Dental Phobia

What is 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 idea 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 routinely 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 percent of Americans (about 30 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 percent of those who don’t see a dentist regularly cite fear as 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 objectively morbid 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 periodontal 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 may be 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 anesthetic 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.

I have Dental Phobia is Sedation the Answer?

Anxiety & Phobia Causes

There are many reasons why some people develop dental anxieties and phobias. A few common themes emerge.

Pain. In a survey of people who had not seen a dentist for 12 months, 6 percent 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 predated many of the advances in “pain-free” dentistry.

Feelings of helplessness and loss of control. Many people develop phobias about situations — like 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 dentist’s face may be just a few inches away — often makes 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, as is someone who has been told how painful dental procedures are.

If a bad experience in the past made you afraid of seeing your dentist, sedation may help you get the treatment you need.
Pain is among the main reasons people go to the dentist. It’s also what keeps them away: Some 35 million Americans are so afraid of pain that they won’t go anywhere near a dentist’s chair until a toothache gives them no other choice.

"I was probably 10 or 11 years old when I had a tooth pulled and it was excruciating," recalls Jim, 56, an account executive "After that, I never went to a dentist unless I was in pain."

It took Jim more than four decades — and a push from his daughter, who wanted to see him smiling in her wedding photos — to get some long-needed dental work done. Most people don’t wait that long to have cavities filled or their teeth repaired, but the anxiety they experience is no less severe. More and more dentists have begun offering some form of sedation to make the experience a little easier.

Less Pain and Stress People who have had painful experiences in the past will understandably be dubious when they’re told that most dental procedures today are nearly pain-free. A shot or two of novocaine will make your jaw or teeth numb, but there’s no getting around the fact that it’s an uncomfortable experience. And the more apprehensive people feel, the more uncomfortable the procedure is likely to be.

Sedation can make a difference. Apart from the fact that sedating drugs have some analgesic (pain-killing) effects, they also reduce fear and anxiety. It’s an option for people who are too afraid to go to the dentist any other way.

Types of Sedation

Getting sedated doesn’t necessarily mean that you’ll be "out" for the duration of the procedure. This is certainly an option, but most dentists prefer “conscious sedation,” in which patients are awake, but relaxed or drowsy.

Conscious Sedation

Some people have no anxiety undergoing treatment. Others find it difficult to even enter the dentist’s office. If you are nervous or fearful about dental treatment, sedation can help relax you, making your experience easier and more pleasant.

Although your dentist may explain the procedures to you and ask if you have questions, he or she may not perceive or understand your fears. Also, if your dentist doesn’t know you are anxious, he or she may not suggest sedation as an option. Talk to your dentist about your anxiety. That may be enough to relax you. If not, there are many anti-anxiety drugs that can be used during dental treatment. Your dentist can even give you one before your appointment, to use if you have trouble sleeping the night before. If you are given an antianxiety drug to take the night before, you should arrange to be driven to and from the office. Also, avoid alcohol and over-the-counter sleep aids, because they can react with sedating medications.

Nitrous oxide is a common inhaled anti-anxiety drug given just before treatment starts. Diazepam (given in pill form) and other similar drugs can be given 30 minutes to an hour before treatment or the preceding night. Diazepam and other oral sedatives do not provide pain relief. You also will receive a local anesthetic injection. Children often receive antihistamine-type sedatives (such as hydroxyzine), which can cause significant dry mouth.

Symptoms of Dental Phobia

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 shouldn’t 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.

Depending on the doses and types of sedatives used, different levels of sedation are achieved. Dr Perry might consider deeper levels of sedation for complex procedures or if you are more anxious.

Anxiolysis. Very light sedation, usually induced by nitrous oxide. It provides a feeling of having no worries.

Conscious sedation. Medium sedation induced by nitrous oxide or intravenous drugs. Your gag reflexes still work and you can respond to commands.

Deep sedation. You are somewhere between conscious and unconscious, but closer to unconscious. You experience a partial loss of your gag reflex and you cannot respond consistently to stimulation or commands. You may also be unable to keep your airway open for breathing independently under deep sedation.

General anesthesia. You are unconscious and cannot keep your airway open for breathing or respond to commands or stimuli. Usually, an endotrachial tube will be used to assist with breathing.

If you will be receiving nitrous oxide, eat lightly before and after your appointment. After your dental procedure is over, you will receive oxygen for several minutes to clear the nitrous oxide from your system. If your dentist just takes off the mask without giving you oxygen, you can experience headache or other side effects. These are rare, however, with the 25 to 40 percent concentration of nitrous oxide typically used by dentists.

If you are taking medication for psychiatric conditions, talk to your dentist before receiving any sedative.