Dental Angst

Overcoming Dental Fear

Does the thought of going to the dentist make you nervous or scared? If so, you're not alone. Here's a frightening statistic: half the U.S. population does not seek regular dental care. Between nine and 15% of Americans avoid treatment due to anxiety surrounding the dental experience. This means 30 to 40 million people are so afraid of going to the dentist, they avoid it altogether.

Why is this a problem? Chronically infected gums and teeth eventually harm your overall health. Dental disease can hamper your speech, even your ability to chew and digest. Well before reaching this serious stage you may feel insecure about your breath and smile, self-conscious in business and social interactions. Unfortunately, staying away from the dentist allows small problems to develop into problems that require major dental treatment. But you can escape this catch-22 by overcoming dental fear.

Where Does the Fear Come From?

First, it's important to acknowledge that many people who are afraid of the dentist have traumatic experiences to back up their fears. They may recall a dentist causing them pain during treatment, or making light of their discomfort. The effect is especially profound when the incident occurred during childhood. Some dentists report patients in their 70s and 80s who still fear dental treatment due to bad experiences they had as children. Fortunately, modern dentists are sensitive to the impact they can have on patients. Many have even had training in psychology.

There are also large numbers of people whose fear of the dentist comes from vicarious learning. They may have never had a bad experience at the dentist's office, but others have told them dentistry is painful -- so they expect it. You've almost certainly heard the sarcastic expression, "I'd rather have a root canal." Dental fear is so prevalent that family, friends, and the media reinforce it. For example, several movies offer up menacing portrayals of dentists, from dark comedy Little Shop of Horrors to The Marathon Man. Dental treatment is used as shorthand for a negative experience or punishment, jokingly or otherwise. It’s no wonder so many people dread the dentist, sometimes even before their first visit.

Common Fears

As you've seen, many people fear the dentist, and their reasons vary. As with any fear, the first step towards overcoming dental anxiety or phobia is to identify what it is that makes you afraid. The three most common dental fears are associated with:

  • The potential for pain during dental treatment
  • Embarrassment, anticipation of being scolded or belittled for the condition of one’s mouth (i.e. "My teeth will be the worst the dentist has ever seen.")
  • Loss of control during dental treatment, feeling helpless

Communication and knowledge are powerful weapons against fear. A caring dentist who is responsive to patient needs can work with you to make sure you feel comfortable with your treatment.

How Dentists Can Reduce or
Eliminate Pain

It’s not that dental treatment is never painful – on rare occasions, it is. However, most of the time, dental treatment is completely painless or at worst only slightly uncomfortable. Many dentists take pride in being "painless practitioners." They are acutely aware that causing people pain during treatment is a good way to lose patients. Today’s dentists have a wide range of methods at their disposal to reduce discomfort, including:

  • Anesthesia. The first step dentists take is to evaluate the required treatment in terms of anesthesia, usually given by injection. Potent topical anesthetic gels numb the area, so that you feel the injection much less or not at all. Dentists also use very thin needles and inject slowly to further reduce discomfort caused by the pressure and volume of the anesthetic fluid.
  • For those concerned about pain after the anesthetic wears off, dentists can use long-lasting anesthesia (bupiyacaine). Pain medications such as ibuprofen, given prior to procedures, have been shown to reduce pain afterwards.
  • Thanks to modern technology, many dental procedures can be done comfortably without anesthesia. For instance, shallow cavities on the side or biting surface of teeth can be treated with gentle devices like the dental laser or the air abrasion unit.
  • General anesthesia is considered safe and effective, but costs more and may pose an increased health risk for some patients. This method is used only when there is no other option. Patients receiving advanced surgical procedures and those with certain physical or mental handicaps may require general anesthesia, along with a very small minority of highly phobic patients.
  • Sedation. Oral sedative drugs (such as diazepam or midazolam) are taken before treatment to produce light sedation, or the night before your appointment to ensure restful sleep. The sedative effect of these drugs is unpredictable and may vary among individuals. Because the drugs are taken by mouth, it is impossible to quickly increase of decrease the amount of sedation. While under the effects of the drug, patients must be accompanied by a responsible adult and refrain from driving or operating other machinery.
  • Inhalation sedation, a mixture of oxygen and nitrous oxide ("laughing gas") is breathed in through a rubber face-mask. The nitrous oxide reduces anxiety and improves cooperation without causing unconsciousness. Its effects wear off quickly and the patient can leave the office without the need for an accompanying adult. This method is safe for most patients, but long-term exposure has risks and some people (such as pregnant women and those with respiratory problems) must avoid it altogether. Talk to your dentist about whether this type of sedation is right for you.
  • Behavior Management. This is the simplest method of treatment for nervous patients. Most dentists realize that a person’s emotions have a significant impact on his or her perception of pain. The dentist uses a careful, sympathetic approach, explaining each part of the treatment ahead of time and moving at the patient’s pace, allowing the patient control. For some patients, bringing a friend along for support makes a big difference. It may also be possible to play relaxing music or watch a video during treatment.
  • Hypnotherapy. Although it is not widely available, reducing dental anxiety through hypnosis can greatly benefit those who respond well to hypnosis in general. It can be done by hypnotist working with a dentist, or by the dentist if he or she is qualified in hypnotherapy.

The Patient-Dentist Relationship

Ideally, your dentist and you have equal roles in your dental health. The dentist should understand your expectations and needs. He or she should work from that understanding to improve your dental health, then educate you in how to avoid future dental problems. You should feel safe and confident enough to take an active role in your care. Communication is the key.

The dentist’s role should not be that of a disapproving authority figure. Fear of being chastised by the dentist for poor oral hygiene probably originated years ago, when some dentists thought they could "help" their patients by shaming them. Most dentists today realize this approach ultimately backfires, and it’s more important that the patient feel comfortable enough to get treatment.

Patients who have a strong need to be "in control" – especially those who are accustomed to having a position of power – may struggle with situations in which they feel they are relinquishing that power to the dentist. Your dentist should allow you to help "call the shots" whenever possible with regard to order of procedures, methods of pain management, etc. Many dentists and patients work out a non-verbal signal (e.g. raising one hand) for the patient to use if he or she is having pain or needs to take a break for any reason.

What You Can Do

  1. Get regular check-ups. Have your teeth professionally cleaned and receive the care you need. In the long run, it’s much less painful and expensive than putting off treatment.
  2. Find an understanding dentist who is willing to take the time to work with you, and who will try whatever it takes to make you comfortable with your treatment. Don’t settle for any less; your smile and your health depend on it. Finding the right dentist may take time on your part as well; don’t give up. You may need to try more than one dentist.
  3. Consult first. Schedule your first appointment with any new dentist to be a consultation session only, with no treatment. Discuss your concerns with the dentist, and see how he or she reacts. You should be able to quickly get a sense of whether this dentist’s approach is right for you. It’s important to establish trust with your dentist before going in for any treatment that makes you nervous. That trust could make the difference between receiving care and canceling your appointment. If you feel uncomfortable with your dentist, you should not feel guilty about switching to a new dentist.
  4. Get plenty of rest. Lying awake terrified the night before your dental appointment only compounds the problem, because lack of sleep can decrease the effectiveness of the anesthetic. Caffeine and high doses of vitamin C can also have this result.
  5. Practice relaxation techniques. Concentrate on breathing slowly and steadily. When anxious or uncomfortable, many people hold their breath without realizing it. Lack of oxygen increases those feelings of anxiety and magnifies pain. Another common reflex is to focus attention on the area where the dentist is working. Instead, focus your attention on a part of your body that is nowhere near your mouth. Focusing on the rise and fall of your abdomen as you breathe is a good way to combine these first two techniques. Use your natural powers of visualization not to imagine what is happening in your mouth (which will only increase your anticipation of pain), but to imagine yourself in a relaxing place such as the beach or lying beside a mountain stream. Other techniques include progressive muscle relaxation and various methods taught in yoga.
  6. Know what to expect. An educated patient is a less anxious patient. Make sure your dentist explains every procedure you undergo beforehand. Dentists usually have videos, pamphlets, or books available so that you can learn more. Ask questions and voice your concerns. An understanding dentist will provide straightforward answers and work with you to make you as comfortable as possible.