172 REVIEW

Nicola Allison
DOI: 10.1308/rcsfdj.2015.172

Hypnosis in modern dentistry:

Challenging misconceptions
by Nicola Allison

The world of hypnotism carries with it many

misconceptions. The term ‘hypnosis’ is often associated
with magician types, swinging pendulums, deep sleeps
and stage performance. Many are unaware that the art
of hypnosis carries great therapeutic benefits in the
medical, psychological and dental fields. This review
provides an insight into the history and development
of hypnosis as a therapy, and explores its applications
in support of hypnotherapy as a powerful tool in the
modern dentist’s armamentarium.

Author: Nicola Allison

E: nicolaallison@live.co.uk

Keywords: Hypnosis, Sedation, Anaesthetic

FACULTY DENTAL JOURNAL October 2015 • Volume 6 • Issue 4


‘Hypnosis’ originated from the Greek word ‘hypnos’
meaning sleep. Interestingly, it’s implication as a sleep
state is another major misconception. It is agreed that
hypnosis is a modified state of consciousness that is nei-
ther wakefulness nor sleep but somewhere in between,
with a high degree of susceptibility to outside influ-
ence.1, 2 Hypnosis is characterised by an increased atten-
tion to suggestion; however,, the subject has profound
concentration even in the deeper hypnotic states and is
fully capable of making their own decisions at all times.3
The experience has been explained as an interaction
between the hypnotist and their subject, in which the
hypnotist uses suggested scenarios to encourage a shift
in focus towards inner experiences to influence percep-
tion, feelings, thinking and behaviour.4,5 Hypnosis is
now believed to be not something a hypnotist does to a
subject but is used autonomously.4 In a hypnotic state,
the conscious mind is suppressed and the subconscious
is released, allowing involuntary and effortless re-
sponses. Abdeshahi et al suggest that hypnosis enhances
control over stress, pain, muscle tension, perception,
memories, emotions and feelings.1 Within dentistry,
the term ‘hypnosis’ encompasses a wide variety of
techniques, ranging from use of ‘hypnotic language’ to
create a positive environment and distraction, to deep
hypnotic trances to achieve more profound results, such
as surgical analgesia.
Hypnosis for promoting healing or positive develop-
ment is called ‘hypnotherapy’, which aims to reprogram
patterns of behaviour to overcome fears, suppressed
emotions and negative thoughts.6 The physical effects
include a decreased pulse and metabolic rate, and
a feeling of heaviness/lightness in the limbs, along-
side vasodilation, vasoconstriction, pain perception
modification, paralysis and unconscious movements.4
The effects depend on the level of hypnosis and the
hypnotist’s suggestions; hypnotists can induce ‘light’
and ‘deep’ hypnotic trances. It is important to stress,
however, that, even in the deepest levels of hypnosis,
patients can still open their eyes, talk, walk and carry
out tasks as normal.
History of hypnosis
The history of hypnosis is long and complicated. There
is evidence that hypnosis has been practiced, under
various labels, for centuries. Egyptian soothsayers, tribal
medicine men, witch doctors, Greek oracles, Indian yogi
and Hindu Fakirs all practiced different forms of hypno-
tism to heal the sick.3, 4 However, the history of modern
hypnosis is thought to begin with the Austrian physicist,
Franz Anton Mesmer (1734–1815),7 who practised
‘animal magnetism’ during the late 18th century.
Mesmer would treat crowds of people by connecting
them with cords and ‘magnetising’ the subjects as he
touched them with a glass pole, inducing a ‘crisis’,
involving convulsions, hysteria, laughing and crying.3,7
The phenomenon became known as mesmerism and,
as a result, Mesmer developed a large following until
he was exposed by a commission in 1784 stating that
the cures were due to the imagination, not magnetism.3
REVIEW 173
by the turn of
the 20th century,
hypnotic suggestion
became regarded
by many dentists as
the primary mode of
patient management
and control
There is nevertheless no doubting Mesmer’s importance
in the establishment of hypnosis as a therapy. The title
of ‘father of modern hypnotism’, however, belongs to
the physicist Dr James Braid, who coined the term ‘hyp-
nosis’. In his books, Neurohypnology and On hypnosis,
published in 1843 and 1860, respectively, Dr Braid
introduced concepts of suggestions and monoideism
(focused attention on a single idea). He recognised that
the subject cannot act beyond his/her will, and em-
phasised the operator/patient relationship.4 Although
slowly accepted, hypnosis emerged as a science by 1884
with the publication of De La Suggestion by Hyppolyte
Bernheim,7 who, together with Ambroise-Auguste
Liébeault, developed Braid’s theories and opened the
first academic treatment centre to use hypnosis to treat
patients, the Nancy Medical Faculty, where they treated
over 1200 0 patients.1, 3
History of hypnodontia
Hypnodontia is the use of hypnosis in dentistry, which
was first documented in 1829 to facilitate a dental
extraction.1 By the turn of the 20th century, hypnotic
suggestion became regarded by many dentists as the
primary mode of patient management and control.8 Its
relationship with inhalation analgesia began with street
‘professors’, who used to entertain crowds with hypnotic
induction and lectures on the wonders of chemistry;
they would end a show by demonstrating the effects of
nitrous oxide. One night in 1844, a performance was
watched by the dentist Horace Wells, who observed a
volunteer stumbling around and badly bruising himself
after he inhaled nitrous oxide. Afterwards, Mr Wells
questioned the volunteer, who said he felt no pain until
the gas wore off. The next day, Wells allowed a col-
FACULTY DENTAL JOURNAL October 2015 • Volume 6 • Issue 4
174 REVIEW
Nicola Allison
league to extract one of his own teeth under inhalation
anaesthesia with nitrous oxide, later proclaiming it as
“the greatest discovery ever made!”.3
Interest and study in hypnosis increased further during
the 1st and 2nd World Wars. With few or no dental
facilities, medicines were not readily available and, with
abundance of maxillofacial trauma, it was commonplace
to apply hypnosis for anaesthesia.
Hypnosis today
Within dentistry, hypnosis has both therapeutic and op-
erative uses. Therapeutically, uses include dental phobia
and anxiety, extensive gag reflex, trigeminal neuralgia
pain, benign chronic orofacial pain, temporomandibu-
lar joint dysfunction, adaption to dentures, behaviour
modification, such as thumb sucking/bruxism, and
as an adjunct to inhalation sedation. Operative uses
include analgesia during surgery, control of haemor-
rhage/salivary flow and analgesia/faster postoperative
recovery.1,4,10 In all cases, hypnosis; transforms mental
states and improves cognition, changes pain percep-
tion, manages stress; and modulates neurovegetative
reactions (heat rate, blood pressure changes, gag
reflex, etc.).4
Some authors have described light and deep hypnosis,
which can have different applications.3 Deep hypnosis
takes time to achieve and would not be suitable for rou-
tine dental practice; however, it is required for analgesia
and to modify behaviours. Reaching a ‘light’ state is
easier and quicker to achieve, and is more commonly
used in hypnodontia on a day-to-day basis; for example,
to relax an anxious patient.
The dental profession is well-suited to clinical hypnosis.
Fross stated in 1966: “All dentists have been using a
form of hypnosis for years. It is known as ‘chairside
manner’, they use it to calm fears and apprehensions”.8,
11 This suggests that hypnosis does not have to be a
trance-state; simply focusing your patients attention and
suggesting a calm and pleasant environment can be a
considered a form of hypnosis. ‘Hypnotic language’, by
putting a positive spin on depressive language, can be
used to create a relaxed environment.2
Dental fear and anxiety
Controlling fear and anxiety is one of the largest uses
of clinical hypnosis, which is strongly associated with
dentistry. Competency in both pharmacological and
behavioural techniques for anxiety management has be-
come an essential skill for the modern dentist.4 One in
seven people are highly anxious about dental treatment,
which has been linked with irregular attendance.12,13
Anxiety predicts the experience of pain and correlates
with postoperative recovery; if psychotherapeutic
interventions can reduce preoperative anxiety, patients
feel less postoperative pain.14 Light hypnosis is sufficient
to relax the patient and influence the frightened dental
patient whose pain threshold has been lowered by nega-
tive emotions, which is said to be effective in up to 80%
of the population. Control of a prominent gag reflex,
FACULTY DENTAL JOURNAL October 2015 • Volume 6 • Issue 4
which can be regarded as a sort of panic attack due to
high dental anxiety follows similar logic,1 Simple light
hypnosis can also achieve short-term effects. A patient
that suffers from persistent gagging during denture
wearing requires a more intensive approach, which is
also applicable to behavioural modification applica-
tions such as thumb sucking and bruxism, or for oral
hygiene habits.1,5
Paediatric dentistry
Hypnotic suggestion is used regularly when managing
the paediatric patient, with techniques such as distrac-
tion, reframing and imagery suggestions considered
forms of hypnosis.13 Hypnotic techniques can be
particularly effective for the paediatric or anxious
patient in conjunction with inhalation sedation.
Pharmacological sedation is a temporary respite for a
single procedure; hypnosis can achieve both excellent
physiological sedation and treatment of anxiety and
phobias, and reductions in sedative and analgesic doses.
Hypnosis is particularly effective in children ages 8–12
years, although as young as children 4 years of age can
be responsive.5
Analgesia
Hypnosis use for analgesia has been largely superseded
by pharmaceutical sedation and general anaesthet-
ics; however, hypnosis plus local anaesthesia delivers
effective sedation, improving patient wellbeing and
allowing full autonomy and immediate postoperative
discharge without the need for recovery.1 When using
hypnosis for analgesia, the patient must reach deep
hypnosis, which takes time, and have an environment
free from distractions and interruptions. 5 In a study of
hypnosis for extracting third molars, ‘hypnotic-focused
analgesia’ increased pain thresholds by up to 220%,
with patients able to undergo surgery with hypnosis as
the sole anaesthesia. Even if patients can reach only
partial hypnotic-focused analgesia, they are better able
to tolerate local anaesthesia.1 The study also investi-
gated the effect of hypnosis on postoperative recovery,
reporting that 93% of hypnosis patients had a decrease
in postoperative pain and haemorrhage. Hypnosis in
conjunction with pharmaceutical sedation or anaesthe-
sia improves patient safety by reducing the cardiovascu-
lar effects of dental treatment and the required dose of
sedative drugs.1
Patient management
In every hypnosis session, it is important that the hyp-
notherapist obtains consent and lowers patient expecta-
tions, which is critical to its success. The hypnotherapist
begins with simple induction exercises and makes it
clear that the patient can emerge from the hypnotic
state at any time. At the end of a session, the hypnotic
state must be reversed.
A number of studies have compared hypnosis with
inhalation sedation.4 A relevant advantage of hypnosis is
the capability of reaching full relaxation, deep sedation
and, sometimes, amnesia, while maintaining patient
collaboration.4 Hypnotic induction can take as little as

1–3 minutes in expert hands, with the patient guided
towards focusing on a single idea and excluding other
stimuli. A disadvantage is the environmental needs;
even room temperature can have an impact on induc-
tion.1 The dangers of hypnosis are negligible when
employed by a trained professional within the context
of a structured therapeutic programme; it is consid-
ered the safest of the psychotherapies, with no studies
reporting adverse effects.3-5 In a qualitative study
exploring general dental practitioner attitudes towards
hypnosis,14 the majority stated that they would not use
hypnotic techniques due to time constraints, lack of
confidence with the techniques and feeling stressed
while treating anxious patients. Conditioning patients
to hypnosis can indeed be time consuming; however,
this time is regained at subsequent appointments, when
induction is faster and efficient; more so than with
intravenous sedation.4
Limitations
A limitation of hypnosis is that not everyone can be hyp-
notised. ‘Suggestibility’ describes the susceptibility of an
individual to hypnosis, and was defined by Peretz et al
as the degree to which an individual is inclined toward
the uncritical acceptance of ideas and propositions.13
Evaluation of susceptibility is based on chronological
and mental age, emotional stability and social environ-
ment.14 Some studies have reported that everyone
has some degree of susceptibility; no less than 80%
of the population is hypnotisable.1 Intelligent, highly
motivated individuals are good hypnotic subjects due to
their ability to concentrate; in addition, exhibitionists
are easy to induce. Patients with lower IQ who find it dif-
ficult to focus, those at the extremes of age and scientifi-
cally minded persons are harder to hypnotise.3 There
are, of course, some contraindications to hypnotism,
primarily those with psychopathologies: they are more
prone to the dissociative effects of hypnotic suggestion,
and induction may complicate and worsen their mental
state. Other contraindications include drugs/alcohol
and uncooperative or cynical patients.
Conclusion
Hypnosis is an underused, yet powerful, benign tool in
dentistry, it provides effective sedation, while leaving the
patient in full control. Hypnosis has many uses within
the dental field, ranging from simple relaxation of the
anxious patient to complete analgesia for surgery. Used
alone or in conjunction with sedation, it is a unique
management option for many patients struggling with
current anaesthetic and sedation methods. With proper
training and appropriate patient selection, it can add
value to a professional’s practice and skill set. The
current lack of use of hypnosis in general dentistry may
be down to a lack of knowledge of the therapy and its
applications. Widespread promotion of clinical hypno-
sis, emphasising its benefits and ease of use, alongside
exploring the various types of hypnosis and introducing
light hypnosis techniques to relax patients, may encour-
age practitioners to use it for other applications. The
key to hypnodontics is to increase dentists’ knowledge
and promote courses in clinical hypnosis. In an era
REVIEW 175
where dentistry is centred around both patient manage-
ment and surgery, the key is to increase confidence with
additional behavioural management skills, of which
hypnosis is an excellent example.
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