A  Tribute to Dr Garlard Fross (1992)


Though I had seen reference to Dr. Garland H. Fross in various books, I first became familiar with Dr. Garland H. Fross a some months ago while reading an article by him in 1967 Journal of the American Institute of Hypnosis. A few months later, I was given his book Handbook of Hypnotic Techniques. I was impressed with his writings and his contributions to the wider acceptance of hypnosis. He was once President and Fellow of the American Institute of Hypnosis and a member of the Institute's faculty as one of its principal instructors. He was an Honorary Member of the British Society of Medical Hypnotists, the second dentist in the world to have received this honor. He practiced general dentistry from 1926 until his retirement in 1964. In the same year, he was also retired from the U.S. Navy Reserve with the rank of Commander. He had several articles published in various professional journals and other publications.



A. The Advantages of Hypnodontics

B. Hypno...Analgesia and Hypno...Anesthesia

C. Information to Include in a Brochure

D. Hypnosis for Children

E. The Gagging Problem

F. History of Hypnosis


Our own Dr. Milton has enumerated more than fifty kinds of pain. One of the most severe of these is a throbbing toothache. Is there anyone who has never had a toothache? If there is one, he is indeed, among the fortunate few.

Unfortunately, in the past at least, the first trip to the dentist was because the fear of the dentist was less than the fear of continued toothache. In my early days of practice - I began the general practice of dentistry in 1926 parents brought their child to me only after they, the parents, had been kept awake for a couple of nights by the child's toothache. As a result, things were unpleasant all around. Here was an emergency that must be sandwiched in between regular appointments. The crying child was close to hysteria. The parents were upset. At that time, I had no knowledge of dental hypnosis. It was a traumatic experience for all concerned.

It is small wonder then, that so many adult patients have unreasoning phobias and fears about dentists and dentistry. Any experience such as has been described has the same effect as a powerful and lasting post-hypnotic suggestion. Even today, too many adults visit the dentist only because their fear of the dentist is less than their fear of toothache. They may fear that the irritation of the soft tissues of the mouth may be or may become cancerous. Almost everyone is afraid of the unknown. An example of this is a fear of snakes. Because the person does not know the difference between a poisonous and a harmless snake, he is afraid of all snakes.

Indirect suggestions are always more effective than direct suggestions, especially in the waking state. When a child overhears a conversation between relatives and friends, their remarks are quite often remembered, at least subconsciously. Since most people are prone to exaggeration in telling of their experiences at the dentist's office, each person attempts to make his experience more horrible than the preceding one. Thus, the child is bound to hear some fearsome and gory tales. These wild and frightening tales may be consciously forgotten, but they are buried deep in the subconscious and cause both fear and anxiety in the child and adult patients.

Let me give a few examples of negative suggestions I have heard parents give their children. "Sit still and take the pain like a little man." "You behave so you won't get blood all over the doctor's clean, white coat." "The doctor isn't going to hurt you very much." Then there is the negative suggestion directed to the dentist "I do hope he doesn't throw up like he did the last time!" All these negative suggestions remind me of the classic one "Don't think about an elephant."

There is almost always the memory of an unpleasant, emotional experience when the patient was a child. These memories are at least partially forgotten consciously, but they are there in the subconscious. The subconscious is, therefore, feeding fear and anxiety into the conscious, causing all the symptoms of trembling, cold sweat, clutching the arms of the dental chair, tension of the muscles surrounding the teeth, tongue thrusting against the mouth mirror and instruments -all these things making dentistry difficult for both dentist and patient. These un- pleasant experiences were usually caused by the patient's delay in seeking help until pain, swelling, and infection had made any treatment painful and un- pleasant. We have not always had the wonder drugs to control infection that we have today.

I am sure that all of you have, when undressing after hunting, playing basketball, or participating in some active sport, discovered a bruise, a cut, or a scratch on your leg or body and wondered :where and when you got it. Usually, you cannot remember where or when you received the injury because you felt no pain nor discomfort at the time. You were concentrating so hard on some phase of the sport that you had no warning nor conscious memory of the injury.

But suppose someone were to say to you, "Hold still. I'm going to scratch your arm." He could scratch you, and you would receive an injury no greater than the one you received during your game or hunting. The statement that he was going to scratch your arm would immediately produce fear, anxiety, and anticipation. You would most certainly feel pain. Even so the preliminary anxiety and anticipation would likely make you more uncomfortable than the actual injury.

It is this anticipation of discomfort which keeps patients away from dental offices and makes them tense and un. cooperative when they do come for appointments. They may rationalize that it is the cost of dental treatment that keeps them away; but what really happens is that they suggest to themselves

that they are going to be hurt. This is truly a negative suggestion.

The cause of the fear is really of secondary importance. The really important thing is, what are we going to do about it because of fear, many people today are turning to tranquilizers and general anesthetics to fortify themselves for dental procedures. Unfortunately, no drug has yet been found that will permanently remove these unreasoning fears. The next time the patient needs dental care, he will once more need a general anesthetic or even greater doses of tranquilizers.

To paraphrase former President Roosevelt, today the only thing a patient has to fear in a modern dental office is fear itself. A calm, relaxed patient suffers little or no pain in a modern dental office. Any dentist can tell his patients to calm down and relax, but that is easier said than done. Witness the huge quantities of tranquilizers and sleeping pills sold and consumed each year.

General anesthetics may, and usually do, control pain completely, but they do not control fear. Many times, a patient is literally scared to death. Ten thousand patients died on the operating tables in the United States last year. I It would be difficult to estimate just 1 how many of these deaths were caused I' by fear. A general anesthetic for a tooth I' extraction seems to me like killing a mosquito with a baseball bat. It has e been said that a local anesthetic is ten thousand times safer than a general anesthetic.

Now let us talk about some of the good methods of controlling fear and pain. Many times, before using hypnosis for the first time with a patient, I tell him that I am not going to "hypnotize" him, but that I am going to "de-hypnotize" him and remove the bad or negative suggestions others have given him or that he has given himself.

It is my belieĀ£ that the ideal way to practice dentistry is to use hypnosis in conjunction with a small amount of a local anesthetic. While many patients never reach the depth of hypnosis where hypno-anesthesia can be obtained, it is logical to use hypnosis alone whenever the patient can reach that depth. It certainly must be attempted in all cases where chemical anesthetics are contra-indicated, even if it takes up to a dozen sessions in preparation for the patient's actual dental work to be performed with hypnosis. Most authorities are of the opinion that a patient who has not achieved hypno-anesthesia in ten sessions, will probably not go any deeper in subsequent sessions.

Hypnosis is a very useful means of sedation, either with or as a substitute for drug pre-medication. It can be used to produce operative amnesia and to improve post-operative morale. It can be used to raise the threshhold of pain and to reduce the need for post-operative narcotics. It may be helpful in reducing post-operative nausea and vomiting. Writing a prescription for a barbiturate or other sedative does not insure the patient's obtaining a good night's sleep before the surgery. When a patient is anxious and disturbed, he is apt to be restless and uncooperative, no matter what his medication may have been.

Where surgery under a general anesthetic is necessary, the following suggestions given during hypnosis are recommended for the day before the surgery. They were formulated by Dr. Bryan and are very effective. "You will relax and sleep soundly tonight. You will feel relaxed and comfortable in every way for the surgery tomorrow. During surgery, you will feel serene and perfectly safe. The anesthetic will be administered carefully and safely and the operation performed skillfully. When you awaken from surgery, you will awaken quietly and comfortably, as though awakening from a long, health-restoring sleep. You will have prompt and regular bowel movements and prompt and regular urination. You will feel pleasantly hungry, vigorous, and full of life, pep, and vitality. You will have a dry wound and be up and around very soon. You will first awaken in the recovery room, the safest place for you to be. You will concentrate on waking up. You will be relaxed and rested at all times and find the experience fascinating, interesting, and rewarding."

These suggestions may be changed slightly to fit the oral surgery to be done. When used, the patients will be greatly benefited by these suggestions. For the very religious patient, the following might be added: " As you rest peacefully and calmly, you will know that God constantly watches over you, and you are able to trust in His infinite , goodness. Now, you will sleep soundly and well and wake up sound in body, sound in mind, sound in spirit, and sound in health."

The dentist who works on tense, nervous, fearful patients soon absorbs these tensions. The tensions of the dentist are then communicated to the patient, setting up a vicious cycle. The dentist who teaches his patients to relax and uses self-hypnosis to help himself to relax - that dentist will preserve his health and prolong his usefulness. He is sure to improve his relationships with his patients and his family.

Ninety-five percent of all dental patients can experience hypnosis to a degree sufficient for dental purposes for the calming of fears and apprehensions. The five percent who can not be hypnotized are the very young, the mentally retarded, and some, but not all of the psychotic. It is fairly safe to say that a person with an I.Q. of less than seventy is not capable of being hypnotized.

If anesthesia were the only value to be derived from hypnosis, I would have discontinued its use long ago. Although only about one-third of my patients have experienced painless dentistry from hypnosis alone, more than ninety-five percent have experienced relaxation and calming of fears. To my way of thinking, this is the real "pay dirt" of hypnodontics. The hypno-anesthesia is the frosting on the cake.

Let me repeat - It seems to me, hypnosis in conjunction with a small amount of a local, chemical anesthesia is the ideal way to practice routine dentistry. Many times, the quantity of the local anesthetic may not amount to any more than a placebo and many times of course, no chemical anesthetic is needed at all. The threshold of pain is raised in direct proportion to the relaxation of the body. Even in the lightest stages of hypnosis, the patient is relaxed to some degree, because hypnosis can not take place until both mind and body have ceased to resist.

Hypnosis acts on pain in the same manner that narcotics do. It does not affect the sensation of pain per se, but, like morphine, it enables the patient to ignore the pain. Unlike morphine or similar drugs, hypnosis is not habit forming and has no after effects.

I should like to give the following quotation from Lester A. Millikin, M.D., a past-president of the American Institute of Hypnosis. It deserves your careful consideration.  "I visualize everyone as a good hypnotic subject if he wants to be and thinks he can be, because each has been doing his own hypnosis since being born and by now should have become an expert. When a patient's need is great and he is positively motivated by the hypnotist, he will achieve the desired depth sufficient for his needs."


Words - The Principal Tool of Hypnosis: ORIGINALLY, two persons were necessary for thinking. Not until man reached a relatively high degree of civilization was he able to "double" and take the part of the other person. Thinking and speaking are the same with the ancient and primitive peoples. Their thinking is their conversation.

Semi-literates even today do not understand the written word unless they read it aloud. They must vocalize what they read for it to have any meaning for them. Therefore, it seems logical that human intelligence has its origin in the ears. This was brought to my attention about twenty years ago on a visit to Mexico. At that time, sound trucks were the principal means of advertising. It is difficult for us who gain a large portion of our information by reading or by sight, to realize that a large portion of the peoples of the World still receives most of its impressions by ear.

Some puzzling dental phobias, fears and anxieties, and strange hysterical symptoms may be traced back to some saying of father, mother, relative, or friend when the child was under emotional stress. The child's impression was gained through hearing.

If there is any validity to the theory that we regress to childhood during hypnosis, we must use simple, uncomplicated words which are sure to have the same meanings to both the patient and the dentist. This may be graphically illustrated by the story of an American GI. in Australia.

He asked an attractive young Australian girl if she would (p 1) like to dance. Her answer was, "Why don't you go and jazz my sister? I am knocked up." The translation is "Why don't you dance with my sister ? I'm tired." This shows quite clearly that the same words have different meanings at different times in different places.

It is impossible to think without words. It also follows that no word or label exactly describes any object. All of us live in a world of words. There are actually few thoughts or ideas without words. Words are the most powerful drugs used by man. There is real magic in the way they affect the minds of men. No one could ever evaluate the influence ! of the words of Jesus uttered two thousand years ago I but still quoted today. In modern times we have had Winston Churchill. Not only the words he used but how he spoke them, influenced the lives of millions of men and quite possibly changed the course of history.

Man may not be the only animal to possess a language, but he is certainly the only one to possess a written one. Even so, that written language dates back only about six thousand years, while the human race as we know it today dates back at least half a million years. This means that the written language has existed about one percent of the time of the human race. It would seem from this that the spoken word would have greater effect on the "old" part of the brain, or the subconscious, than any other influence.

By the use of a few well-chosen words, a person can arouse the most violent behavior in another human being. Also, we know that "Soft words turneth away wrath." Imagine the effect on you if, after a physical examination, your' physician were to say to you, "You have a brain tumor." Just five little words, but what a difference they would make in your life! Dentists and physicians, above all men, are in a position to do the utmost harm to their fellowman by an unfortunate suggestion, carelessly given.

Conversely, they can give suggestions that will bring the greatest benefits. We must learn how to use the right words, learn how words work and their effect on the listener. Mark Twain said it best of all: "The difference between the right (p 2) word and the almost right word, is like the difference between lightning and the lightning bug." Nowhere does the choice of the right word mean so much as during hypnosis. People under hypnosis are extremely literal in their reactions to statements made. As an example, when a patient was asked, "Will you tell me your name?" the answer was "Yes." Suggestions should never be ambiguous or confusing.

Keep them simple. Never use words or statements that can be misinterpreted. Words or statements that may have a double meaning only create confusion under hypnosis. This we do not want. Only positive statements should be used.

The word "pain" should be deleted from all statements made during hypnosis. Instead, tell the patient he will feel a little pleasant pressure, or that the tooth will feel like wood or leather. He may be told that the tooth will feel pleasantly cold and numb (if the patient is familiar with the feeling of numbness) . Use words and comparisons that are within the patient's experiences or they will have no meaning for him. I sometimes suggest to the patient, "If anything annoys you, just say to yourself, 'This is a little annoying, but I'm not going to let it bother me'." Many times it is evident during a dental operation that the patient is having some discomfort. This statement will usually take care of the situation, especially if the post-hypnotic suggestion is given, "You will remember only the things that are , pleasant and helpful to you." The word "relax" is a magical word. It suggests peace, serenity, tranquility, ease, comfort, and calmness-in what) has become a very tense and stressful world.

Do not make suggestions that will upset or offend in any way. Jokes are entirely out of place in the operating room where hypnosis or chemical anesthetics are used. Patients have no sense of humor during the trance state. Hypnosis should not be used as a toy for amateurs. It is as senseless to use hypnosis for fun as it is to use heroin or nitrous oxide for entertainment.

It is disconcerting to what extent bad habits in the (p 3) choice of words creep into the inductions. During the induction of a somewhat overweight woman, I said, among other things, "Your limbs are growing heavier and heavier." No sooner were the words out of my mouth than I noticed she looked unhappy and annoyed, with a very noticeable frown on her face. Seeing this, I immediately retreated and said, "1 mean your limbs are beginning to feel heavier and heavier." The frown disappeared and was replaced by a placid expression and the remainder of the induction was uneventful.

Perhaps it would be a good idea if we made tape recordings of our inductions occasionally to be sure we are not stepping on any psychological sore toes.

During my early days in the use of hypnosis, I would say during the patient preparation, "You will not be asleep or unconscious. You will hear everything I say ." Most people do not listen because they are thinking about several things at once. Because of the preconceived, mostly erroneous, ideas almost everyone has about hypnosis, upon awakening from trance, even a very deep one, the patient would invariably say, "Doctor, I don't believe I was hypnotized. I heard everything you said." Naturally, this was upsetting to a novice in the field. Now , I say, before and during hypnosis, "You must be able to hear everything I say or I can not help you. Whether or not you remember everything when you awaken is not important. It is important that you hear everything I say while you are under hypnosis." This will usually keep the patient from feeling that he has failed and keep him from being disappointed in what should be a pleasant and relaxing experience. What is even more important, it keeps the dentist from becoming so discouraged that he will not use this wonderful tool as often as he should.

Even the word "sleep'.' may have unpleasant connotations for some children. The phrase, "I am going to put you to sleep," may remind the child of the time his pet dog or cat was "put to sleep" permanently. It is small wonder that our inductions are not always as smooth as we expect them to be. (p 4) No one can tell you the exact words or phrases to use on all occasions. By watching the expressions on the faces of the patients, we can see immediately when a word or phrase is the wrong one for that particular patient. We can then retreat and use a different word or phrase to express the idea.

Perhaps the best way to be sure that the patient has the same images in his mind that the dentist has in his is to paint word pictures, using the senses of hearing, seeing (imaginary, mental pictures) , feeling, tasting, and even the sense of smell. Every dentist would like to have a perfectly quiet, restful office, but there are necessary noises in connection with dentistry. Since the sounds cannot be eliminated, use them. Tell the patient that all the sounds will blend together like a beautiful symphony. One of the best group inductions I ever saw was by Dr. William J. Bryan, Jr., beside a rather noisy fountain in front of the Grand Hotel on Mackinac Island in Michigan. The rhythmic regularity of the falling water seemed to serve as a background lullaby. In this same way, the patient can be told that the water from the high speed drill is like the spray from a waterfall or fountain. The water in the cuspidor may also be said to sound like a fountain or waterfall. Tell the patient that he will see the picture in his mind's eye. Use the present tense to describe the colors, sizes, and shapes. It is not necessary to go into great detail. The patient will fill in the details for himself. Aromatic medicaments may be said to smell like perfume. This associates the odor with pleasure.

As Aladdin used his lamp, so can we as hypnodontists use words to produce miracles in removing fear and apprehension in our patients.

Mighty indeed is the power of the correct word in hypnodontics. The success of hypnosis depends on the right suggestion. The success of the suggestion depends on the proper word.

Be wise when you hypnotize. Have the best tools of hypnosis at your finger tips. Use the right words and watch your percentage of successful cases increase. (p 5)

A. The Advantages of Hypnodontics:

1. Hypnodontics is completely safe. There is no record of any case where hypnodontics has hurt anyone.

2. Ninety-five percent of all patients can be relaxed and their dental fears allayed through the use of hypnodontics.

3. Face and lip muscles can be relaxed, making the dentist's work easier and more accurate. This is especially true since the advent of the high-speed drills.

4. When in the hypnotic trance, the patient does not talk nor waste time spitting and rinsing the mouth. These stalling tactics can double the time required for any given operation, upsetting the dentist's schedule and lowering the quality of his work. I estimate that two years of my life have been spent waiting for patients while they spit and rinsed their mouths.

5. Hypnodontics can be used to prevent gagging, always succeeding temporarily and almost always succeeding permanently.

6. It removes fear and apprehension for the injection of the local anesthetic.

7. Under hypnosis, the patient can keep his mouth open for long periods of time without fatigue and muscle cramping. (p 13)

8. Analgesia of teeth and gums can be induced in many instances without the use of drugs.

9. When hypno-anesthesia can be obtained, post-operative swelling, pain, and nausea can be eliminated. There is also more rapid healing. Even when hypno-anesthesia can not be obtained, when hypnosis is used, less chemical anesthetic is required. This in turn decreases post-operative swelling, pain, and nausea.

10. Post-hypnotic suggestions eliminating the dread of future appointments can always be made.

11. The dental appointment can be made a period of rest and relaxation. The patient can leave the office refreshed and rested.

12. All the chemical means of removing pain can be improved by the use of hypnodontics. The amount of drug or medication used can be cut to one-half or one-fourth of the usual amount used.

13. Under hypnosis, the patient is conscious at all times.

He can follow suggestions and directions and can assume any position convenient for the dentist. No throat packs are needed.

14. Excessive saliva and bleeding can be controlled by the patient who is using hypnosis. (p 14)

Kay and the Use of Waking Hypnosis: Case History: Kay was just two and a half years old when she was brought to .me for dental work. She \vas the youngest patient I had had since becoming interested in hypnodontics. In using hypnosis with her I learned many things. Kay taught me that therapeutic goals in the very young are more important than anything else. She also taught me a great deal about waking hypnosis.

Kay had rampant caries and an extreme dislike for her former dentist. This was a real challenge. Since children are in a chronic state of hypnosis, I hit upon the idea of having her teach a large, imaginary, pink bunny how to have his teeth fixed. I explained to her that the pink bunny had a great many holes in his teeth. If he didn't get those holes fixed, he would have a toothache and would not be able to eat.

Kay was intrigued with the idea of a make-believe pink bunny at the dentist's. While she refused to close her eyes at any time, it did become an absorbing game between Kay and me to teach the pink bunny acceptable behavior. It sounds really silly to an adult, but that pink bunny became quite real to this little two and a half year old, and remained so for the next six years. Rampant caries continued, but there was no loss of teeth, no tears, but much squirming. This was my first experience with waking hypnosis, but it proved to be richly rewarding for both Kay and me. (p 150

B. Hypno...Analgesia and Hypno...Anesthesia: It is my opinion that all dental operations-fillings, inlays, crowns, bridgework, deep scaling--can best be done with a local anesthetic. This is the easiest and most comfortable method for the patient, unless the fear of the "needle" is encountered. However, under even the lightest stage of hypnosis, the patient usually will not object to nor fear the "needle." A very small amount of chemical anesthetic will do a very large dental job, when coupled with the proper suggestions given under hypnosis.

It is an established fact that fear can not be experienced when the muscles of the body are completely relaxed. It has also been proved that the threshold of pain can be raised in direct proportion to the relaxation of the muscles. This relaxation of the muscles can be accomplished in any stage of hypnosis.

Only about one person in five can have painless extractions, pulp extirpation, or similar procedures performed with hypnosis alone, especially at the first session. Therefore, hypnosis alone is not recommended since the patient may unexpectedly come out of trance or have it lightened sufficiently so that he may experience pain. The only alternative is general anesthesia which to me seems like killing a mosquito with a ball bat.

You are probably thinking, then, why use hypnosis at all ? The reason is quite simple. Fear of the "needle" and (p 77) fear of dentistry in general can be removed by suggestion under hypnosis. General anesthetics will not remove either.

Hypnosis used in conjunction with any chemical anesthetic will substantially reduce the quantity of anesthetic needed.

Where a chemical anesthetic is contra-indicated because of the health of the patient, then an adequate number of sessions for conditioning the patient are recommended, no matter how many it will take. If the motivation of the patient is strong enough, the number of sessions may be surprisingly few. There are cases on record, though they are rare, where sufficient depth of analgesia and anesthesia has been produced at the first session. In these cases, the motivation was sufficiently great.

While chemical anesthetics will produce the absence of i pain, they do not produce the absence of fear. While free from pain, the patients have many times in the past been literally "scared to death." The patient may even be asleep under a general anesthetic but still be suffering from anxiety. Proper management of pre-anesthetic apprehensions call for calm and authoritative reassurance. The use of hypnosis for pre-operative sedation and for post-operative suggestions (pre-operatively administered) is seriously recommended.

Hypnosis is a useful means of sedation, either with or as a substitute for drug pre-medication. It can be used to produce operative amnesia and to improve post-operative morale. It can be used to raise the threshold of pain and to reduce the need for post-operative narcotics. It may be helpful in reducing post-operative nausea and vomiting.

Writing a prescription for a barbiturate or other sedative does not necessarily insure the patient's obtaining a good night's sleep. When a patient is anxious and disturbed, he will be restless and uncooperative, no matter what his medication may have been.

Where surgery under a general anesthetic is necessary, the following suggestions under hypnosis are recommended, on the day preceding the surgery. They are very effective. "You will relax and sleep soundly tonight. You will feel (p 78) relaxed and comfortable in every way for the surgery tomorrow. During surgery, you will feel serene and perfectly safe. The anesthetic will be administered carefully and safely and the operation performed skillfully. When you awaken after surgery, you will awaken quietly and comfortably as though awakening from along, health-restoring sleep. You will have prompt and regular bowel movements and prompt and regular urination. You will feel pleasantly hungry, vigorous and full of life, pep, and vitality. You will have a dry wound and will be up and around very soon.

You will first awaken in the recovery room, the safest place for you to be. You will concentrate on waking up. You will be relaxed and rested at all times and find the experience , fascinating, interesting, and rewarding."* These suggestions may be slightly changed to more nearly fit the dental surgery to be done. When used, your patients will be greatly benefitted by them.

For the very religious patient, the following paragraph might be added: " As you rest peacefully and calmly, you will know that God constantly watches over you, and you are able to place your trust in His infinite goodness. Now, you will sleep soundly and well and wake up sound in body, sound in mind, sound in spirit, and sound in health." Many dentists have criticized hypnosis because they say it takes so long to induce the patient that it is impractical.

Nothing could be further from the truth. The vast majority of patients can be induced in five minutes. By using the Oriental Pressure Point Method, I have induced many patients in a fraction of a second.

There are four major methods of producing hypnoanesthesia. They are: 1. Direct suggestion. 2. Modified direct suggestion. 3. Visualization. 4. Dissociation.

In direct suggestion, there are four approaches. The one I usually use is the simplest. After the patient has been induced and the trance has been deepened as far as possible, (p 79) I gently press on the tooth or teeth to be worked on. Then, gently, I rock it (or them) from side to side. The patient is given the following suggestion: "Your tooth (or teeth) is (are) becoming cold and numb, pleasantly cold and numb, so pleasantly cold and numb that nothing will bother you, nothing will upset you. You will feel only pressure on this tooth (these teeth) . The pressure will make it (them) more cold and numb, as cold and numb as if it had been anesthetized. " Another direct suggestion would be to tell the patient, after he had been hypnotized and deepened, that "Your tooth will feel like a block of wood ( or a piece of leather) .

There will be no more feeling in the tooth than there would be if it were made of wood. You will feel only pressure on this tooth. That pressure will make it feel more and more like a block of wood." After the patient has been induced and deepened as much as possible, still another direct suggestion may be used. Let us say, for purposes of explanation, that the dental work to be done is on the right side of the patient's mouth. These suggestions might be used: "Now , relax completely and make your body as soft and limber as a rag doll, while I rub your right cheek. (I gently massage the right cheek with a circular motion) . You will feel the right cheek growing numb as I rub it. Raise the index finger of your right hand as soon as you feel the numbness starting. Your cheek is feeling pleasantly cold and numb, stiff and numb, tingling and numb, pleasantly cold and numb. As I continue gently rubbing your cheek, the numbness goes through your cheek and numbs the gums, the bone, and the teeth on this side of your face. Signal with your finger when your teeth and gums begin to feel numb. (Repeat this suggestion until the patient gives the desired signal) . This side of your face, the teeth and gums, are becoming more and more numb. I shall count to five, and as I count, the numbness grows deeper and deeper. When I get to five, there will be no feeling except pressure. The pressure will make the teeth and gums more and more numb. (p 80)

"One. . . more and more numb. ( Gently massage the cheek while counting) . Two. . . feel the numbness in your mouth getting deeper and deeper, all the way to your tongue and the roof of your mouth. Three. . . the gums, teeth, and bones are becoming more and more numb. Four. . . more and more numb. Five. . . now your gums, teeth and bone are completely numb. The more I press on a tooth on this side of your mouth, the more numb it becomes.

"The left side of your mouth is still sensitive when I press this instrument lightly against your gums on the left side, you will be able to feel it. When I press this same instrument against the gum on the right side, you will feel only pressure. The harder I press, the more numb it becomes. That's fine. Now, open your mouth wide and keep it open until I tell you to close it." The dentist may now proceed with the dental work to be done, and the patient experiences no discomfort during the procedure.

In the fourth approach to direct suggestion, the anesthesia is transferred from the patient's hand to his mouth. In this approach, glove anesthesia is produced on the back of the patient's hand. Instead of rubbing the cheek gently, the back of the patient's hand is rubbed. The same suggestions are used for the hand as were used for numbing the cheek. When the patient is satisfied that his hand is anesthetized (this is shown by testing first one hand and then the other), he is told to place the back of his hand against his cheek and transfer the numbness from the hand to the cheek and, thence, to the teeth and gums. After the transfer has been made, the hand, relaxed and normal in every way, is returned to the patient's lap.

A suggested wording for this method is the following: After the patient has been induced and deepened as much as possible, say, "Now, as I stroke your right hand, it will become pleasantly cold and numb, pleasantly cold and numb.

You will signal with the index finger of your left hand when your right hand becomes cold and numb. I am going to test your hands to see which one is cold and numb, (p 81) pleasantly cold and numb. I shall touch the left hand with this instrument. (Do so) . It is still sensitive. Let us touch this instrument to your right hand. Notice how numb and without feeling this hand is ? That's fine. Let us now place your hand against your left cheek and transfer the numbness from your hand to your mouth. Signal with the index finger or your left hand when you are ready. Fine. Now, press the back of your hand against your cheek and transfer the numbness through the cheek to the teeth, gums, and bone.

As the numbness leaves the hand the cheek, teeth, and gums become more and more numb. Signal with the index finger of your left hand when all the numbness has been transferred from your hand to your cheek, teeth, and gums.

When you are sure that all the numbness has left your hand, let your right hand drop gently into your lap. Your hand will be relaxed and normal in every way ." The count to five may be used during this procedure, as it was in the preceding method.

The modified direct suggestion is especially useful where the patient has never had a local anesthetic. Strange as it may seem, there are such people. This technique I first heard described by Dr. Bryan. The dentist says to the patient, "I want you to see in your mind's eye, a row of six, multi-colored electric lights. The colors-red, green, blue, pink, yellow, lavender-may be arranged in any order you like. When you see this row of colored lights, raise the index finger of your right hand. That's fine. Now, imagine that you see an electric switch under each light. I want you to imagine that you are connecting each switch with the light above. When you have finished connecting all the switches to all the lights, signal with your finger. Now, you have a row of colored lights and an electric switch to each one. You will now select a certain color to connect to the back of your right hand. Signal with your left index finger when I mention the color of the bulb fastened to your hand. Is it red? Green ? Blue ? It is the blue one, then. Fine. Throw the switch and turn off the blue light. (Now, the dentist tests the patient's right hand. If the patient flinches or (p 82) indicates that analgesia is not complete, the dentist should continue in a positive manner) . Take a look at the blue light. It appears to be on again. (The patient will probably nod or signal in some way that the light is on) . The reason you are feeling pain is because you failed to turn out the blue light properly. This is all your fault. You have been using bad switches. Turn off the blue light again and tape it shut with friction tape so it can not go on again. Then your hand will stay numb."

When the patient accepts the suggestion that the reason he felt pain was because the blue light was on, then turns the blue light off again, his hand must be numb. If the patient still shows signs of feeling pain, the dentist has one more suggestion. "Your friction tape is no better than your switches. There is only one thing to do. Reach up and unscrew the bulb." It is obvious that the blue light can not come on if it has been unscrewed. The patient relaxes, and anesthesia is thus established on the back of the hand. From there, it is transferred to the mouth in the usual way.

The first time I heard this method of visualization, I heard it while I was myself in hypnosis. While in hypnosis, the patient is asked to visualize a long corridor down which he is walking. At the end of the corridor, he can see a bucket from which steam is rising. He is very curious as to the contents of the bucket. He is told that, as he approaches the bucket, he can see that there is hot water in it. The water is hot, but not so hot that it would burn his right hand, should he plunge his hand into the water. The patient is instructed to plunge his right hand into the water. He immediately jerks his hand out, feeling it burning and tingling. The hyperaesthesia makes the patient desire anesthesia or some antidote. Another advantage here is that there is a marked difference between the overly sensitive right hand of the patient and his normal left hand. The dentist now takes a rounded, blunt instrument, such as a ball burnisher, and touches the patient on the back of the right hand, telling him that he is injecting an anesthetic (p 83) to make the hand cold and comfortably numb. He will feel the anesthetic entering his hand and will wonder which finger will become numb first. After the numbness has been established in the hand, it is transferred to the mouth in the usual way.

With this method, the patient is motivated to want anesthesia so that he may get rid of the burning sensation. He is apparently given a choice when the suggestion is made that he will wonder which finger will become numb first. He is not really being given a choice of whether or not he wants an anesthetic) but only which finger will feel the numbness first. If he decides that one finger is becoming numb, he has accepted the suggestion and the remaining fingers will follow. The anesthesia is then transferred from the hand to the mouth.

The dissociation method is most valuable when used with operations on some part of the body which the patient can not see. Therefore, it is especially applicable for dental operations. All dentists have had patients who wanted to see everything that was happening in their mouths, with the result that the patient's mirror was always in the way of the dentist's instruments or his vision. Under hypnosis, the patient is told that he can unscrew the jaw and place it on the bracket table where he can watch the entire operation from start to finish, as if were being performed on someone else.

Sometimes a patient who has unscrewed his jaw and put it on the bracket table may become fearful and produce pain to be sure the maxilla or mandible is still fast to his body. To remove this fear, the dentist should tell the patient in advance that he can screw the part back on any time he desires and that it will be perfectly normal in every way when it is replaced, just like apart of an automobile which has been detached and then replaced.

A few of the usual problems resulting from hypno-analgesia and hypno-anesthesia should be discussed, with possible solutions of them. If, during the dental procedure, the patient should complain of pain, the dentist might ask, " Are (p 84)

you sure you are feeling pain ? Or are you just remembering it?" The patient will usually be glad to jump to the second idea presented by the questions and will usually say, "I'm just remembering it." Then, the dentist will answer, "Good. Forget it." By the use of one of the deepening techniques, the anesthesia is restored and the patient again relaxes without pain.

Before any operation is done under hypnosis alone, the patient should be reassured that, should he need a chemical anesthetic or drug of any kind during the operation, it will be given to him, safely and skillfully.

Maintaining anesthesia can sometimes become a problem. Anxiety leads to tenseness, which leads to loss of relaxation, which leads to the loss of anesthesia, then to pain, then to more anxiety. This vicious cycle will interrupt the deepest anesthesia. Once started, it must be broken quickly and completely, and reversed by direct suggestions as quickly as possible. If the patient complains of pain in the middle of the operation, the operation should be stopped as soon as possible, and the patient told, "We have all the time in the world. Whenever you are completely relaxed again and ready for us to start, let us know by signaling with your right index finger. We shall rest and you may rest until you are ready to begin again." When the patient is assured there is plenty of time and that there is no need to hurry, that the operation will not be resumed until he is completely relaxed and ready, this assurance is usually enough to stop the pain at once. When the patient's anxiety is removed, the pain stops and there is anesthesia again, relaxation, and loss of anxiety. The cycle has been reversed.

On some rare occasions, the patient may become anxious about some procedure or noise he does not understand. The easiest approach is to ask the patient what is troubling him. The patient can then be reassured, anesthesia re-established, and the oper1.1tion continued. This type of interruption seldom lasts more than a minute, providing proper action is taken immediately.

Dr. Bryan tells the story of a patient who was imagining (p 85)  himself on the beach beside the ocean while the operation was being performed. The patient became agitated and asked the surgeon to please hurry. When questioned, the patient declared he was in no pain, but that the tide was coming in and he was about to get wet. The patient was moved up on the beach, away from the approaching waves, and the operation was finished without any more difficulties.

On rare occasions, when the patient becomes anxious about the anesthetic, a supplementary chemical anesthetic may be introduced. A token amount is usually sufficient. Sometimes a placebo is sufficient, but not always.

In conclusion, I should like to offer two ideas or suggestions, one especially for those dentists who are new in the field of hypnosis and the other especially for those who have used hypnosis for some time. Each idea, however, is worthy of the attention of all. For those dentists who are new in the field of hypnosis, my personal "rule of thumb" may be found helpful. If the patient can produce "glove anesthesia," he can transfer it to the mouth, teeth, gums, and bone, and he will have painless dentistry with hypnoanesthesia. If he can not produce "glove anesthesia," then a small amount of chemical anesthetic must be used in conjunction with hypnosis for completely painless dentistry.

For those dentists familiar with hypnosis and who have used it for some time, I should like to give this quotation by Dr. Lester A. Millikin. It deserves your thoughtful consideration. "I visualize everyone as a good hypnotic subject if he wants to be and thinks that he can be because each has been doing his own hypnosis since being born and by now should have become an expert. When a patient's need is great and he is positively motivated by the hypnotist, he will achieve the desired depth sufficient for his needs." (p 86)

C. Information to Include in a Brochure: A neatly printed brochure covering all the important facts about dentures is a good idea. People have a tendency to believe what they read in print. They sometimes conveniently forget or misinterpret what you tell them. Personalizing the brochure with the patient's name" at the top and your name signed at the bottom, is good, too.

Some information that should be included in such a brochure is the following :

1. The upper denture usually stays seated better than the lower because it covers a greater area and there are fewer muscle attachments.

2. The lower denture seems to "float" because of the dislodging action of the tongue and cheek muscles.

3. At first, the patient may think food tastes different.

There are no taste buds in the palate. Because the denture covers the tactile and temperature cells of the palate, food may seem to taste different, but it does not.

4. The sense of smell has more effect on the taste of food than the taste buds of the tongue. The taste buds register only sweet, salt, sour, and bitter. Without this sense of smell, a raw onion cannot be distinguished from a raw apple.

In order to make the wearing of dentures more pleasant, a few important facts told the patient while under hypnosis should include these:

1. The patient will be pleased with his more youthful appearance.

2. The patient will chew on both sides of his mouth at the same time.

3. The bony ridges of the jaw tend to absorb or dissolve slightly with time and even the so-called permanent dentures should be replaced at least every five to seven years. (p 91) Temporary or immediate dentures should be replaced within a few months.

4. The patient will keep his tongue in the front of his mouth at all times.

5. The patient will actually enjoy the "floating" feeling of his new lower denture because the denture is actually massaging the gum, increasing the blood supply, and thereby increasing the nourishment to the gums and bone, thus slowing down the shrinking process.

6. The patient will be happy with his new dentures. He will enjoy looking in the mirror to see his nice smile.

7. He will enjoy keeping the dentures in his mouth at all times, taking them out only to clean them.

8. The patient will be pleased at how quickly he masters his new dentures.

This last suggestion is a nice, elastic statement. It sounds good but gives no definite length of time. The patient is not told that he will need no adjustments and have no sore spots. It is a positive statement in that the patient is told he will master his new teeth.

Let me say here that I have never had a failure in prosthetics where the patient allowed me to use the formal type of hypnosis. Unfortunately, older people tend to be set in their ways and dislike trying anything new to them. This attitude will undoubtedly change in the near future as more and more dentists utilize hypnosis. (p 92)

D. Hypnosis for Children: THE DENTIST must make every effort to prevent the children in his dental practice from having fears and phobias so often seen in adults. The use of hypnosis with the young patients is the best way to prevent these insane dreads and fears, which are completely out of proportion to the reality of the situation.

A child is hypnotizable from birth. He responds to his mother's caresses and the lulling sounds she makes with her voice. When a child is held and rocked in his mother's arms, the warmth of her body and the rocking motion spell security to him. This is a form of hypnosis. However, it is difficult to prove that this is hypnosis as the phenomena associated with hypnosis are difficult to demonstrate in very young children. Since this is true, perhaps it would be better if we should strive for therapeutic goals instead of formal hypnosis in the very young. The label is not important, so long as we get the desired results. I found this to be the case with my youngest patient to respond to a hypnotic technique. She was just two and a half years old.

Inducing hypnosis in children is comparatively easy, because children are in a constant state of hypnosis and have very active imaginations. We have all witnessed children who have imaginary playmates. We adults can not see them, yet the children play with them and converse with them.

There are three rules for inducing hypnosis in children. (p 94)

They are:

1. Gain the child's confidence.

2. Tell the child what you are going to do before you do it. Use general terms and express them in language he can understand. An example would be, "We are going to $et rid of old Mr. Tooth Decay and replace him with a shiny, new, silver filling,"

3. Use any, suitable technique.

The task of gaining the child's confidence is often more difficult than the hypnotic induction itself. Until his confidence has been gained, hypnosis can not be induced. We must realize that an injured child, or one with a toothache, is not trying to be mean or angry toward the dentist when he screams and fights frantically. He is, in reality, pleading for help. He is using the only means known to him to make adults know how serious his trouble is, and thereby get a little relief.

The injury may seem trivial to an adult, but it is not trivial to the child. He knows that he is in pain. He may even be afraid he is going to die. The dentist who does not understand this is apt to say, "This is really nothing. It doesn't hurt that much. You're just being a cry-baby." To the child, this dentist becomes just another stupid adult who does not understand. How can such a stupid dentist make him well, when he does not recognize a serious condition when he sees one? However, if the dentist approaches the child on the child's own level, sincerely recognizing the severe pain and the horrible fears, and discussing them with the child, he then becomes a reasonably intelligent grown-up who may be worth listening to.

Listen, observe, evaluate,-then, act. Do not minimize the child's injury if you expect to win his confidence.

One rather religious dentist I know uses prayer to gain the confidence of his child patients and thereby have rapport. This would work very well indeed if the child came from a religious family where he had been taught to pray. The dentist says, "Now, clasp your hands together tightly, (p 95) close your eyes, and ask the Lord to make my hands light and gentle so you will be comfortable and will enjoy having your teeth fixed." Naturally, the procedure used for each patient will be different. When telling the child what you intend to do, adapt the words and descriptions to his age group.

There are a number of techniques suitable for children. The television technique works well for children three to nine years of age. It is a good technique because most children enjoy watching television. To arouse the child's interest, I ask, "Would you like to watch my magic TV?" As soon as the child nods or indicates his agreement, I proceed, "Close your eyes and make yourself as limber as a rag doll. That's fine. Now, let's make believe we are going to your house. We walk up the walk, open the door, and go into the room where the TV is. I'll turn on the set while you lie down on the floor and get ready to look up at the picture. First, we can hear the sound. Now , here comes the picture. The cartoons are on and all the cartoon characters are mixed up together. I can see Deputy Dawg, Jinx the Cat, Pixie and Dixie. Sometimes this show is in color. If you open your eyes, the cartoon characters will go away.

As you look up at the cartoons, isn't it funny, you can't open your eyes because you want to see the cartoon show." As I begin the dental work, an occasional suggestion of the entrance of some new cartoon character or some action is usually sufficient to keep the child in the hypnotic state.

If the child is having difficulty keeping his mouth open wide enough for me to work, I give him this suggestion: "The wider you open your mouth, the better you can see Deputy Dawg." In some rare cases, children say they were not able to see the cartoon characters. However, they were trying so hard to see what was being described that the results were as good as if they had seen the cartoons vividly.

Another interesting method of induction for this age group is the eye fixation on an egg timer. Tell the young patient that the sand in the glass came from the bag of (p 96) sand the Sandman carries. If he watches the sand closely, it may make him sleepy, very sleepy. When all the sand has trickled through to the bottom of the glass, his eyes will close and he will be fast asleep. However, tell him he will be able to hear everything you say. Continue to talk to him in a lulling voice about what a good boy he is. Tell him that he is a champion and that you are going to make his teeth well. Tell him how proud you are and how proud his mother is because he is being such a good boy and is helping. Tell him that holding his mouth open will make him more and more comfortable. N ow, you will be able to proceed with the necessary dental work.

For the child from nine to twelve years of age, almost any technique will suffice. This one, however, seems to work quite well. The child is seated in the dental chair. He is told to make himself as comfortable as possible. His hands are placed in his lap with the palms down. A face has previously been drawn on the thumb of his right hand. He is told to fix his gaze on this face and not take his eyes away from it. The dentist places his hand over the child's hand being careful not to cover the face on the thumb. The dentist exerts pressure against the child's hand, at the same time giving the suggestion that his hand is getting heavier and heavier. The pressure is gradually lifted. As the pressure slackens, the patient is told that his hand will feel light and airy and will float gently upward into the air, toward his face. He will watch the face on the thumb as it comes closer and closer to his face. When his hand touches his face, his eyes will close, and he will go deeply to sleep. Be sure to tell him that he will be able to hear everything that is said. Tell him that, as his eyes close, his hand will descend slowly into his lap and he will relax all over and become as soft and limber as a rag doll. Now , he may be instructed to count silently backward from one hundred to one. He is to lift the index finger of his right hand when he reaches one. If the dental work has not been completed by the time the patient has finished the counting, have him repeat the counting as often as necessary. (p 97) Instead of having the patient count backward, he may be told to watch his favorite TV program, or even to relive a movie he has seen recently.

For the older children, those over twelve, the adult techniques may be used. Many of the authorities are of the opinion that, although children are very easily induced, they do not as a rule go very deep into trance. For this reason, it is advisable to use a small amount of chemical anesthetic, if sensitive teeth are to be prepared for filling. This is especially true at the first induction.

Here is one suggestion about fees for children's dentistry which may prove helpful to you. I usually tell the parents, "I don't charge any more for children's work than for adults' work." This usually startles the parents because most of them think that restoration of deciduous teeth, which eventually will be lost, should not cost so much as restorations for adults. My experience has been that work with children takes as long or longer than similar work for adults. Therefore, fees should be at least as high, or even higher, than for adults.

Making elaborate records about the hypnosis used is not necessary. However, an "H" on the record could indicate that hypnosis was used with the patient. "L," "M," or "D" could record the depth of trance for the patient.

Words like "woods," "television," "beach," or "movie" when written on the patients chart may be helpful to the dentist in remembering what technique was used. This is especially helpful if the child will not have another appointment for four or six months. Noting any special hobby or interest of the child is also advisable. These bits of information help to re-establish interpersonal relationships quickly.

In treating the child under hypnosis, in gaining his cooperation for dental work, in breaking bad dental habits in all these, the child must be taught to respect himself. This includes body, mind,, and his capacity to behave and to cooperate with the dentist for his own welfare. (p 98)

The most effective technique in hypnosis for children is to speak simply and earnestly to the child in order to fixate his attention. By using words the child can understand, we are able to induce a light to medium trance which is sufficient for dental purposes.

Children are usually more amenable to hypnosis than adults, although we can not expect a very wide range of hypnotic phenomena. The very young child has not lived long enough to have had much experience. Almost any technique that can be used for adults can be used for children, if we use simple words and keep the suggestions within the realm of their experience. (p 99)

E. The Gagging Problem: This technique is the one taught by Dr. Bryan. It rarely fails.

The difference between the gagging reflex and the gagging problem should be explained. There is no attempt to remove the gag reflex. The gagging problem is the symptom to be removed.

This is Dr. Bryan's technique. The patient is handed a tongue depressor or mouth mirror. The doctor says, "Please demonstrate your gagging problem for me," stepping back to emphasize the patient's problem. After the demonstration, the doctor says, "My, you do have a problem, don't you ? Let's get rid of this gagging problem for (p 103) you. With your help and cooperation we can do it. Do just as I tell you. Take three very deep breaths, hold each one as long as you possibly can, then let it all the way out.

Now, one-all the way in. Hold it! Now, all the way out! Two-all the way in. Hold it! Now, all the way out! Three -all the way in. Hold it! Now , all the way out !" N ow the doctor steps closer to the patient to indirectly express his confidence, hands him the tongue depressor or mouth mirror, and asks, "How are you now ?" After checking for himself, the patient will usually answer, "It's better, but it is still there." "That's right," is the doctor's comment. "But you are much improved, aren't you ?" The patient will nod agreement. "However, you did not breathe deeply enough! Now, let's do it again and really breathe deeply this time." This last comment produces a guilty feeling in the patient, implying that it was his fault the problem was not resolved.

The same technique is repeated. The doctor now steps close to the patient, hands him the tongue depressor or mouth mirror, and says emphatically and forcefully, "Now you won't gag !" The patient makes the test with the mouth mirror and finds he does not gag.

The doctor asks, "Would you allow me to put your problem back, if I remove it again permanently?" The patient will usually consent to this, because it appeals to his sporting blood.

The doctor instructs the patient, "One, take a deep breath. Hold it! Now , let it all the way out. Two, take a deep breath. Hold it! Now , let it all the way out. Three, take another deep breath. Hold it! Now , let it all the way out." The tongue depressor or mouth mirror is again handed to the patient. After checking, he finds that the problem is back but is not so bad as it was originally.

The patient is now told that his gagging problem will be removed permanently. He is hypnotized and this can be done very quickly as the patient is well conditioned by this time. The doctor says, "Now, this time, I want you to (p 104) breathe deeper than you have ever done before in your life. One-all the way in! Hold it. Now, all the way out !

Two-all the way in! Hold it. Now , all the way out! Three -all the way in! Hold it. Now , all the way out! Your gagging problem is now gone forever !" The last statement is repeated forcefully three times. Then the usual awakening procedure is followed. The point of the last part of this technique is to show that, if any symptom can be manipulated, it can be removed. (p 105)

F. History of Hypnosis: Dr. Bryan, in his recent book entitled Religious Aspects of Hypnosis, advances the theory that Jesus, too, healed by hypnosis. It is interesting to note that the value of prestige in inducing the hypnotic trance is illustrated by the fact that even Jesus could perform no miracles in Nazareth, his own home town.

Among the Romans, Esculapius often threw his patients into a deep sleep and allayed pain by stroking with his hands.

Hippocrates, Father of Medicine, said, "The affections suffered by the body, the soul sees quite well with shut eyes." In the tenth century, Avicenna, a great physician of his day, said, "Imagination of man could fascinate and modify a man's body, either making him ill or restoring him to health." (p 112)

The high number of psycho-neurotics or men suffering from battle fatigue produced by World War I, gave a great impetus to the use of hypnosis. Up to that time, there was only one successful approach to the treatment of battle fatigue. That was the psycho-analytical approach founded by Freud. This method takes from three to five years. Since there were only three hundred trained psychiatrists to do the work that would require from five to ten thousand, hypnosis was called in to speed up the process. Dr. Bryan reports the cure of one girl in eighteen days by hypno-analysis. The average time for cure by hypnoanalysis is ten to twelve weeks. The use of hypno-analysis results in a truly miraculous saving of time and money. (P 118)