One day in 2013, as Christina DiBona Pastan, D91, DG94 was about to observe an endodontics postgraduate teaching resident perform a procedure, she noticed not all was well with the student.
“She had a panic attack before her first apicoectomy, which is a surgery on a failing root canal,” recalls DiBona Pastan, who is director of Mind-Body Wellness and assistant clinical professor of endodontics at Tufts University School of Dental Medicine (TUSDM). “I stepped out of my clinical role for the first time and asked if I could teach her the three-part breath I knew from my yoga classes.”
For DiBona Pastan, shifting to mindfulness mentoring was seamless. She had been practicing yoga and meditation for 15 years and over time had noticed that more students, faculty, and peers in the dental field were struggling to manage their stress. On this day, the resident learned a new breathing technique and successfully completed her first apicoectomy. But the resident also told DiBona Pastan that in naming her anxiety and teaching her how to address it, DiBona Pastan had changed her life with the most important tool she’d ever been given.
The feedback, in turn, changed DiBona Pastan’s life. She began a 200-hour yoga certification program at Kripalu Yoga Center, later returning to earn a 100-hour meditation teacher certification and a 25-hour chair yoga teacher certification. She developed a wellness course for TUSDM that introduces first-year dental students to mindfulness and yoga techniques.
DiBona Pastan also teaches a weekly drop-in meditation class for dental students, faculty, and staff, and in December 2022, received a Tufts Springboard Grant to support the creation of a Mindful Dental Practitioner training course focused on reducing clinical anxiety and stress and enhancing resilience in third- and fourth-year dental students.
DiBona Pastan shares tips on how patients might use the same mindfulness practices she teaches to dental students to ease their stress and anxiety before and during dental appointments.
Could you describe a few of the practices and techniques that you’re teaching to Tufts dental students?
In their first semester, our dental students are introduced to different types of mindfulness meditation. This includes the body scan, which is a practice of feeling sensations and focusing the mind on different body parts from the feet up to the head. There’s awareness meditation, which guides them to be aware of sounds and feelings and the environment around them. And visualization meditation, where they visualize themselves succeeding at something when they’re struggling.
One of my favorites is lovingkindness meditation, where they cultivate lovingkindness for themselves and others, which science has shown to really improve our capacity for compassion.
One of your students said in a video that using the techniques you’ve talked about allowed them to gain control of themselves and then of the situation. Can that also work for patients facing an appointment that’s causing them stress or anxiety?
Absolutely. For patients anticipating a stressful procedure, I think diaphragmatic breathing is probably the most effective, easiest way to ease their anxiety. It’s called the three-part breath. It uses the diaphragm, the lungs, and then the upper chest.
You start by breathing from the belly, into your lungs, and then you lift your collarbone as you breathe into your chest. Then you exhale on a long slow breath that’s twice as long as the inhale. It engages the parasympathetic nervous system, and it’s a very conscious and effective way to relax the body, the nervous system, and to focus the mind.
If they can practice this, it’s great if they can get into the rhythm of making their exhale twice as long as their inhales. Patients can start doing that at home and know that they can breathe that way when they’re driving in the car on the way in, and in the waiting room, and they can continue even in the dental chair.
It’s something I do, too, when I go to the dentist. If a patient can get comfortable breathing through their nose, they can practice diaphragmatic breathing even with their mouths open.
Do you have another one for folks who, for whatever reason, might not be able to breathe through their nose so well?
Visualization can also be effective. If patients can visualize themselves surrounded by a protective white light and feel the chair as a support, almost as if it’s a cradle, that can help. And visualize having the sense that they’re safe, relaxed, and at ease, rather than being fearful and afraid.
What advice do you have for people unfamiliar with these techniques or to those who’ve tried meditating in the past, but thought it was too difficult?
With patients that struggle with “I can’t meditate,” I bring us back to the breath. Everybody has to breathe. Just focusing on your in-breath and your out-breath as an anchor distracts the mind so that you’re not sitting with your thoughts.
You could also say a mantra like, “I am relaxed, I am relaxed.” Or say a prayer silently to yourself. Just breathe and use a word or a phrase as an anchor, or just notice your breathing. It’s very simple.
Music can also help. A lot of patients come in with their earbuds and want to listen to their own music. Sometimes a heavy blanket is very comforting during a dental appointment. Patients can ask themselves, “Am I going to be fine with this on my own? Or should I bring something to distract myself?”
What about kids? Can parents teach their kids these same skills ahead of a dental appointment?
With younger kids, say under 12, it’s important that parents reinforce that the dentist is a helpful doctor in their life and that dentistry is a positive, important part of their overall health. It helps to encourage young kids to think about going to the dentist as something fun: You’re going to be riding up and down in a chair, there’s a water gun–getting them to think about the dentist as a good experience.
When these younger kids start to get nervous about it, it helps to get them to breathe and to say to them, “When you take deep breaths; it’ll calm you down.”
With older kids, coupling music with breathing can be very effective. Many kids love music, so let them have those earbuds in and encourage them to focus on their music and feeling relaxed and supported in their chair. This is helpful for kids with anxiety.
Beyond specific practices to manage dental appointment anxiety, what else can people do in the face of this stress?
It’s really important for patients to express their fears and anxieties to their dentist and their staff–you often see the front desk and the dental assistants before the dentist.
As an endodontist, I do root canals and patients seem to be very fearful of that. I often thank them for telling me that they’re afraid, and when I ask for more details, it turns out they’re most afraid of being in pain, and understandably so. Who wants to feel pain?
Knowing about their fear tells me that I, in turn, need to communicate more with them. So communicating and knowing that your practitioner is going to work with you–if you can get off to that start, the rest is usually very smooth.
