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Anxiety (Dental Fear and Phobia)

Clinical Overview

Are you afraid of the dentist? Feeling nervous or fearful about dental treatment is one of our most common fears and a major reason why people don’t go to the dentist. In 2000, the U.S. Surgeon General’s report called Oral Health in America confirmed this fact, finding that about one third of all adults in the United States do not regularly see a dentist for treatment, and that fear of dental treatment was a significant reason for dental neglect and poor oral health in our population. Fear is a basic human emotion and is an unpleasant feeling of perceived danger, while anxiety can be defined as a learned fear of the unknown accompanied by physical stress. A phobia is a more extreme and irrational type of fear that causes the individual to avoid the fear-inducing situation.
This year in The Journal of the American Dental Association, an article by Dr. Ray Dionne and others reported on studies done in 12 different countries that indicate about 10 percent of all dental patients have a high level of dental fear or anxiety, and about 5 percent of patients have dental phobia. This article also reported that about 18 percent of all patients in the United States would see their dentist more frequently if they could take a medication to reduce nervousness.
Although some apprehension prior to or during dental treatment is a normal human reaction, higher levels of anxiety and fear can be a barrier to getting regular dental care and maintaining good oral health. Dental phobia is a severe form of fear that can be psychologically and physically debilitating to the person suffering. Instead of communicating problems about dental anxiety or fear with their dentist, many people “white knuckle it” through their dental visits and do not ask for help in resolving the fear.
Even though the dentist and his or her staff may consider much of the treatment they provide to their patients to be routine, the psychological impression and apprehension many patients have when they visit the dentist is comparable with reactions to surgery. Dentists who excel in helping anxious patients are very aware of this situation, and deliver both compassionate and technically skilled care in order to provide patients with safe and comfortable treatment.
Fear of Pain
People perceive pain differently and have varying pain thresholds, but no one wants to experience pain during any kind of medical or dental treatment. Studies have shown that people with dental anxiety tend to expect more pain to occur during treatment than what they actually experience. This fear of pain is often the result of an especially painful or traumatic dental experience that happened in the past. For example, a person who had a painful past experience with the dental drill or an anesthetic injection (“shot”) recalls this every time they go to the dentist. Anticipation of pain can result in fear of the dentist and avoidance of routine dental care.
One problem that contributes to dental anxiety and fear is the misconception that many types of dental treatment such as root canal therapy, gum surgery and tooth extraction are very painful and/or traumatic. The media often make matters worse by portraying dental experiences as torturous on TV or in movies. The good news is that with effective anesthetic and sedation techniques and other high tech equipment, today’s dentistry is slightly uncomfortable or painless.
Unfortunately, people who have avoided dental care for years due to dental anxiety and phobia have often suffered much more pain and distress due to untreated dental disease than the pain they fear. In the past few years, thousands of dentists across the country have been trained in delivering simple, safe and effective conscious sedation to patients, using a benzodiazepine medication called Triazolam or Halcion, which is taken by mouth prior to dental treatment. Dentists are also taking continuing education courses focusing on a variety of ways to help fearful patients successfully cope with and receive dental treatment. Also, more reliable information on dental anxiety and fear is becoming available through the internet, so that people with dental anxiety can become empowered.
Most importantly, the fear of pain or the fear of anything else that might occur during dental treatment is something that patients need to talk through with their dentist BEFORE any treatment begins. The patient’s dentist needs to: 1. be able to take the time and effort to listen to the patient’s concerns and fears, 2. acknowledge that the patient is being courageous in coming to the dentist, and 3. the dentist needs to assure the patient that he is willing and able to help the patient effectively cope with concerns and fears, using a variety of methods if needed.
If the dentist is not capable of doing all the above, it is his responsibility to act in the patient’s best interest and refer to another dentist who can properly manage and treat the patient. If the patient is not comfortable with the dentist or does not feel that he is getting what he needs, it is the patient’s responsibility to talk to the dentist about the problem and work toward a solution.
Fear from a negative or traumatic past dental experience
A past negative dental experience is probably the most common cause for dental anxiety, according to a study entitled Negative Dental Experiences and their Relationship to Dental Anxiety by Dr. David Locker and colleagues at the University of Toronto. This study reported that people with dental anxiety had a past dental experience that was painful, frightening or embarrassing. The negative or traumatic past dental experience is vividly remembered and can be recalled again and again when it is time to see the dentist for treatment in the future. Since humans are “wired” with survival mechanisms like the “fight or flight” response and want to try to escape a situation involving pain or harm, it is a natural human reaction to become anxious about or want to avoid something that caused pain in the past. This is one way that dental anxiety, fear or phobia develops.
If a close friend or family member has also had a negative past dental experience, many times the friend or family’s description of the experience can become magnified or exaggerated, and sound much worse than it actually was. Even though a person may not have dental anxiety and may have not experienced a negative past dental experience, this person can develop dental anxiety through transference, where the anxiety or fear results from believing that their friend or family’s negative dental experience will or can happen to them. Studies have actually found that 92 percent of patients having root canal therapy, for example, reported less or much less discomfort than expected, and that people who personally experienced root canal therapy were four to five times more likely to describe the procedure as painless.
Fear of a loss of control or feeling of helplessness Dental anxiety and fear due to loss of control is widespread, and even ranks higher than the fear of flying. Here’s why: In the dental setting, patients have to relinquish a great deal of control, sit in the dental chair for significant periods of time (usually fully awake and flat on their back), and watch and hear a lot of things going on around them and inside their mouth, without being able to see what is actually happening.
Some people cope well with this lack of control, but others do not. Many people are used to being in control or in positions of power in their home and work life, and the dental setting can cause these kinds of people anxiety and distress. The dentist can alleviate the stress by explaining and showing what is happening during treatment, and allowing the patient to raise his or her hand to communicate discomfort or a question. Sedation or other relaxation techniques may also help.
Fear of harsh criticism or embarrassment for having poor oral health Some people with dental anxiety, fear or phobia have not seen a dentist for years and may have experienced a number of dental problems such as gum disease, breakdown of teeth due to decay, and loss of teeth. Having poor dental health often contributes to the person’s dental anxiety, because the person is embarrassed to have the dentist see their mouth in this poor condition. The patient may also fear being subject to a harsh reprimand. Some dentists did believe that patients who neglected their oral health deserved to be scolded, but the good news is that this reaction is a thing of the past. Today, dentists know that there is nothing to be gained from being hard on a patient with who has not gone to the dentist due to fears or financial problems. Dentists want to help patients who are taking a big step forward in their oral health.

Last updated: Dec-26-06

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