Anxiety dentist and professor Ad de Jongh says goodbye: “Dentistry can be even more humane”
ACTA is one of the few dental schools that teaches students to deal with anxious patients in the dental chair. That is the work of “anxiety dentist” and psychologist Ad de Jongh, who dedicated his career to making dentistry more humane. This Thursday he will take leave of the UvA.
Why are people afraid of the dentist?
“The best explanation is powerlessness. At the dentist, you lie back in the treatment chair and are at the mercy of the dentist. Many people have already experienced a situation in their lives where they were powerless, in the worst case, for example, sexual abuse. During the dental visit, those memories and feelings can resurface.”
“But the school dentist in the 1960s and 1970s didn’t help much, either. That was the equivalent of a laboratory situation to induce fear in children: the three pathways of fear all came into play. First, direct confrontation with a traumatic experience. In the sixties, schoolchildren had an average of 15 cavities - soda pop and chocolate had been introduced after World War II and no one had learned to take good care of their teeth - and there was little time for anesthetics. Also, there were often three of you on the bus watching what the other kids were going through, also a route to fear, called modeling. Lastly, there was a lot of disinformation in the schoolyard. Children often exaggerate when they tell stories.”
“Finally, fear of the dentist puts you in a vicious cycle. If you are afraid of dogs or elevators, you avoid them. But if you avoid the dentist, the problem gets bigger and the threshold to seek help gets higher and higher.”
2018 Honorary Professor at Queen’s University, Belfast
2017 Honorary Professor of the School of Psychology, University of Worcester
2015 Director of Scientific Research at the Psychotrauma Expertise Center (PSYTREC) Mental Health Institution, Bilthoven.
2011 Honorary Professor of the School of Health Sciences, Salford University, Manchester
2003 Special Professor of Anxiety and Behavioral Disorders in Dental Practice, at ACTA, instituted by the Foundation for Special Dentistry (SBT)
1999 Director of the Center for Psychotherapy and Psychotrauma (CPP), Center of Expertise in the field of Eye Movement Desensitization and Reprocessing (EMDR), the treatment method first introduced in the Netherlands by De Jongh in 1993.
1995 Doctorate at the UvA with the dissertation “Dental Anxiety: A cognitive perspective”
1991 Cum laude graduation in clinical psychology at the UvA
1986 - 2001 Working as a (fear) dentist the “De Witte Jas” health center (Amsterdam) and “De Tandhof” (Delft, the Netherlands).
1985 Graduated as a dentist at the University of Amsterdam
When was dental anxiety recognized as a problem?
“It happened gradually. In 1993 the documentary Choosing Between Fear and Pain was broadcast on Dutch television, which was about the dental practice in which I worked as an anxiety dentist. In that documentary, patients talked about how dental anxiety ruined their lives. That’s when people felt heard for the first time. Before that, fear of the dentist was a taboo subject, even though it is the most common fear in the Netherlands, where 4 percent have a phobia of the dentist, a quarter say they are afraid of dentists, and 80 percent of patients experience anxiety during treatment. There were centers in the 1970s and 1980s where people could get treated with nitrous oxide or hypnosis, but the research was still mainly done from a medical angle by dentists and anesthesiologists, not from psychology.”
When you graduated as a dentist, why did you still want to study psychology?
“It was because of the last lecture in dentistry in which a dentist specialized in hypnosis was invited, mainly for entertainment. He did spectacular things like put people in a trance and show how he could make a wound stop bleeding. That got me very excited.I also took a magic course, but it seemed too crazy to do some kind of magic in the dental practice in addition to treating people better. That’s how I also got interested in psychology.”
“After graduating, I started a dental practice in Amsterdam’s Staatslieden neighborhood at the De Witte Jas health center, which was founded from the squatters’ movement. We then took over an old dental school van from Haarlem for 1,500 guilders. In it, we treated people who were afraid of the dentist and refugees for 25 guilders an hour, also applying hypnosis techniques.”
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And did it work, the hypnosis?
“Yes, especially if you are predisposed to it. In the 1980s, the hypnotherapy association was still one of the largest psychotherapy associations in the Netherlands. Now it is no longer so popular and cognitive behavioral therapy has taken over. I was always thinking along those lines with the scientific research I started doing, asking myself: How do you get negative images and thoughts out of the heads of anxious people?”
How do you help someone get rid of fear?
“Everyone who is afraid imagines a disaster. You get rid of it by experiencing that the disaster doesn’t occur when you start testing it: ‘First do and then dare,’ is my motto. If you start talking, it can take forever before someone dares to go to the dentist again. Exposing the patient directly to what they are afraid of proves most effective.”
Are you afraid of the dentist?
“No. I did undergo painful dental treatments in the past, but I learned from that. Maybe that’s why it fascinates me so much. In fact, the most important trick is not to create flashforwards or image disasters. The trick is to deliberate tax your brain’s working memory, a technique also used by daredevil athletes such as people who climb skyscrapers without a rope. You can do that yourself by very consciously taking in your surroundings or by doing math in your head so there is no room to allow an imagined disaster. You can train yourself in that.
Can anyone get rid of dental anxiety?
“Of course, everyone can, but you need help to do that. That’s why we have had a postgraduate course in Dental Anxiety Counseling in the Netherlands since 2001.”
Nowadays, dental students are also trained to deal with anxiety. Does that also decrease the number of people with dental anxiety?
“You would think so, that the dentist has become less of a bogeyman, but we don’t see that reflected yet when we do research on this. Parents can easily transmit dental anxiety to their children. Also, there is still a lot of disinformation. In addition, a quarter of the Dutch population have a mental disorder, which can also be expressed in the dental chair, because it remains a vulnerable position.”
What patient has stayed with you the most and why?
“One I will never forget was a bouncer, a tough guy, with whom I was never allowed to just turn on the dental lamp during treatment, something that is automatic for a dentist. I asked him where this came from and he told me that he had been in a youth boarding school for a long time. At night there he was regularly raped by a social worker who shone a flashlight in his face. I performed many treatments on him and it ended well.”
“I then invited him to tell about his experience at an anxiety practicum at ACTA, and students hung on his every word. The next year I wanted to invite him again, but he told me that something strange had happened and that maybe he shouldn’t come. He had visited a dentist in Groningen, where he had not properly explained what he had experienced. The dentist from Groningen then shone a lamp in his face. After that, he couldn’t remember exactly what happened. He turned out to have recovered in a doorway quite a distance away, and had given the dentist a good beating.”
“I asked him to come right then because that’s exactly what I want to teach students. If, as a dentist, you really make an effort to get to know your patient and understand who is sitting in the chair in front of you, you can also treat them better and more humanely. And what better way to remember that than through a story like that.”
You brought psychology into the dental practice. Are you confident that that knowledge will be passed on?
“Yes, and no. As I see it, there is still too little attention in dental practice paid to the person behind the teeth. I can give you an example. Before the summer, I had to take some exams with dental students who were treating patients at ACTA. In their presentations, they talked exclusively about teeth, gums, and their treatment plans. I then asked the students: But who was actually sitting in that chair? One of the patients had completely ruined teeth, a clear case of an extreme cannabis addiction, I could see in the pictures. The student had made a comprehensive treatment plan with crowns and bridges, but how relevant is that when the patient can’t afford it anyway?”
“For 30 years I taught anxiety and psychopathology and tried to instill in students how important it was to learn to understand the patient, and then you find out just before summer that students learn something completely different from the lecturers in the treatment room. Fortunately, I was invited to brush up on this with ACTA’s classroom teachers during ACTA’s summer school. Also, changes have since been made to the patient’s history, where "Do you experience stress?" was the only psychosocial question included for the time being. Now, fortunately, there are also questions about, for example, the patient’s cultural background, as some cultures deal with dentistry differently.”
“And I am only talking about ACTA. At many other dental faculties, there is probably even less attention to the human side of dentistry. I hope the generation after me will be able to keep this important topic on the agenda.”
On April 11th at 4:30 p.m., Ad de Jongh will deliver his farewell address at the Old Lutheran Church.
