The treatment is called Three Appointment Therapy and was developed by Dr Michael Leu (pictured with patient), based on an accidental finding. “He was working on the treatment of severely handicapped patients, and he found that when he omitted local anaesthetics, patients suffered less from pain and swelling, even if he had to carry out extensive treatments,” Kaiser explains. “The reason was because he was only using GA, which was the only way to work with disabled patients. As he started seeing more and more patients, he refined the therapy to what is now the Three Appointment Therapy.”

In 1997 Leu set up the German Association for Dental Phobia, a condition that affects between 10 and 16% of people. Of course everyone, to some extent, experiences anxiety or even fear at the prospect of a dental appointment. But dental phobia is on another level.

“The phobic reaction is what distinguishes someone who’s simply afraid of the dentist from someone who has a dental phobia,” Kaiser says. “That reaction cannot be controlled: sweating, trembling, nausea at the mere thought of the dentist. The dental phobic could never actually enter a dental clinic. Someone who’s afraid, even quite severely, might still be able to go to the dentist, but the phobic could never do so.”

Rate your phobia

The consequences can be serious: Poor dental care can lead to oral and nutritional problems, and the resulting damage to teeth can be a cause of social and economic difficulties in the long run. But how do you find out if you’re phobic, and not just scared of the dentist to a “normal” degree?

“We have a questionnaire on our website, the internationally recognised Hierarchical Anxiety Questionnaire, which anyone can fill out,” Kaiser says. “If your score on that test exceeds 38 points, you are suffering from dental phobia. Some of our patients with an extreme dental phobia show 50 to 55 points, which is the absolute maximum.”

The treatment consists of three appointments: the first to determine a treatment plan; the second during which the entire treatment is carried out in one go under GA; and a third for the placement of permanent prostheses if required. The use of GA is no longer common in Belgium, Kaiser explains, because of the way procedures used to be carried out.

“In the past, many dentists carried out procedures under GA by themselves. The dentist put the patient under GA, then went ahead with the treatment. There was no way to monitor the patient properly, and this is why many accidents happened. We always have an anaesthetist on-site as well as an assistant – so two people for the GA alone – and then we have a dentist and dental assistant. So that’s four people exclusively for one patient. If these precautions are taken, it is absolutely safe to treat a patient under GA.”

Cost-benefit

The availability of GA treatment is welcome news to German and Swiss expats, Kaiser says, who are more accustomed to the procedure and may not want to travel home to find it. And it may be safe, but surely it has to be more expensive?

“It depends,” says Kaiser. “What we offer is dental treatment all in one, so the patient doesn’t need to visit the office multiple times as they might have to otherwise. Our treatment might cost upwards of €7,000 to €10,000 for dental replacement. The anaesthesia alone costs about €1,000 to €2,500. Of course you don’t have those costs if you’re not being treated under GA.”

However, the fact that the entire course of treatment is finished within the space of three appointments brings savings of its own, he argues, not least in the time spent away from work. “We have more and more patients who are not phobic - business people, athletes and so on - who cannot take too much time off work. Well, they come to us and they get the same treatment as dental phobics.”

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