Dental Anxiety and Phobia

Dental anxiety and phobia are disorders causing people to avoid dentists and important dental treatments. People suffering with anxiety experience increased stress and nervousness when at the dental office and are therefore reluctant to visit the dentist. Those suffering from dental phobia, a more serious condition characterized by a severe, unreasonable fear, are actually panic-stricken and would rather suffer from gum disease, tooth pain, tooth loss or unsightly teeth, than visit the dentist.

People with dental anxiety or phobia have a higher risk of gum disease and tooth loss. In addition to the monetary costs associated with avoiding necessary dental care, emotional costs of avoiding the dentist include feelings of self-consciousness, insecurity and low self-esteem. More troubling still is the fact that research shows that neglecting dental care can lead to serious health problems, such as heart disease, stroke and diabetes.

Who Suffers from Dental Anxiety and Phobia?

If you fear the dentist, you’re not alone. A survey by the American Association of Endodontists found that 80 percent of adult Americans fear dentists; more than half say this fear may keep them from seeing a dentist. Approximately 5 percent to 10 percent of adult Americans are considered dental phobics — people so terrified of dental treatment that they avoid dental care at all costs.

Women and children report more dental fear than men and the elderly. Understandably, people tend to be more afraid of invasive procedures, such as oral surgery, than they are of less invasive treatment, such as professional cleanings (prophylaxis).

What’s the Cause?

Causes of dental anxiety and/or phobia are numerous and include factors both related and unrelated to dentistry. Among them are:

• Fear of pain
• Feelings of helplessness and loss of control
• Embarrassment or shame about the look and condition of the teeth, as well as the fearful behavior itself
• Past bad experiences. This not only includes physically painful dental visits and treatments, but also psychologically uncomfortable experiences, such as being humiliated by dental professionals, family, friends or others.
• History of abuse. Dental phobia is common among sexually abused individuals, especially children. Physical or emotional abuse by an authority figure also may contribute to dental phobia, particularly when combined with bad experiences shared with dentists.
• Uncaring dental professionals. Pain inflicted by dental professionals who are perceived to be “cold” and “controlling” has a negative psychological impact, according to research.
• Observational or vicarious learning. If a parent or other caregiver is terrified of dentists, children also may learn to be scared, even in the absence of their own bad experiences. Hearing other people’s dental “horror stories,” or being exposed to negative dental images and/or information in the mass media also may trigger fears.
• Post-traumatic stress. Research suggests that people who have suffered terrible dental experiences demonstrate symptoms typically reported by individuals with post-traumatic stress disorder, which is characterized by oppressive thoughts of the negative experience and dental-related nightmares.
• Fear of needles (needle phobia), injections, drills, gagging, etc.
• Costly and/or extensive treatment
• Hopelessness that neglect or the condition has made it too late to do anything
• Adverse effects of medication or their ineffectiveness in providing relief from anxiety and pain

Strategies for Addressing Anxiety & Phobia

There are several psychological and behavioral approaches for addressing dental anxiety and/or phobia. These effective strategies include the following:

• Realize that others share your fears and are ready to help you overcome them through self-help and peer support groups, some of which are online. Professional psychological counseling and psychotherapy also are available for more serious cases.
• Identify your fears and educate yourself about realistic and unrealistic expectations, possible treatment options and what they involve, how to find the right dentist, areas of specialty, etc. Discuss your treatment with your dentist so you will know exactly what to expect. Ask for information you can read at home, and conduct research online.
• Choose a dental team with the technological-savvy, tools and skills to make you feel safe and well cared for; one that possesses the patience and expertise to reassuringly guide you through the treatment plan.
• Communicate your fears and anxieties to your dental team. Good dentist-patient communication is considered a crucial factor for relieving dental anxiety and phobia. Openly expressing your concerns will let them adapt the treatment to your needs.
• Before a dental appointment, eat high-protein foods, which produce a calming effect; avoid foods high in caffeine and sugar, which may increase jittery nerves.
• Practice relaxation techniques like deep breathing, progressive muscle relaxation, guided imagery and hypnosis.
• Control the situation as much as possible. For instance, try choosing a time for your dental appointment (perhaps a Saturday or early-morning time) when you’re less likely to feel rushed or pressured. Discuss a signal (such as a raised hand) that lets your dental team know you feel uncomfortable or need a break.
• Take advantage of in-office distraction amenities. Some dental offices offer television, music or virtual reality glasses to entertain you. Pillows, blankets and aromatherapy also help people relax. Other practices (occasionally dubbed dental spas) even offer complimentary spa-like services, such as mini massages and hand/foot treatments during procedures, and full spa treatments at additional cost after dental procedures.

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Pharmacological Techniques for Addressing Anxiety & Phobia

Along with psychological and behavioral approaches, most people with dental anxiety and/or phobia also need pharmacological methods to cope with their condition during dental appointments.

Sedation dentistry techniques, which may be mild or moderate, can alleviate fear/anxiety, but do not entirely eliminate pain. Therefore, these are frequently used in combination with local anesthetics that control regional pain.

Sedation dentistry consists of the following:

• Oral sedation involves no needles. Instead, you take a pill that helps you feel calmer and sometimes drowsy during dental treatment. You’ll remain conscious and able to communicate with and respond to the dental staff.
• Inhalation sedation involves breathing in nitrous oxide (“laughing gas”) through a mask worn on the nose; it produces conscious relaxation and dissociation.
• Intravenous (IV) sedation is administered with a needle directly into your arm or hand. IV sedation, also called “twilight sleep,” is conscious sedation. You can breathe independently and respond to verbal instructions.
• General anesthesia (GA), a deep sedation, renders you completely unconscious and free of pain (even without local anesthesia). You may not be able to breathe independently and unable to respond to verbal commands.

Oral sedation is frequently used for many anxious dental patients and works extremely well. GA and IV sedation are appropriate for people receiving long and/or complex oral surgical procedures (such as implant dentistry) and those with certain physical/mental handicaps, but are recommended for only a small percentage of highly phobic dental patients. IV, inhalation and GA sedation are considered safe and effective, but cost more and may increase cardiovascular and respiratory problems.

All medications should be administered and monitored by dental professionals such as dental anesthesiologists (“sleep dentists”) specially trained and skilled to provide the safest dental experience.