Dental Anxiety: Fear or Phobia

Being afraid of the dentist and of receiving dental care/treatment is very common, severe forms of this fear are often referred to as: dental phobia, odontophobia, dentophobia or dental anxiety. It has been noted, however, that there are many different levels of this fear, all as important as the other.

A fear or phobia of the dentist can be from something as minor as feeling slightly uncomfortable in the chair, to being so frightened that their fears may resemble those with post-traumatic stress disorder.

Fear of the dentist can be brought on by a first-hand traumatic incident in their early years or recently, this is known as a direct experience. It can also be brought on from hearing about family or friends experiences at the dentist, or being a witness to some traumatic treatment, this is known as an indirect experience.

Direct experiences:

This is the most common way that people develop a fear of the dentist. Most people report that their dental fear began after a traumatic and maybe painful dental experience. The person attaches these bad memories to the familiar sounds and sensations at the dentist, making them feel distressed and frightened of the dentist and even of the dental surgery itself. However, painful or traumatic dental experiences cannot be the sole explanation as to why people develop dental phobia.

The manner and personality of a dentist can also affect how at ease their patient is, dentists who were perceived as being “cold” or “impersonal” were found to cause fear in students, even if the experience or treatment was uneventful. Whilst other students who underwent eventful treatment, that may have included pain and discomfort did not report having developed a dental fear or phobia because their dentist was found to be “warm” and “caring”.

Indirect experiences:

These include vicarious learning, stimulus generalisation, helplessness, perceived lack of control and lastly mass media. Hearing stories of other peoples traumatic experiences or negative views of dentistry may develop a phobia of the dentist in that person, otherwise known as vicarious learning, as that person hasn’t experienced any negative or traumatic treatment directly themselves.

Stimulus generalisation occurs when a person develops a phobia of the dentist as a result of some traumatic experience in a non-dental environment. For example, a bad experience in a the hospital could make people subconsciously afraid of people in white coats and antiseptic smells, a very clear reason why a lot of dentists nowadays choose to wear different uniforms!

Research has shown that if a person feels they have no way of controlling or influencing a negative event, they experience helplessness and this perception of their lack of control leads to their fear. In the same way, it was found that if a patient feels they have some control in stopping the treatment, their fear is lessened, so a patient who knows that signalling to the dentist will stop treatment become more at ease. This fear can also result from direct experiences when a dentist did not pause treatment even though the patient may have appeared to be in obvious pain. The media, such as cartoons, have also created a negative stereotype of dentistry, which could contribute to the development of dental fear in adults and children.

People that suffer from severe dental phobia, tend to avoid going to the dentist for regular check-ups and only go and get treatment for dental emergencies, like tooth ache or a dental abscess. Those that are extremely fearful of dental care can sometimes experience a “cycle of avoidance”, which happens when they avoid dental care until they experience a dental emergency that would require extensive treatment, this then enhances their fear of the dentist because of the possibly traumatic treatment needed.

In order to help combat the anxiety of visiting the dentist, methods such as drug use, retraining the mind with hypnotherapy and only doing minimal treatment are employed. The treatments often include a combination of behavioural and pharmacological techniques. It is very common to suffer from a fear of the dentist, whether it is mild or severe, and it is important that people seek out a dentist that makes them feel comfortable. Finding a good dentist, with whom they feel comfortable, is important so that they can benefit from proper dentistry and be put at ease.

Having minimal treatments completed can often help build the trust between the patient and the dentist, this will eventually lessen the fear. Dentists use techniques like “show-tell-do”, in which the dentist explains the procedure (tell), then gives a demonstration of the sights, sounds, smells of the procedure in a non-threatening way (show), and lastly carry out the actual procedure (do.) This technique puts the patient at ease and allows them a little control and understanding in their treatment, although some dentists and patients prefer not to use this technique.

Dentists also use IB sedation “conscious sedation” to help patients that need extensive treatment; it helps them cope with the treatment and the amount of time they spend in the dentist chair. An oral sedative, such as a benzodiazepine like diazepam (Valium) is sometimes prescribed, it helps calm patients and can cause drowsiness but the patients are still conscious and able to communicate with the dental staff. Intravenous sedation uses benzodiazepines administered directly into a patients arm or hand. IV sedation allows patients to breathe on their own, but have their heart rate monitored; they are still responsive to the dentists prompts. General anaesthesia means that patients are more deeply sedated, are unable to breathe on their own and will not be responsive to verbal or physical prompts. After the treatment is finished and the patients oral health is restored, dentists then use the above techniques to encourage positive reinforcement and talk about the reasons for the phobia in order to allow the patient to be at ease and visit the dentist without needing sedation.

Hypnotherapy may be suggested to help patients, because continual use of sedation can prove to be more costly than the actual treatment required and may sometimes pose a bigger risk to the patient. Hypnotherapy is used only by certified hypnotherapists and is used to treat anxiety and phobias. This is all done by accessing a patients altered conscious state and incorporating a different way of processing information.