What Every Dentist Should Know About Managing Dental Anxiety – PDP050

Jaz’s Introduction: Managing anxious patients is not only one of the most difficult things in dentistry, and sometimes they can be very stressful encounters, but they are actually some of the most rewarding experiences sometimes this defines us as dentists, a dentist who cares, attentive who can really give people hope. People lose hope. And that’s part of the anxiety. They won’t know if they will get along with you. But they won’t know these patients. If they can never trust another dentist again, they’re too scared of pain. They’re too scared of just general dentistry. And I think if you could master the art of treating the anxious patient, you will be so so so busy, profitable, or more important, your value and your sort of self worth as dentists and enjoyment and fulfillment can really really increase and that’s why out today on this episode, Protruserati, PDP050, 50 Episode 50 raising my bat. Thank you so much for sticking with me all the way to 50 episodes. I’ve got an amazing person. This clinician, Dr. Mike Gow, if you’ve ever met him, I met him in Switzerland course few months ago in , this guy is just something else like, Here I am, right? I’m placing local anesthetic, sometimes when I’m placing retraction cord, right? So I take the temporary crown off. And I need to get scanner impression to go to a definitive crown for example, and I’m placing local anesthetic for retraction cord. Yeah, I’ll put my hand up. I do that sometimes. Right? Where as this guy, Okay, Dr Mike Gow. He’s worked with dentists alongside him. And through his hypnosis and just amazing management of anxious patients, their team has managed to place implants and do sinus lifts WITHOUT local anesthetic. Yeah, you heard that right, right? Without local anesthetic to do a surgical procedure, and place an implant. That is amazing. I’m not saying you guys should aspire to that level. But don’t you think we can learn so much from Dr Mike Gow. And just even as a GDP if we can learn a few tips from this episode, which is absolutely jam packed full of it. It will really help you in the management of nervous patients. We asked about Mike’s journey, how you got involved with nervous patients, what his top tips are, he explained what he was feeling like just before he’s about to operate on this patient when placing the implants without local anesthetic, like, that’s a big ask. And a lot of these were being televised and filmed. So there was a lot of pressure for him and his team. But it’s just amazing the outcome and we sort of find out what kind of patient is suitable for going as extreme as that. Yeah, not everyone is suitable. And it depends on a few factors, which might covers fantastically. So I’m really excited to share this episode with you. The Protrusive Dental pearl I have for you may change your life in a massive way. Like it changed my life in a massive way, right? When you’re sometimes doing treatment plan that is at home, and you need to just see an x ray, or you need to see exactly what the conversation was with a patient, you need to read your notes, right? And let’s say it’s a weekend sometimes I’m spending weekends doing treatment plans as you know from the previous episodes. So how can you access the notes it’s been something that really bugged me for a long time. So we use them in the UK a lot of people use SOE Exact and when no matter what system you use, you can download something called anydesk. Now anydesk will allow you to access any other desktop or computer or laptop that’s got anydesk involved and it’s like completely secure. So you’ve got these like long keys, passwords, encryption, all that sort of stuff. And then now you are able to access your work computer and if your work computer is on you can then log into your dental management, patient management software. And you can look at your X ray, you can you know find out emails of patient so you can email them the treatment letter. And that literally really helped me so much in terms of saving time in ways you couldn’t imagine. And also so I’m not constantly hassling or bugging the receptionist to send me this email or send me that piece of information or show me this x ray. So now I can just do it myself. You take the burden off the reception team. So if you ever wanted to know how can I access that information while out and about or at home or at different practice, I would download anydesk on your laptop or computer and also the work one and it’s really easy to use. So I really hope you enjoy anydesk. I’ll put the link for it on the protrusive.co.uk website on the under the Show Notes for this episode, but also on the Protrusive Dental community Facebook group which has been just amazing recently, so much activity on there, people are really embracing the term Protruserati which is awesome. I’d like to thank enlightened whitening for their support in sponsoring this episode. And they’re a premium brand of whitening that we use. And it’s just phenomenal, the patients get a really great response, it’s more about the feel that they get that hey, I’m actually using a quality system, the tray design is just on point, it’s a really like thicker trays, which have is a superseal effect. And so I whenever I fit these trays, I’m always impressed at the seal that’s achieved. I was really impressed the first time I use enlightened a few years ago that when the pack came in the delivery, there was like a cold pack with it as well. Because of course, we know that it’s so important to keep your carbamide peroxide or hydrogen peroxide cold, right? So we instruct our patients to keep it in the fridge. So I was impressed even in transit, these gels are being moved around with this cold pack to keep the gels at the right temperature. And I think that could be part of the secret if you like as to why Enlighten, it performs so well and why people get such great results with it and why they can give this B1 guarantee. Whether you use enlightened already or using an alternative whitening brand. I think you can learn a lot from Payman Langroudi, he does a one hour training on teeth whitening. And of course, you’ll get to learn a benefit specifically about what makes enlightened, unique as a premium brand of teeth whitening. So if you go to protrusive.co.uk/enlightened, you’ll be taken to the page where you can sign up for the one hour free training with Payman, who will becoming on podcast soon, because I want him to talk about these things. And I want to make it controversial. I’m gonna probe him and probe them and try and get out and gonna find out is the light, we know people use the in-chair lights on the teeth, Is that even worth it? Like you saw kind of know the answer. But what’s the sort of history behind that our practice is still doing that? What makes whitening more efficacious? Is that the right word? How can we do more whitening like whitening is such a, I want to say, easy procedure. But it’s like it’s a reversal procedure. It’s so safe, and it can really, really uplift patients and give them a much improved smile compared to doing invasive procedures. So it’s something worth checking out. So go to protrusive.co.uk/enlightened to check that out. So again, thank you to Payman and the team Enlightened for sponsoring this episode. And we’re gonna dive right in with Dr. Mike Gow.

Main Interview:

[Jaz]
Mike, welcome to the Protrusive Dental podcast, how are you my friend?

[Mike]
I am very well, thank you. How are you?

[Jaz]
Fantastic. And I’m really, really excited to talk about all the themes we’re talking about today. I just think it’s crazy. Right? I’m going to say it now. I think it’s crazy that you can do treatments without local anesthetic. And I’m so jumping the gun a little bit. But I mean, you’re sort of claim to fame. For me, there’s room for bringing you on, is that an amazing accomplishment if anyone doesn’t know, and we’re sort of setting the scene here is, I mean, here I am using local anesthetic to place a retraction cord, right? And you have to have been involved in sinus lifts and immediate implant placements without local anesthetic. And we’ll talk about that today. And we want GDPs and dentists all over the world to learn techniques to manage nervous patients. But what you achieved with that is just mind blowing. Before we jump into that, just tell everyone about a little bit about yourself where you practice. You have a beautiful practice in Glasgow called the Berkeley tell us a little about just you.

[Mike]
Yeah. So yes, I’m I qualified in Glasgow in 1999. And actually got a really keen interest in in anxiety management right from the beginning of my career, even as a student, I was I was interested in anxiety management. I did my dental while Lexus and hypnosis as well back in those days, and I’ll get into that story a little bit more shortly. Over the years I’ve trained I’ve got masters in hypnosis apply to dentistry from University College London, postgraduate certificate in the management of dental anxiety, as well, Yes, and but you know, my practice is that the vast majority of my patients either are or have been anxious at some point in the past and that’s really the main core of the work that I did with anxious.

[Jaz]
What attracted you to that? I mean, you said from very early on as a student but what why that, why not orthodontics why not, you’re essentially everything to a very large number you’re there everything, you are there orthodontists, you are always going to be doing the ortho, you’re the oral surgeon, you’re a lot of services to certain people who will probably refuse to go to anyone else. Because, you know, when you have an anxious patient and they like you, they’re you know, we know that they will stick with you. So what is it that? Is it Did you know that hey, this is really important in my career that can be my USP or is this some other factors that made you, you drew you towards the management of anxious patients?

[Mike]
Definitely. I wasn’t, I guess business minded enough at the time just to realize that actually, it was a great USP to have. What it was actually there was a patient of mine as a dental student who was on the student clinic who shouldn’t have been she was terrified. All I was doing was making a set of dentures. And I still remember to this day all my student colleagues, you know, complaining about patient management and you’re struggling to do certain things clinically. But at the end of helping this particular lady, she was so great. If all that had got her through her treatment, she actually gave me a little Parker pen, this lady was not well off, she was a little old, classical widow, you know. And at the end of the treatment, I got this Parker silver Parker pen with Michael engraved on the pen. And she gave me the biggest hug and said, You’ve changed my life. And from that moment on, I thought, that’s what I want to do. I love dentistry. I do love clinical dentistry. But I love that feeling of changing somebody’s life and with phobic patients, you know, often people that haven’t been to the dentist are often decades, you know, they have no social life, they’re struggling finding work, they’re struggling to find a partner that will confidence, pain, unable to eat, and have very low expectations, they think their life cannot change. And to be able to take somebody through that journey to a point where they’re out of pain, they can chew, and we can smile again. And you know, it’s just, you know, it’s a privilege and an honor to be part of that journey with somebody. So that’s where I get my [buzz] And my kick every time is from how it changes people’s lives.

[Jaz]
I can definitely relate to that buzz I mean, I think all dentists are all dentists who mean well, who have a kind heart and gentle hands, who the kind of dentist that puts topical anesthetic, you know, there’s some who don’t, and some who do and I just automatically divide those two groups. And I think those who do, you know, maybe I’m saying things I shouldn’t be saying. But I think those who place topical care more than those who don’t, that’s just,

[Mike]
Here’s my thing, about topical, since you raise it. It is first of all, you’ve got to put it on for at least 90 seconds. So make sure this stuff works, give it a chance. But see, but by using topical anesthetic, you’re telling your patient you care, and you’ll go the extra mile. And for that minute and a half, you’ll buy appreciation, you buy the patient’s comfort, it’s so worth doing every time even if the patient’s not nervous.

[Jaz]
That’s exactly my mantra and a you know, so anyone listening out there, who don’t use topical, just use it, it just makes sense. It shows that you’re a caring dentist, it’s a no brainer for me, you probably have a, Mike, and just tell me just because it’s fun to know, where it is the furthest a patient travels from to come and see you.

[Mike]
Oh, my that question. I get patients from all over Europe, I actually saw a, sadly I had a patient who was due to see me from France, but of course they’ve not been able to come. So I think probably European is the farthest but again, this is one of the things Yes, patients will travel. But part of why I want to do that I don’t want to create a patient who believes that I’m the only dentist that can ever treat them, you know, it’s great for my ego, you know, it makes me feel nice. If that’s the case. However, it’s not very useful for the patient, if we go into lockdown, or there’s a pandemic, or, you know, I’m ill or something. So a big part of the journey I take the patient through is to rebuild their own confidence, their own ability to see how dentistry can be. Once they know how dentistry can be and that they have control over it. And you know, I will frequently recommend patients to see other dentists and especially if it’s someone I know, I’ll take them on the first part of the journey, get the majority of the treatment completed, you know, go other patients that will travel from England to see me, I find out where they are. And of course dentistry is a small world, I will know somebody local to them who I knew was an excellent dentist. And I say look, you can see, Jaz, he’s a great guy, he will look out for you. And then they’re not having to come and see me every six months. So yeah, patients travel, but I’m not for a minute seeing that that’s how it should work.

[Jaz]
That’s very admirable. The fact that you you know you look for that arrangement that you want to build up their confidence that they can see anyone and that’s the real hallmark of patient. Dentists that really cares about their patient going forward as well, because quite rightly said that you don’t want them to become too dependent on you. And I think it’s great that you take them through that process. And that’s amazing. So talking processes tell me you how do you get to a point where you even have the thought of doing a sinus lift without any local anesthetic? Like I’m afraid of the rubber dam clamp to pinch the palatal gingiva and then to sort of feed it and your like all the surgical thing. So tell us, you know, tell us a story behind that happening. Wow, I mean, I can only fathom all the different skills that you need to do that, but how do you do it?

[Mike]
But I think that, you know, I guess one of the skills is just having the bravado to say let’s make this happen and do it because, you know, as you know, you can use local anesthetic and the patient may still feel something. You know, one of the questions that people often ask me is what would you have done if one of those patients said had felt something? Well, guess what, that’s what we do every day. You know, we’re in that scenario all the time, the patient might feel something at any point, it was exactly the same. And so I guess, you know, first of all talking about pain management. Pain is unique to every individual who’s alive. It’s a very, very complex thing. You know, not only physiological, but emotional expectation, history, there are so many things wrapped up. And not only the experience of pain, but the interpretation of actually what that means. You know, the word pain in itself, actually, the origins of it means punishment. And you get words like penalty, and penitentiary, and all these kind of words from the same origin. So it’s a very, it’s associated as a very negative thing. So the first part of that journey when preparing a patient for something like that is to say, look, here’s the procedure that we are going to do. And the reason why we are doing it is to achieve your goals of promoting your health, promoting the aesthetics, you know, listening through all the reasons why they’re doing it. Now, during that process, your body will give you signals to tell you that there’s danger, something’s happening, there’s a surgical thing. However, you know, that this is a whole constructive, it’s all healthy, we’re doing a good thing by doing that. So you can interpret that signal [inaudibe]. So that’s kind of part of the introduction to how do you interpret the signals. Now, if you watch a lot of people talking about pain management for, you know, surgical situations, using hypnosis, the mistake that’s often made is the talk about seeing you will not feel anything. Okay? Now, I would never even see this if a patient was having local anesthetic, or you won’t feel anything. Because you do, of course, you feel something. But you’re going to feel pressure, you’re going to feel vibrations, you’re going to feel x, y and z. So yes, you’ll feel something. But you’ll be surprised how comfortable it is. Now, actually, if anybody ever watches the video that I did with [Phil Friel?], which was the immediate implant placement, and it’s on YouTube, [throat], the procedure, I’m seeing her loss of pressure, you’re feeling pressure vibration movement. At the end, the interviews says, hey, was that, you know, what was it? Was it painful? And she says, No, no, it was just a kind of, and she looks for words. And she says, that was a kind of pressure. And that’s the word side is using and feeding the whole time interpreting it differently. So first of all, for an extreme procedure, it would be quite difficult if the patient was extremely anxious, because that anxiety would drive the pain we know the more anxious somebody is the more pain that they interpret. Now, if you take an MRI scan, the fascinating part of pain research shows that this is not just the person seeing, I feel that painful. When you look at the functional MRI scan, their brain is firing. And these are the cases sometimes where you know the patient’s in the chair, you barely touched the tooth, or you take out a bit of cotton wool, “Ah that was sore. What did you do?” Okay, now, the chances, I mean, maybe there’s a accessory nerve supply, maybe there’s something else going on. But there is a chance that the patient has actually generated a pain response within the brain. Despite there not being a physical reason why it should happen. The pain is just as real as just as painful. So, you know, the big mistake would be to say, you couldn’t have felt that.

[Jaz]
Honestly, I’ve had these patients whereby literally, I’m hovering the needle above the buccal cusp of premolar about to give the infiltration like ahhh, and you know, you think oh my gosh, you know, but these are often you know, in my experience, very, very anxious patient, these are the ones that you’re taking out a lower molar, for example, and you’ve given four ID blocks and three articaine infiltration is going lingual, and then just as you’re putting any pressure on that they’re screaming, so my natural instinct, most dentists will think, Hey, you know what, this patient’s just full of BS. But are you suggesting that actually that there are, there is activity in the brain that matches up with real perceived pain?

[Mike]
100% I mean, first of all, never made the assumption that there’s something that you’ve missed in there, there could be an abscess, there could be [inaudible] could be a reason why they are genuinely feeling something. But I do believe in a lot of cases, especially in very anxious patients, their anxiety drives the expectation and experience of pain, but it’s very real, it’s psychologically generated a bit. It’s just as real as physiologically generated. And that’s, you know, that is something that we have to be super super aware of.

[Jaz]
Was it NLP? Did you use NLP or, or have you sort of done a program learning about NLP? Or is it purely your sort of hypnosis background that you’re able to get a patient like that. And also I want to know is would you be able to take me for example, I’m not mentally anxious, so he said, I think I am. And would you be able to condition me to potentially have a extraction, for example, without local anesthetic, and not that way that I want to go too much in that direction, because I want this to be really helpful for GDPs. And most of us are not going to start doing this. But I think there’s so much we can learn from what you do.

[Mike]
And here’s the thing being hypnotizable is mainly about somebody’s creative imagination and their creative ability, as well as expectation and motivation. Though somebody who’s who’s highly phobic highly anxious and is able to generate the experience of pain, despite the fact you’re doing very little is probably quite hypnotizable. Okay, because they’re already doing it. They’re doing it negatively. Okay? So for those patients, I know that yes, hypnosis can help. Now, could I hypnotize you? I’ve got no idea. I would need to know a little bit more about you. On a general assumption, if I know that you are creative, artistic, all those types of things, then I would guess, yes. You know, if a patient presents and says to me, Mike, I’m a professor of mathematics at the local university. Could you hypnotize me? I’m thinking Probably not, because he’s going to analyze everything. And rather than going with the creative experience, you’re going to be questioning what’s happening all the time, and it actually stops you engaging with experience. And someone says, I’m an artist, musician, they tend to be far more hypnotizable. But actually, as I see if someone says, I have a phobia of spiders, flying, water, the dentist, can I be hypnotized? Them the answer is yes. Because you’re already doing it. So it’s a beautiful self selecting group of patients. If someone comes and says, Mike, I have a phobia. Can you hypnotize me? Yes, it is the answer.

[Jaz]
That’s crazy. Because automatically, I assume that those two patients that you done an immediate placement, sinus lift without LA, I thought, hey, these are not the extremely nervous ones. They’re probably just normal guys that you sort of said, Hey, you know, it’d be really cool to do this. But actually, what I’m understanding now is actually you need that patient who generates those sorts of connections, neural connections that are amenable to hypnosis. So those two patients were, you know, most patient, most dentists would see them as phobic patients.

[Mike]
Not necessarily one of them actually was quite anxious originally, the other wasn’t, you don’t need to be. You don’t need to have anxiety to be hypnotizable or phobic, you just need that creative ability. And most people who are anxious for phobic have that. But you don’t have to have the anxiety element. There’s plenty of creative people that don’t have anxieties. So it’s more the creative ability. That’s important.

[Jaz]
Brilliant, so that now I want to get the learning done here. So you’ve talked about these amazing experiences. And if you send me the YouTube link, I’m sure lots of people want to see this. So I’ll put that on the show notes on protrusive.co.uk, so people can check it out. I want to know, what are some pieces of advice that you can give to dentists listening right now to help us tomorrow, manage anxious patients because anxious patients, phobic patients can be a blessing in terms of you know, their patients for life. so rewarding the great feelings that you get, the hugs that you get, the life that you can change, but they’re also the reason you run 45 minutes late, you have to get the tissues out and give it to your patient. The nurses roll their eyes, all that sort of stuff. They’re also they generate a lot of emotions in dentists.

[Mike]
I think you’re right. But each of the things you’ve mentioned there are things that you would address. So first of all, you know, creating an ethos among your practice of caring for the patient, and actually understanding that these are a really rewarding group of patients to help. And I think, you know, scheduling them at the right time, good communication with care coordinators, you know, all of those things go on massively, and it gives everybody it’s not just me that gets the job satisfaction, it’s the whole team can genuinely, you know, invest in this and feel like they’re, you know, they’re part of changing this person’s life. So make it a team thing, rather than just being about the you know, the connection themselves would be one thing. You know, so ensure that the staff is here and you’re also getting the training and communication and you know, Sedation techniques and whatever else you’re going to offer. And I think having time and flexibility would be the second thing. So I would always avoid if I know somebody is very anxious, I would always avoid squeezing and, you know, for me still the hardest patients manage is a phobic patient NPN squeeze them for 15 minutes. I mean that that is hard. No matter how many NLP or hypnosis courses you’ve done. That’s still going to be very tough because a patient will pick up on the smallest cues of you feeling under stress or pressure or trying to rush at something and the whole thing can just spiral and get at a time quite quickly. So time is really important. And then train, you know, this is one of the things I found interesting when I first embarked on my journey, it you know, dental anxiety management seem to go in one of two directions. So either you were a Sedation Dentist, or you did the behavioral, you know, CBT hypnosis can have side effects. And actually, I found these two different arms very rarely interacted and talked. And it was either the sedation clinic or the hypnosis clinic. And for me, you know, it’s truly to help a phobic patient, it’s about selecting the right mixture of all the things that we can do. You know, we’ve got clinical techniques, you know, injection techniques, learn how to do an Akinosi block, learn how to use computer controls, injection systems, like the ones and make sure you can get it. So there’s very little point in me talking a good game and relaxing a patient and can get it to fit. And so all of that is important. Technology that we have from CAD CAM scanners and impression dentistry is huge as well. Training and pharmacology, so training and sedation techniques, inhalation IV sedation. In fact, that terrified me, I was interested in being understanding the psychology of anxiety. But I knew if I truly wants to help anxious patients, I had to train an IV sedation. And it was one of the best things I ever did. Because, you know, in the right case, IV sedation is phenomenal. And then even on the behavioral side, you know, you have cognitive behavioral therapy, hypnosis, NLP, basic relaxation techniques, communication skills, all of these things come together so that when I’m presented with a new patient, I don’t just think phobic patients sedation, I see myself like, cocktail waiter, okay? The patient presents, and tells me what kind of, you know, we work on what kind of thing is needed. And then it’s up to me to decide how much of this is going to be pharmacological, how much behavior or how much technological, and we make this mixture that’s unique to that person. You know, some people, it’s a pint of vodka, it’s you need IV sedation, and we need to get this stuff. And but it’s always going to be a unique mixture for that person. So that I think is probably the biggest message that I have for people is, you know, train and as many of these different little branches and [ingredients?] as you can because the more things you’ve got to reach for the you know, the, the easier the treatment is going to be for the individual. And that’s part of you know, a few years ago, we developed the International Society of dental anxiety management. And the whole thing about that was trying to have a guess a platform and a place where people could learn lots of different things. So last year, we had a conference, and we had people teaching injection techniques, people teaching rapport skills. It was just wonderful. So that’s the type of thing that again, gets me excited. And there’s nothing you’ll notice yourself doing teaching. It’s nothing more exciting than another dentist coming back saying that thing that you told me I used on this really phobic person who had been struggling with and they’re now okay. And that’s hugely rewarding as well.

[Mike]
That’s fantastic. I really love the cocktail waiter analogy. That’s just phenomenal. I really love that. What percentage of your day is sedation? What percentage of your day are you actually delivering intravenous sedation?

[Mike]
And I would say I would actually put that as a percentage of the week more than a day because I maybe have a session a week or every couple of weeks, I don’t do a huge amount of IV sedation, maybe using an equation a little bit more. Especially just no IV sedation. It’s just a bit more complicated with, you know, chaperones and around Coronavirus, it’s just a little bit harder. But I find maybe once a week or once every couple of weeks and generally these are new patients that are needing a high volume of surgical treatments. So multiple extractions or multiple CMD chrome placements, you know, using the TRIOS. So we’re, you know, yes, the big disadvantage really with IV is the patient has no memory of the treatment. Your patients can seem rubbish because I don’t want any memory of the treatment. But if they have no memory of the treatment, then they’ve actually got no foundation to build their future experiences on seeing that was actually okay. So great to get things started. But it doesn’t necessarily help to cure the phobia in the long run.

[Jaz]
It doesn’t take them through that process of becoming less dependent on you. But it’s a good starting point for maybe a surgical procedure that they’re not maybe something that you probably want to do on their sendation as well, and when you take them through that journey, and they become more trusting, and they can open themselves up to other treatment. And you’ve probably got, obviously, as you said, your whole practice is geared towards that, which is amazing. So Mike has wanted to touch on inhalation sedation, A couple of years ago, I thought before then that inhalation sedation was just for children, right? And I got beat down on Facebook, by some eminent educators in inhalation sedation, like this absolute rubbish. It’s actually used for adults. And that’s when I learned, hey, whoa, there is actually a place for inhalation sedation for adults. So tell us. Can you bust that myth for us about inhalation sedation. And how much of an impact, how much can actually help your patients?

[Mike]
Inhalation sedation, I think is probably one of the most underused anxiety management tools that we have at our disposal. I believe just now, I may be wrong. So please let me know if I’m wrong. But I believe we’re the only clinic in Glasgow that is offering it at all. And it’s so effective. I mean, it’s great for kids works very, very well with kids, but for adults as well. It’s perfect for shorts, minimally invasive procedures. You know, I don’t know if you’ve ever experienced Nitrous yourself before?

[Jaz]
I have dental school, they give us a in fourth year, they give us a little go, you know, and it felt amazing, I felt like I was four points down, but not in like, it kind of four points down, but you know, you’re not gonna get a hangover and you feel fresh. It felt really good.

[Mike]
It did. This is how I explained it to patients. And if it’s a parent of the kids, you’ve got to be really careful as well. So I talked about it being a happy drunk feeling. And I made sure to explain to the kids that with alcohol, you can feel sick, violence, you can get depressed and upset. But with happy gas, it’s called happy gas, because it makes you happy but it’s I mean, it’s gotten me out of many, many difficult cases in the past, you know, it’s occasionally even cases big [10 for IV], where we’ve not managed to find a vein, the patients then being able to proceed with inhalation and actually got on Okay. It’s very, very safe, very, very easy to use. And, you know, it just makes me think why would you not have this? It is not that expensive setup and in practice, very, very easy to do. And you can find training courses through SAAD or the likes of Richard Sheron, who offers training courses in inhalation sedation.

[Jaz]
Yeah, I’m glad you mentioned Richard, it was it was actually Richard Sheron, who would beat me on Facebook about that, but thank you, Richard, because you taught me something. And hopefully, people listening right now, who may have thought, Hey, you know, inhalation equals children, it’s not the case. Inhalation is widely used in those clinics, they use it on adults to a great deal of success. So moving on. Yeah,

[Mike]
I was gonna say, just very quickly, when my VT practice, we had inhalation station plumbed in. And that was a little town called calendar, which is up in past near Sterling. And I always remember my trainer, said this wonderful line to me what he said, he said he loved using nitrous oxide for his patients. He said, “You know, you’re anxious, and you’re difficult patients, they need it, that you’re good patients, they deserve it.”

[Jaz]
But that’s, so your vt practice, you’re vt there, and they had in place sedation as well?

[Mike]
Yeah, so I was, I mean, that was great for me, I was able to use it, you know, straight from the [?].

[Jaz]
That’s amazing. I mean, that reminds me about the book [Outlie], you know, the fact that both Steve Jobs and Bill Gates are both born in 1955. And therefore, when they were a certain age, they were coming to computers, and then for you and your journey, like the fact that you’re already interested in that, and then you’re VT place having in place sedations that only, you know, send fuel to the fire. So it’s amazing.

[Mike]
If you read Matthew Syed, he talks about that as well [whitebox thinking], you know, becoming a table tennis champion, but actually, the top 10 players in the UK all came from the same street, because..

[Jaz]
That was bounce. Matthew Syed Bounce

[Mike]
So but and that is that is true. And so then [inhalation sedation] as I say, it’s well worth doing and actually not and again, I would never say get into anxiety management for financial reasons. However, the fees for doing nitrous oxide are actually fairly reasonable as well. And not only do you get remunerated for what you’re doing, it makes you faster as well. So for a small amount of downtime at the start while the patient is starting, because it takes a few minutes for it to work, you’ve then got a far easier, more compliance and more relaxed patient and the procedure goes a lot faster. So there is a business model on that as well, which is well worth looking at.

[Jaz]
Well, I’m glad you mentioned that because then that can lead nicely to another question I want to ask about businesses Look, when you’re marketing because you’re amazing at managing anxious patients, you’ve built a whole practice around it. You’re trained and invested in your staff to come the way they handle phone calls, the way they greet them. I’m sure every All bases are covered. So now you’ve invest in your team and invest in yourself, how do you attract the right patient that will really benefit from you? Is it just purely word of mouth? Or do you do some marketing within Glasgow And how do you I mean, I’m sure, correct me if I’m wrong, but the patient from Europe and that sort of stuff, I’m sure there’s loads of word of mouth going on. But do you advertise?

[Mike]
We do a little advertising? No, I don’t need to do a huge amounts of anxiety management. What was interesting, actually, when I first came to the clinic that I know, in, and it was a bit of a leap of faith, I’d been working in a mixed practice until that point. And you know, while I trained and hypnosis sedation. So when I first moved to the Berkeley clinic, there was no list. And I thought, This is me, I’m going to establish, Jaz, an anxiety management dentist, and I really had no idea, is there a big enough private market to sustain this? When I knew that 30 to 40% of the population were anxious. But I wondered, are there enough of that population that are prepared to pay a private fee for it? And more or less instantly, you know, the books filled up, it’s, you know, there’s a huge market for anxious patients. And so with regards to marketing, you’re right, a huge amount is word of mouth. And a huge amount actually came from the website that I originally developed, I started a website, as soon as I qualified, called whatfear.com. And it was mainly patient education,.

[Jaz]
Which I would share was that, Mike?

[Mike]
99.

[Jaz]
Wow. So that’s really great. That’s so I mean, so early. I mean, I don’t know, when was Google started? I don’t know. But that was, that’s really good.

[Mike]
I was right at the start. So actually, there were lots of mental health and self help forums ended up linking up because mine was pretty much the only dental anxiety website out there. So it’s become a bit more businesslike and about me, rather than a general thing about anxiety, because there’s better ones stancil for your central.org is a great one to look at. And it has everything in there. So the website helps Actually, I got involved in helping on [inaudibe] so as answering questions to phobic patients, which of course is the free of charge thing. That’s difficult, because it takes a lot of time. But when you know, I still get patients who have read responses and things that I’ve written within the forum, helping other patients, then know that I’m, you know, I’m caring and sympathetic to anxious patients. Of course, then social media, latterly, in the West is a thing. But I think the anxiety forums is probably the main thing that generated a lot of the business originally.

[Jaz]
That’s really fascinating. So there we are, for forums, as they were and obviously now so much of it. So word of mouth, you’re probably the go to clinic for that kind of stuff, which is great. The next question I ask is, now we’re getting to a bit where we’ve got to squeeze all this content and people listening, and then we’ll find out more. So now I want to find some learning points. So your name is Mike Gow. And I know there’s something called Gow gates, did you come up with the Gow gates?

[Mike]
I wish, I wish. You know, the frustrating thing of that is I prefer the Akinosi block. The Gow Gates is a bit harder. The chap who came up with it, his name was Gow, he’s an Australian dentist and the Gow-Gates, the hyphen was his tutor, was his teacher. So Gow-Gates is in honor of his teacher.

[Jaz]
I didn’t know that. So can you just for those who don’t know, what is the difference between a Gow- Gates and Akinosi? And let’s just focus on one, let’s focus on the Akinosi because he said that you prefer it? Obviously, we can’t video demonstrate exactly what if you just give a brief description. But then more importantly, how if I want to learn Akinosi, I don’t know how to do Akinosi, what’s the best way for me to learn Akinosi? So just covered like the difference and then how to learn that.

[Mike]
Okay, so the difference the gow gates block is an open mouth block. And after it’s delivered, the patient has to stay open for a considerable amount of time. And often you need to kind of massage and try and move the anesthetic around. So you know all the time when I want an alternative block technique to an ID block. Part of it is a problem with access. There’s maybe difficulty in seeing landmarks so maybe the patient is a bit overweight, and or they have a large tongue, a gag reflex, so the open mouth techniques are difficult in these cases. And the Akinosi is a closed mouth block, which is what makes it sorts of [inaudible]. So you can use it with patients with limited opening, huge tongues, gag reflex. Pure anatomy. Most of us have probably given an Akinosi inadvertently at some point in the past when you’ve been anesthetized an upper eight, and the patient says my lips starting to go numb to the bottom. You’ve kind of done a high block by mistake. So to do the Akinosi, you’re still using the same needles you use at ID block, retract the cheek as the patient close, and you’re actually going in by the height of the apices of the maxillary molars, at the mucoperiosteum, that’s the height you’re going in, you advance the needle hub to aboat where the distal of the seven is. And you’re actually giving, there’s loads of YouTube videos on this as well. So you’re actually giving the block much, much higher. And one of the reasons it’s not taught to us at university is there’s no body contact. So there’s no guarantee of exactly location and where you are. So again, you need to make sure you’re aspirating, you’re not hit any structures there. I’ve never had any issue with it, I have to say, while I’m doing it, and again, because you’re not going through muscle tissue, as you do with an open mouth block, it’s far more comfortable as well. So if I know I’ve got a needle phobic case, I will sometimes that’s my goal, too, as well, because I know it’s going to be more comfortable. And the patient is not straining to open mouth while we’re doing it. So please definitely learn Akinosi. Learning, certainly that our YouTube videos to look at, we do have in clinical training where somebody supervising is of course that you know the ultimate way of learning and nothing. So certainly look on your portals, look online for your CPD courses and see if anyone’s teaching it, we may well run something through as at some point in the future, if there’s interest, we can get acquired,

[Jaz]
I’m sure there would be, Mike, you know never underestimate the basics. And people want to get the basics right. And I think there would be demand for that. Especially because, you know, I remember back when being a second year student, and how short we all feel petrified of getting our first ID block and your glasses steam up and you can’t see anything and your hands are shaking like this. And now I’m going to stage where you know, you can, most dentist can do everything with our eyes closed. But when he’s trying to do a new technique, even though it’s so familiar, can be really scary. Like, for example, I once read, and maybe you can tell me about this I once read, I think it’s like dental update, or BDJ, that a technique to get your patients to feel that Id block less is that you get into position, instead of you insert a needle, you get the patient’s turn into the needle. But even that I don’t want to change, I don’t want to change anything, right? So it can be quite scary actually, when you’re first sort of doing that sort of stuff.

[Mike]
Certainly with infiltrations, I’ll move the tissue onto the needle, but my worry was asking the patient to move their head is somebody surely going to shake head one day or, you know, you lose control a bit over so that would be my worry with that particular suggestion.

[Jaz]
That’s why I haven’t done it. But it was an interesting thing to read, actually.

[Mike]
I’m gonna say that the Akinosi is simple. It’s not difficult. It’s fairly straightforward. It is like doing an alternative infiltration, essentially.

[Jaz]
So I’ll find a good video on YouTube, and I’ll link it as well, because people like to see that sort of stuff. So we’ve talked about how you track the anxious patients,

[Mike]
you’re gonna say, so just [inaudible] this first ID block that I ever gave. And of course you are you’re trying to get rid of the shakes and amend possession, working out my landmarks, the anatomy, and see after the needle, find the bone and coming back. And it’s just as I started to press the plunger, a wasp landed in my ear. So I just very slowly withdrew the needle. And I still [conversation overlapped] [Jaz]
Everyone always remembers their first time they did whatever you know your first ID block, I remember my first ID block very well. And so that’s a very unique story. I like that a lot. So last couple of questions. Now, actually. One is tapping back into that story of you doing these procedures alongside a colleague without local anesthetic, and depending on hypnosis, which is just again, just still mind blowing, right? You had some TV coverage, I believe we had like a TV set on camera people come in, how did that happen? And what was going through your mind during that because you know, the whole is a professional team. And if it goes wrong, then it can be very embarrassing. What was going through your mind?

[Mike]
Okay, well, first of all, there’s been a number of things have done so there was a progression to this story. You know, hypnosis is an unusual thing, as you’ve heard, it’s just one of the balls in the bag, you know, one of the arrows there’s lots of tools that are used, but because it’s more unusual, I’ve kind of become known as the hypnosis guy, but that’s just part of what what we do. And so, you know, I that’s, you know, I experienced some amazing things with hypnosis. And that same first year, when it was working in the clinic with tinnitus. There was a little lady that came to see me who had chronic pain. We couldn’t find the source of it. I referred her to the pain specialists. The company wrote a letter back saying it’s probably psychogenic, and she saw all sorts of pain specialists, had medication, and I said I’d done this basic training course on hypnosis and I said, you know, hypnosis can help. And she just looked at me and said, I don’t think so. Three months later, her husband came back and said, “she is crying herself to sleep every night. She’s in so much pain. Could you try hypnosis with her?” So of course, I got all my books ready roll up lots of techniques. And I was supposed to see her for her assessment. So she came in for this assessment. And on the day, she’s in tears, she said, I can’t stay for long because I’m so much pain. Let’s just go. So I said to look, can I teach you a really quick technique, and it took off about 10 or 15 minutes of visualization technique of imagining her pain was a number on the dial. I asked her if she could visualize the dial, and just turn it up very slightly. So the pain was just slightly worse for a few seconds, and then turn it back down to where it was, it’s really easy. If you focus on pain to make it worse, turned up, and then back to where it was. She could then turn it down by half a number. And then it’s still number. So we played around for 10 minutes with this idea of the dial actually went away. I then picked her next appointments, and I started folding the folded train me my dad’s who works in hypnosis, and I got all these ideas for the techniques and skills to come back in the following weekend said I commenced my appointment, but you’re gonna be a bit annoyed because the pains gone away. I don’t think I need this appointment. And I said, Really what happened? She said, Well, I went home and I was doing the dial. And she said, See when you get to zero, is it meant to click and just never come back? I said a yes. Yeah, that’s fine. So that’s what got me interested in. I mean, I, as an evidence based dentist, I’m thinking is this coincidence? It could have been any number of things? Am I, did I make that up? Have I ever seen this properly. So that’s when I decided I was going to study the Masters because I wanted to know the science behind it. And that led me to that. So once I had the Masters, of course, you know, there’s only a handful of folks in the UK that have a master’s in hypnosis, and that attracted the attention of some of the TV companies. So the first approach I heard was from BBC Three, and they say Mike, we were doing a program about the power of persuasion, could be film you extracting a tooth with hypnosis? And you know, I panicked and thought we’d be creative, be wonderful to show what’s possible. The first tooth that was extracted with hypnosis was back in like the 1830s 1840s says, it’s not a new thing. But that made again made me think why are we still reporting this as this weird new phenomenon we’ve had this skill for centuries, you know. And by also panicked about giving across the wrong impression of Dentistry of hypnosis. I didn’t want people turning up at my door saying, take my tooth out with hypnosis. So the first case i did was actually a filling. And the guy came in put the rubber dam on, we did the dental restoration using hypnosis. And I thought, I have proved that good dentistry can be done with hypnosis. A year or two later, we had another contact saying, We are doing a program called hypno surgery live. And there’s somebody who’s going to be having a hernia repair operation done live on TV, we would love to film you doing a Dental extraction to be part of the show. And of course, I said the same thing. We’ve been doing it for ages. Why do we need to be proving? I thought, you know what, if we’re going to do it, let’s do something a bit braver, a bit more 21st century let’s look at implant placement. And I research that never been done before implant placement of local anesthetic. And I thought if we can prove that you can place an implant with no local anesthetic. Imagine the power that as dentists we have, we use some of these techniques in combination with what [inaudible] you’re using the things together. That’s the real power of it. So I agreed, phoned up the defense Union, is this Okay? Anything I need to worry about? And they said no, as long as the patient’s comfortable, and your local anaesthetic on standby if you need it it’s fine. So that this case with our bedside here, the lady had a sinus lift procedure done, and then the implant was placed. And I thought, that’s great. I never have to do that, again, with placing implants, there’s been done. And then another TV company contacted us and said, we’re doing a program about alternative therapies would love to have an extraction done under hypnosis, if I’m never gonna get away from this extract, right? But I’d still like the idea of the implant placement showing the you know, the more modern dental techniques. So, I was I got involved with Phil Friel for this case, and he came in film and this is the one that is more widely known and viewed, the lady had to her two central incisors extracted and to immediate placement implants placed just using hypnosis and local anesthetic. For me, I thought, you know, as best me, I’ve proved that I’ve done it, I don’t need to do it again. And then just a few years ago, there was one more approach and it was horizon and horizon said, Michael would love to see a dental extraction. From my swan song with this, I’ll do it. So this case was a bit more interesting, the guy I’d never met before, so I had no opportunity to test his hypnotizing ability or prepare on. He came up with the production team from London. And I met him the night before. And then on the day, we extracted an upper wisdom tooth just using hypnosis. So I did my extraction just using hypnosis myself. So that was that when you asked about how it felt, obviously, during the, you know, these procedures, I think in the earlier cases, I was probably more anxious. So remember, you know, the one with , the one with Phil, you know, there is a degree of anxiety because you don’t know what a TV company is going to do with footage if the patient has a bad experience, you know, how does that affect the profession? How does it affect the perception of hypnosis? Actually, the day that we filmed with Phil, we had two patients, so we actually filmed two and they both worked beautifully. So they selected the case that they wanted to use. A degree of anxiety but as I said earlier on, I think as dentists, we are in that position all the time. Our bread and butter is we are doing something intricate and potentially painful with another human being. And it’s exactly the same. So I had, you know, other hypnotic techniques on standby. And these cases, were not cases where we couldn’t use anesthetic. So we had our anesthetic on standby if it was needed, we just prayed we just didn’t need it.

[Jaz]
That’s amazing. I mean, such a great thing, example profession, I think, and to do it in that in that way. I’m actually excited to share the video with everyone. So I’ve got just one quick fire question. And I want to find out how we can learn more, any sort of the sort of, to the organization that you have as well but wherever you think is the best next step for people who want to get more into either hypnosis or just managing anxious patients, but can you give us one quick fire gem in terms of a communication technique that you can give to any GDP that might benefit and be Yes, how can we learn more? ,

[Mike]
Okay, so communication techniques, there’s language techniques, there’s loads, probably one of the best ones is you know, learn some language skills, avoid saying things like try to patients, try and relax or try and open wider because the word “try” suggests difficulty or you’ll fail. So for kids, just see I bet you can’t open any wider and you’ll get a huge wide mouth. Avoid negative language, you know, don’t think about an Elephant. Elephant is in your head. So don’t worry, that’s what hurts worry this is going to hurt so negative language is a hypnotic technique. You can use it intentionally if you like, but most of us do it the wrong way. So you know, translate things into positive language “relax, I think you’ll be surprised by how easy that you find us today” is a great a great tool. Training wise, for hypnosis, I would say go through you know one of the medical and dental hypnosis societies. In Scotland we’ve got the British society of medical and dental hypnosis, Scotland, and UK, there’s the British Society of Clinical and academic hypnosis. They offer online courses, they offer weekend training courses, and seminars and lots of really cool things. Again, for the general anxiety stuff, the organization that we set up called ISDAM so if you go to isdam.com, there’s also Facebook page for ISDAM as well. And actually, within that Facebook group, there’s experts in sedation hypnosis language and it’s great because often if a young dentist it’s a question and again answers from the top guys in the world at these things about managing the case and their suburbian practice wherever they live. And it’s lovely to see. So join the Facebook group as well.

[Jaz]
I that’s what I love about these Facebook groups. You know, you mean the one that you said I’m definitely join it and share the Word. But also there are some restorative groups or surgery groups and orthodontic ones and woven and there’s so much wealth of knowledge that we can learn from. So Mike, thank you so much for coming on and sharing your experiences, very unique experience to us as unique for you it’s like a normal for me and the others. But there are so many things that we learn from that and we also touched on tangents like the Akinosi and the Gow-Gates, communication techniques, and how important it is to have the entire team on board and those little micro gains that you can get. So thank you so much for coming on and sharing All that knowledge.

[Mike]
Thank you. And thank you so much for the invitation. And I guess as a parting word to the, you know, the guys that are watching here, this is a tough time in dentistry and all the things. Things are difficult just know and dentistry is difficult to say with the extra things that we need to do. And but you’re focused on the stuff you enjoy, and try and get more of the stuff that you enjoy and get some of the passion back because there’s a real risk in the profession just now. Of Us losing our passion, losing a vision of what it is we enjoy doing. So there’s lots of patients out there that need your help. And there’s some great work that you can do, just go for it.

[Jaz]
Amazing. Love it. Thanks so much.

Jaz’s Outro: As always guys, thank you so much for listening right to the end. I hope you enjoyed that episode with Dr. Mike Gow. Wow. I mean, I just still can’t believe the kind of stuff you can do with just words and body language and suggestions and hypnosis. It’s just absolutely crazy. And hats off to Dr. Mike Gow, thanks so much for coming on and sharing that with us. Remember guys, my podcast is one the only dental podcast in the world where you can get CE or CPD via dentinaltubules.com. And so it’s great value just for that, you know, if you’re listening and you want to get your CPD go to dentinal tubules. To get that you just have to acknowledge the aims objectives and answer the question. So you don’t have to listen to me all over again, you just go ahead and answer the question. So it really can’t be any easier than that. And if you enjoy these episodes, could you be a massive favor and share it with a friend share it with a buddy. That’s how the podcast grows and that’s how I can find more guests and have the highest caliber and how the podcast grow. So I really appreciate that if you could thank you and join me for the next episode.