnotist to dull the pain. In an article from the UK (2), it seems a man did just that. He got his teeth pulled with little to no pain.
Ok, now I'm more interested... teeth pulled with no pain (and no Novocain)? As a dentist, I find that a little hard to believe (hey, I know it hurts). So I kept looking. A little more looking around brought me to the International Medical and Dental Hypnotherapy Association (3). Wow, that's really official sounding. It seems like they are definitely behind the hypnotherapy in regard to medicine. Their mission statement includes the following (4):
To provide and encourage education programs to further, the knowledge, understanding, and application of hypnosis in complimentary health care; to encourage research and scientific publication in the field of hypnosis; to promote the further recognition and acceptance of hypnosis as an important tool in health care and focus for scientific research; to cooperate with other professional organizations that share mutual goals, ethics and interests; and to provide a professional community for those complimentary health care professionals, therapists and researchers who use hypnosis in their work.
I put all of that there because it sounds to me like they are looking to gain acceptance, and I think that's important to the discussion. Because, and here's the skepticism, there is little to no regulation regarding hypnosis. In just about every state, anyone can say they are a hypnotist (the laws are ever-changing, but suffice to say, I could not find any hard regulation that is consistent on a state-by-state basis. Indiana used to be one that was fairly restrictive, but they repealed that last year (5)).
So the above makes me a little skeptical about the entire thing. Unless you are accredited, you can't say you're a dentist ANYWHERE in the US. No state will let you hang a DDS shingle unless you have the proper credentials. Same with a physician, a lawyer, etc. But hypnotist? Not so much.
Now let me be clear -- I am not trying to belittle hypnosis or the like -- there seems to be enough evidence that there IS something to it. To give an example, the American Psychological Association (APA) -- 154,000 members strong, and is the largest professional organization of its type -- gives hypnosis credit. They admit is has been controversial, but "most clinicians now agree it can be a powerful, effective therapeutic technique for a wide range of conditions, including pain, anxiety and mood disorders." (6)
You know what? That's a pretty strong endorsement. It's like anything else -- where there's smoke, there's usually fire, and in cases like this, it's been around long enough (and has enough people swearing by the effects) that there is "something" to it. So I find myself on both sides -- the natural skeptic in me says "no state license is telling," but I'm also logical and practical -- there's enough information out there that makes me say "okay, maybe there's something to this hypnosis thing." So my advice to you is to do some research and make your own decision.
One last thing I'll mention -- I also uncovered that the USC School of Dentistry (technically the Herman Ostrow School of Dentistry of the University of Southern California) is teaching hypnosis as an alternative to needles and Novocain (7). So yes, there definitely could be something there.
All in all, I found this an interesting topic. There's a lot of information out there, both bad and good (and fair warning -- there's a lot of associations that claim to certify someone, but the certification is generally meaningless). I hope you enjoyed it.
Until next time, keep smiling.
1. http://www.mayoclinic.com/health/hypnosis/MY01020
4. http://imdha.com/mission.php
5. http://www.in.gov/pla/hypnotist.htm
6. http://www.apa.org/topics/hypnosis/index.aspx
7. http://www.medicalnewstoday.com/releases/123764.php
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Two years ago my new dentist used so many injections to ready a lower molar for a crown (and I still felt 30 - 40% of the drilling) the next day I woke up to find an ulcer inside my gum that was so big the root of the molar was fully exposed. I had never experienced an anxiety attack, but when I had to have an extraction (same tooth that had the crown then a root canal that didn't work) I had a full blown anxiety attack. The dentist stopped before he even started, sending me to a colleague who used knock out drugs to put me out of my misery while the dirty deed was done.
That well-intentioned but disastrous dental event was the beginning of a hyper-vigilant nervous system that physiologically overreacts to fear/stress with an intensity I have no control over. When all that cortisol gets dumped into my bloodstream it pushes my immune system into overdrive. I do have that prescribed bottle of alprazolam nearby but it sure would be much nicer if hypnosis could turn down that flight or fight response to normal levels instead.
As stated, the practice of hypnosis is a self-regulated, rather than a state-licensed, profession. And as you pointed out, it is important to critically consider the qualifications and experience of any practitioner when making utilization decisions. I teach Continuing Medical Education courses for PAINWeek, an annual medical conference for licensed front line pain clinicians and I teach Specialty Certification courses in hypnotic pain relief and medical and dental hypnosis for major certifying organizations like the IMDHA (International Medical and Dental Hypnotherapy Association), the ICBCH (International Certification Board of Clinical Hypnotherapy). I have also been published in a peer-reviewed journal (Hypnosis in Disability [Pain] Settings, IAIABC Journal, Vol. 46 No. 2, 57-76).
I agree with Scott Sandland, adding a certified hypnosis to a dental practice will benefit patients and staff as well as the dentist. I am confident that hypnosis practitioners who are certified by the above organizations with certifications in sub-specialties will be found to be competent and effective complementary health care professionals.
Please consider me a resource.
Michael Ellner
Faculty: PAINWEEK
Diplomat IMDHA
I'm a practising hypnotist and have used self-hypnosis to undergo a root canal treatment without chemical anaesthetia at my local dental surgery.
It was a comfortable experience and my recovery was pain-free.
Dr Helen Crawford's brain imaging work using functional Magnetic Resonance Imaging (fMRI) at Virginia Tech suggests that the area of the brain responsible for experiencing pain lies in the anterior cingulate.
When in hypnosis, fMRIs show that area of the brain is silent and the prefrontal context is active. It's a curious phenomenon and we still don't understand how it works but from my personal experience, it works!
Since you point to the Mayo Clinic, one of the most extensive metastudies was done by Dr James Stewart in 2005 and is available as a free download here at the Mayo Clinic Proceedings' website. (http://www.mayoclinicproceedings.com/content/80/4/511.full.pdf+html)
It covers 40 years (covering 1964-2004) of studies on hypnosis, hypnotism and hypnotherapy and points to areas where hypnosis is most effective such as pain management, irritable bowel syndrome, etc. In the UK, for example, insurance covers hypnosis treatments for Irritable Bowel Syndrome since it's the best solution, based on evidence.
So thanks for bringing this up so that more people can learn about the amazing way our mind can be used to affect change in our bodies.
Joe Nathan Lourdes
Hypnosis Works
Singapore
I'm a hypnotist who has been working in a dental practice for over 7 years. I have worked with the students of both UCLA and USC Schools of Dentistry at the Children's Dental Center of Los Angeles, and am on the board of directors for the International Medical and Dental Hypnotherapy Association (which you mentioned in your article). I also teach medical hypnotherapy techniques at seminars throughout the U.S. With that as a background, I can say that a well trained hypnotist can be incredibly helpful--to both the dentist and the patient--with a variety of dental issues.
Not only is hypnosis helpful in reducing both chronic and acute pain, it can be used in many less dramatic ways, such as:
- Reconditioning a hyper responsive gag reflex
- Reducing bruxism or TMJ dysfunction (clenching or grinding teeth)
- Eliminating fears or phobias associated with dental work
- Smoking cessation (stains teeth and can damage gum tissue)
I have worked with these and many other dental issues for years now and have seen both short term and long term success.
Integrating hypnotherapy into your dental practice can improve quality of life and outcomes for both you and your patients. I encourage you to learn more about it.
Hope this helps,
Scott Sandland, C.Ht.
Newport Beach, California
P.S. You are correct--currently there is no state license or accreditation for the practice of hypnosis, only board certification by organizations like IMDHA.