What Is Dental Anxiety and Phobia?
Treatments and Coping Methods

Causes Of Dental Anxiety And Phobia

Some people don't look forward to dental appointments any more than they look forward to visits to a physician. Most dental procedures aren't painful, but just being examined can make people feel stressed.

Some anxiety about going to the dentist can be considered acceptable. For those with dental phobia, however, the thought of going to the dentist is terrifying. They may be so frightened, in fact, that they'll do just about anything to avoid a dental appointment.

A phobia is an intense, unreasonable fear of a specific activity, object or situation. People with dental phobia often put off routine care for years or even decades. Rather than make an appointment, they'll put up with gum infections (periodontal disease), pain or even broken and unsightly teeth.

Dental anxiety and phobia are extremely common. It has been estimated that 9% to 15% of Americans — about 30 million to 40 million people — avoid seeing the dentist because of anxiety and fear. A survey commissioned by the British Dental Health Foundation found that 36% of those who don't see a dentist regularly say that fear is the main reason.

People often use the words " anxiety" and " phobia" interchangeably, but they aren't the same thing.

Those with dental anxiety will have a sense of uneasiness when it's time for their appointments. They'll have exaggerated or unfounded worries or fears. Dental phobia is a more serious condition. It's characterized by highly instense fear or dread. People with dental phobia aren't merely anxious, but terrified or panic stricken.

People with dental phobia have a higher risk of gum disease and premature tooth loss. Apart from the physical consequences of avoiding the dentist, there may be emotional costs as well. Discolored or damaged teeth can make people self-conscious and insecure. They may smile less or keep their mouths partly closed when they speak. Some people can become so embarrassed about the cosmetic qualities of their teeth that their personal and professional lives begin to suffer. There is often a serious loss of self-esteem.

There are varying degrees of dental anxiety and phobia. At the extreme, a person with dental phobia may never see a dentist. Others may force themselves to go, but they may not sleep the night before. It's not uncommon for people to feel sick — or, in some cases, to actually get sick — while they're in the waiting room.

Dental phobia, like other mental disorders, can be treated. Without treatment, dental phobia is likely to get worse over time, in part because emotional stress can make dental visits more uncomfortable than they need to be. People who are unusually tense tend to have a lower pain threshold, which means they may experience pain at lower levels than other people. They may need additional anesthetics or other pain treatments. They may even develop stress-related problems in other parts of the body, such as headaches or muscle stiffness in the neck or back.


Causes Of Dental Anxiety And Phobia

There are many reasons why some people develop dental anxieties and phobias. When researchers interview patients, however, a few common themes emerge.

Pain — In a survey of people who had not seen a dentist for 12 months, 6% reported fear of pain as the main reason. The fear of pain is most common in adults 24 years and older, probably because their early dental experiences happened before many of the advances in " pain-free" dentistry.

Feelings of helplessness and loss of control — Many people develop phobias about situations — such as flying in an airplane — in which they feel they have no control. When they're in the dental chair, they have to stay still. They may feel they can't see what's going on or predict what's going to hurt. It's common for people to feel helplessness and a loss of control.

Embarrassment — The mouth is an intimate part of the body. People may feel ashamed or embarrassed to have a stranger looking inside, especially if they're self-conscious about the appearance of their teeth. Also, the physical closeness that occurs during dental treatments — the hygienist's or dentist's face may be just a few inches away — can make people anxious and uncomfortable.

Negative past experiences — Anyone who has had pain or discomfort during previous dental procedures is likely to be more anxious the next time around.


Symptoms

There isn't a clear boundary that separates " normal" anxiety from phobia. Everyone experiences various fears and concerns and copes with them in different ways. However, the prospect of dental work does not need to fill you with terror. If it does, then you may need some help overcoming the fears.

Some of the signs of dental phobia include:

• You feel tense or have trouble sleeping the night before a dental exam.
• You get increasingly nervous while you're in the waiting room.
• You feel like crying when you think of going to the dentist. The sight of dental instruments — or of white-coated personnel in the dentist's office — increases your anxiety.
• The thought of a dental visit makes you feel physically ill.
• You panic when objects are placed in your mouth during a dental appointment or you suddenly find it difficult to breathe.

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Treatments and Coping Methods

Communicating With Your Dentist

This is the key to beating dental distress. Modern dentistry can be almost painless, so it's worth taking the time to discuss your fears — and the potential treatment options — with your dentist.

Participating in decisions about your treatment can give you a feeling of control that can help you to feel less anxious. Your dentist should discuss all the procedures you may need and ask whether you prefer to have several done at one time or have a series of shorter appointments. Ask your dentist to describe the types of pain control available and decide which you feel will work best for you.

To help lower your anxiety during the appointment, ask your dentist to explain what's happening at every stage of the procedure. When you know what the dentist is about to do next, you can prepare yourself and you won't be taken by surprise.

On the other hand, some people may feel less anxious if they don't know what's happening. If this is true for you, explain this to your dentist. He or she should be willing to accommodate your wishes whenever possible.

Another helpful technique is to agree on a hand signal, such as raising your hand, which means you'd like everything to stop right away. This will give you a sense of control and can help to lessen your anxiety. You don't have to wait until you're experiencing pain to give the signal. You may ask the dentist to stop because you'd like to rinse your mouth or simply catch your breath, or just take a break for a few seconds.

You may feel embarrassed to discuss your fears. Remember that you are not alone. Fears are not uncommon. Once your dentist knows what the issues are, he or she will be better able to find workable solutions.

Distraction

One way to reduce stress during a dental appointment is to distract yourself with something more pleasant. Some dentists provide headphones (or you can bring your own) so you can listen to music. An increasing number of dentists use virtual-reality goggles, which provide lifelike images and sounds. This can be a welcome distraction while your dentist is treating you.

Pain Control

Research has shown that fear of pain is the main reason people avoid seeing the dentist. Even those who schedule regular dental appointments cite fear of pain as being a significant issue.

In recent years, dentists have developed a wide variety of medications and techniques that can reduce or eliminate pain during most procedures. These include:

• Topical anesthetics — Applied with a Q-tip, topical anesthetics are used routinely to numb an area of the mouth or gum prior to the injection of a local anesthetic.
• Laser drills — Recently approved by the U.S. Food and Drug Administration (FDA), laser drills may cause far less pain than conventional mechanical models. They can be used to prepare some cavities for fillings.
• Electronic anesthesia — This may be used as an alternative to uncomfortable injections of local anesthetic. The dentist puts electrodes on the cheeks, which transmit a numbing electrical current into the jaw. Some patients report that electronic anesthesia is more effective than medications.
• Cranial electrotherapy stimulation — This is another form of electronic anesthesia. Electricity passes into the brain and causes feelings of relaxation and " heaviness." The patient controls the intensity of the current, and can increase or decrease it as needed to control pain.
• Nitrous oxide (laughing gas) — This is one of the most common forms of in-office pain control. The gas helps people feel relaxed or even euphoric, and the effects wear off quickly once the gas is turned off. Nitrous oxide generally is used as a supplement to other drugs, not as a replacement.
• Electronic anesthesia delivery systems — Many people dread the shot of anesthetic that precedes many dental procedures. It's not the injection itself that causes most of the pain, but the pressure of the fluid entering the body's tissues. Electronic delivery systems, which are attached to a syringe, adjust the flow of anesthetic so that it finds a route through the tissues that causes the least discomfort.
• Intravenous sedation — This technique usually is reserved for patients who are undergoing extensive dental procedures, although it can be used for those who are simply too anxious to have dental treatment done otherwise. A tranquilizer is injected into a vein in the hand or arm. The patient will be awake, but deeply relaxed.
• General anesthesia — This involves putting the patient to " sleep" for the duration of the procedure. Some dentists have the equipment and staff to perform general anesthesia in the office, but it's often done in a hospital setting. Because of the risks of side effects, including drops in blood pressure or heartbeat irregularities (arrhythmias), general anesthesia should be only used when other forms of sedation or pain control aren't enough.

Relaxation Techniques

When you're tense or upset, your body releases " stress chemicals," such as adrenaline. These chemicals cause a variety of physical responses. Your muscles tighten, you breathe faster, and the pain receptors in your brain become more sensitive. These reactions themselves can make you feel more fearful and anxious.

Studies have shown that relaxation techniques can help reduce levels of stress hormones as well as pain and anxiety. People who practice these techniques often discover that their " fear responses" diminish over time.

There are many types of relaxation techniques. Some of the most effective include:

• Guided imagery — This is a simple mental technique in which a health care professional helps you imagine having a pleasant experience or being in a soothing environment. The idea is to create as much mental detail as you possibly can. You may find that you become so involved in the mental images that you're hardly aware of what the dentist is doing.
• Deep breathing — Also called diaphragmatic breathing, this technique involves breathing slowly and deeply. It floods the body with oxygen and other chemicals that relax the central nervous system and help reduce discomfort.
• Progressive relaxation — With this technique, you consciously try to relax each muscle in the body, starting with the toes and moving all the way up to the head (or vice versa). Progressive relaxation reduces muscular tension, which can help to reduce pain.
• Relaxation techniques are easy to learn, although you have to practice in order for them to be effective. Many therapists and dentists incorporate these techniques in their practices and will teach you the best ways to begin.

Sedation

Unlike analgesics, which block pain, sedatives such as diazepam (Valium) relax the central nervous system and help people feel calmer and more relaxed. Dentists often avoid oral sedatives because they typically take about 30 minutes to work, and the side effects, such as drowsiness, may last for hours.

However, sedatives may be prescribed by a dentist or psychiatrist as part of an overall treatment plan.

Hypnosis

Forget the Hollywood image of someone losing consciousness while they stare at a swinging watch. Hypnosis is simply a technique that creates a profound state of relaxation. The effects of hypnosis are similar to the effects of meditation, and you may be able to practice on your own.
Many therapists practice hypnosis, and some dentists are familiar with the technique. Self-hypnosis is effective, but some people get better results when they work with a skilled practitioner. Some people with dental phobia sometimes ask their therapists to accompany them to the dentist's office until they master the techniques on their own.

Acupuncture and Acupressure

Originating in China more than 4,000 years ago, acupuncture is a form of medicine that involves inserting needles into certain locations, called acupoints, on the body. Research has shown that acupuncture may trigger the body to release pain-relieving chemicals in the body called endorphins. Western medical practitioners, who once scoffed at acupuncture and other Eastern medical techniques, are increasingly agreeing that these practices may have some value. A related technique is acupressure, in which pressure is applied to the acupoints instead of needles.

Acupuncture is becoming more common in general medicine, but for now, it's something of a rarity among dentists.

Support Groups

Most communities have support groups for people who suffer from anxiety or phobias. Support and self-help groups do more than provide emotional support. They're also a useful source of practical tips and coping skills.

You can learn about support groups in your area by calling mental health professionals or hotlines. Or use the Internet. A good place to start is with the American Self-Help Clearinghouse.

Therapy

People who neglect their dental health because they are phobic may want to see a mental health professional. Psychologists and psychiatrists often use a technique called systematic desensitization, in which patients are exposed gradually, in a controlled and careful manner, to the things they're afraid of. This is an effective treatment for many types of phobias, including dental phobia.
Other types of therapy include cognitive therapy, in which the therapist helps people develop practical strategies for overcoming dental phobia and psychotherapy, in which patients are encouraged to understand where their fears come from and make peace with difficult events in the past.

Another option is to attend a " dentophobia" clinic that specializes in helping those with severe anxiety. Many of these clinics are located in hospitals or dental schools.

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Reviewed by the Faculty Columbia University College of Dental Medicine
Provided by Aetna Dental Plans