International Handbook of Clinical Hypnosis - E-Lib FK UWKS

HYPNOSIS IN DENTISTRY 295
appearance be elicited, and an appeal is made to the child's desire to be more
mature and attractive.
If there is an underlying traumatic or symbolic basis for the thumb sucking, it
can usually be clari®ed by an interview under hypnosis, utilizing either the
fantasized theater technique or using age regression to the time when thumb
sucking would ordinarily have been given up as an outworn habit. If such dynamics
are uncovered, their working through must become a primary goal of treatment.
Under hypnosis, the child is told that the thumb will begin to taste bitter and that
this will act as a reminder that the wish to suck the thumb is gone. The child is told
that should the thumb come to the mouth, the bitter taste will be the motive to move
the thumb away. Any improvement is given immediate and ample praise, both to
the child and the parents, as the symptom has usually become a focus of hostile
interaction between parents and child. Self-hypnosis is quite often taught in the
control of this problem.
Another favorite approach is based on Milton H. Erickson's `Be Fair to
Fingers'. The statement is made that the right thumb is entitled to the same
attention as the left thumb. The result is that as both thumbs are sucked, sucking
the left thumb is cut by about 50%. The habit is naturally reduced. `The right
thumb hasn't had a turn; the ®rst ®nger hasn't had a turn; not a single other ®nger
has had a turn. So now, be fair and give each of the ®ngers a proper turn'
Erickson, 1990).
After the child has been given these suggestions, the parent is called in and
instructed to help remind the child to suck all the ®ngers. Parents and children are
usually pleased with this approach because it shifts all the energy from what not to
do, to a positive attention-getter that gets old quickly. Results are very favorable.
EXAGGERATED GAGGING
The normal physiological gag re¯ex holds an important place in dentistry because
it prevents potential life-threatening obstructions of the gastro-intestinal tract by
foreign objects and alerts the dentist that undesired material has slipped into the
pharynx area. However, a phenomenon termed the excessive or exaggerated gag
re¯ex, a hypersensitive response to most foreign oral stimulation, may be found in
some patients. Exaggerated gagging can successfully prevent the dentist from
examining or operating on the patient. The tendency to lurch forward while
retching poses a danger to the patient and liability to the dentist if sharp dental
instruments are positioned within the oral cavity. Other than being a dental
nuisance, however, the exaggerated gag re¯ex rarely poses any other threat to the
patient. Most patients who claim to be unable to place foreign appliances into their
mouth, or even to perform routine dental procedures, such as tooth brushing, ®nd
no dif®culty in managing solid foods.
One of the following three factors probably contributes to an exaggerated gag
re¯ex in a patient. First is the belief on the part of the patient that for ef®cient