Do redheads dread a trip to the dentist?
When I stumbled across this article in the New York Times back in 2009, the conclusions seemed eerily familiar. In my own personal experiences as a dentist in Orange, CT and elsewhere, patients with red hair seemed to be more apprehensive regarding dental care, and also seemed to have the dreaded “well, it looks like you’re not quite numb enough with the first shot, let me give you a bit more” phenomenon occur to them with much greater frequency than patients with darker hair and complexions.
As much as I would like to delve into the true scientific details, those facts go beyond the scope of this post. But to summarize, redheads have a mutation (basically a change in their genetic makeup) that produces red hair and fair skin. But that same mutation also affects receptors in the brain that govern pain perception. Although the exact mechanism is not quite fully understood, studies show that redheads have resistance to lidocaine. Lidocaine is the most commonly used dental local anesthetic used in the United States. Chances are, when you visit the dentist, and get “The Shot”, you are receiving lidocaine.
So if redheads have resistance to lidocaine, then they are more likely to feel pain during a dental procedure. But does that translate into more dental anxiety? Of course. You don’t need published research to reach that conclusion! However, in medicine and dentistry, we do like to have our conclusions backed up by sold research. A 2009 article by the Journal of the American Dental Association did confirm that redheads have “increased dental-care anxiety” and exhibit “avoidance of dental care.”
As a practicing dentist, I always look at research and then ask myself how the findings apply to my patients, either past, present, or future. This is true not just with this specific research finding but with all the developments that are continuously occurring in dentistry. A lot of research doesn’t immediately apply. However, this is one case in which the findings have immediately impacted how I approach my patients – specifically patients with red hair.
No dentist is perfect and can get 100% of the patients 100% numb with the first injection. Any dentist that claims that is lying. There are too many factors that come into play. As a dentist, it is tempting to find something or someone to blame when your patient does not get numb with the first injection. Blame the assistant! The anesthetic must be expired! The patient moved! The sun was in my eyes! The sun was in the patient’s eyes! It was a full moon last night! This happens to all dentists and to all patients – independent of hair color.
However, upon thinking back on my own patients who were “tough” to get numb, a disproportionately large percentage had red hair and fair skin. These patients seemed to require 2 to 3 injections to get numb. Another observation is that these patients always knew they would need more. They were the first ones to say “Hey doc, I always seem to need 2 or 3 shots every time I get a cavity filled.” But they never knew why they needed more local anesthetic.
In my experience, if you know a patient is going to be a challenge to effectively anesthetize, administering extra local anesthetic right off the bat is the best solution. The patient appreciates it. The second injection, if done properly, will rarely hurt, and will almost guarantee that the patient does not feel any part of the procedure. Since this article was published in the New York Times in 2009, I’ve told numerous redheads about it. Upon telling them, they nearly universally have an expression of “Wow!! Now I finally understand why I’ve always felt pain and dreaded coming to the dentist.” And from then on, their fears are reduced, permanently.
So how do we approach redheads who avoid care because of past negative experiences? This is a lot more challenging! Most redheads are unaware that their genetics are pre-determining them to have more pain in the dental chair (unless more local anesthesia is administered). So they must be informed of this. Simply informing anxious patients of this genetic phenomenon and how we address it is enough for many patients. More severe cases of dental anxiety require different approaches. I have training in sedation dentistry which has allowed me to treat patients who have moderate to severe dental phobias. This has allowed me to personally treat hundreds of patients too scared for “regular dentistry.” But unfortunately, very few dentists have the training, equipment, and staff to do sedation dentistry safely. I will try to describe other techniques in a future blog post.
Many redheads still do dread the dentist, but now they don’t need to anymore. There are many dentists out there equipped with this knowledge helping redheads overcome their anxieties, one patient at a time.