What is Dental Phobia?

A "phobia" is traditionally defined as "an irrational severe fear that leads to avoidance of the feared situation, object or activity" Exposure to the feared stimulus provokes an immediate anxiety response, which may take the form of a panic attack. The phobia causes a lot of distress, and impacts on other aspects of the individual's life, not just their oral health.

Dental phobics will spend an awful lot of time thinking about their teeth or dentists or dental situations, or else spend a lot of time trying NOT to think of teeth or dentists or dental situations. Which is pretty hard in today's society, which is saturated with ugly reminders such as toothpaste commercials.

The difference between anxiety, fear and phobia

A distinction has been made between dental anxiety, dental fear, and dental phobia.

DENTAL ANXIETY is a reaction to an UNKNOWN danger. Anxiety is extremely common, and most people experience some degree of dental anxiety especially if they're about to have something done which they've never experienced before. Basically, it's a fear of the unknown.

DENTAL FEAR is a reaction to a known danger ("I know what the dentist is going to do, been there, done that - I'm scared!!"), which involves a fight-or-flight response when confronted with the threatening stimulus.

DENTAL PHOBIA is basically the same as fear, only much stronger ("I know what happens when I go to the dentist - there's no way I'm going back if I can help it. I'm so terrified I feel sick"). Also, the fight-or-flight response occurs when just thinking about or being reminded of the threatening situation. Someone with a dental phobia will avoid dental care at all costs until either a physical problem or the psychological burden of the phobia becomes overwhelming.

The impact of dental phobia on daily life

Dental phobia can have wide-ranging consequences on a person's life. Not only does their dental health suffer, but dental phobia may lead to anxiety and depression. Laughing out loud is out of the question - too hard to hide one's teeth... Depending on how obvious the damage is, the individual may avoid meeting people, even close friends, due to embarrassment over their teeth, or not be able to take on jobs which involve extensive contact with the public. Loss of self-esteem over not being able to do something as "simple" as going to a dentist and intense feelings of guilt over not having looked after one's teeth properly are also very common. Dental phobia sufferers may also avoid doctors for fear that they might want to have a look at their tongue or throat and suggest that a visit to a dentist might not go amiss.

If you suffer from dental phobia, you'll be inclined to think that nobody else feels the way you do - after all, who else would rather be dead or have open-heart surgery than meet up with a dentist?

Actually, quite a lot of people! While there are no reliable statistics (after all, few dental phobics will freely admit to never visiting a dentist... that's if they hang around to complete the questionnaire!), the most conservative estimates reckon that 5% of people in Western countries avoid dentists altogether due to fear. And many more are anxious or scared about dentistry.

However, most people actually don't mind going to the dentist. There is a reason for this - nowadays, dentistry can be pain-free and there are many personable, kind and compassionate dental professionals around. Many if not most people who've suffered with dental fears and phobias reckon that having found the right dentist for them has made all the difference.

COMMON FEARS

1. The Dentist: Fear of "the dentist" or "dentists" is pretty common. If you've had ( not-so-great) experiences with dentists in the past, it is very easy to make the assumption that dentists, in general, are bad people.
2. Loss of Control: Many people are scared of the loss of control they experience in the dental chair. This can be due, for example, to past experiences where a dentist proceeded to do things to you and not stopping, in spite of you being in obvious distress, a or a general preference for being in control of situations.
3. Pain:If you reckon that dentistry is simply too painful to bear, it is highly likely that you've had at least one very painful experience in the past. This could have been due to a number of reasons: the dentist starting the procedure too early, before you were properly numbed; a dentist having trouble getting you numb due to anatomical variation (that is, nerves being in a slightly different location from where they are in the majority of people); an infection (this can prevent the anaesthetic from working properly - but infections can be treated with antibiotics first); the dentist hitting a nerve; or you may have been refused anaesthetic in the past (in which case you'll most likely fear the No Needle, rather than the needle aspect!). You may have had a dentist who wouldn't stop even though you were obviously in a lot of pain. And, of course, some dentists are much more gentle than others - you do get the odd dentist who simply lacks the dexterity required for the job!
4. Needle Phobia: If you're very anxious about needles, you're not alone! The Adult Dental Health Survey (UK) 1988 stated that 8% reported a fear of injections. Some studies suggest that almost 5% of the population may be phobic of needles in general.

   Thankfully, there are various methods of help available.

5. Sight, Smell, Sounds: Sights, sounds and smells are powerful environmental triggers. If you suffer with dental phobias or fears, merely evoking the images, sounds and smells you associate with dentistry is enough to generate intense feelings of anxiety or even panic.

   The Smell

   If the "typical" dental surgery smell gives you the creeps, relax - it's gone (in modern places, anyway!) I'd actually take it as a bad omen if a place reeked of "dental office"... Very unlikely it's going to be phobic-friendly. However, some smell of antiseptic can occasionally be unavoidable (especially in waiting rooms, for some reason unbeknownst to me). So take into account the overall atmosphere of the place.

   The Sights

   You can tell a place isn't phobic-friendly if all instruments are laid out in plain view. As much of it as possible should be hidden away, and only taken out as and when needed. A cluttered environment and instruments laid out in plain view also suggest that modern standards of infection control may not be adhered to.
   
   Some dental office/practice layouts and equipment are much more phobic-friendly than others. Does the place look clean (but not "sterile")? Is there a "happy atmosphere" (or at least not a "scary" atmosphere)? What's the overall "feel" of the place? Of course, the people who occupy the space (i. e. your dentist :-)) can make all the difference in changing the overall atmosphere, but if the treatment room doesn't look clean, this is a bad sign. Avoid.
   
   If you're scared of the sight of instruments being put into your mouth, simply closing your eyes might work for you. On the other hand, there are people who like to see exactly what is going on, in which case you can ask your dentist to show you what's going on with the help of mirrors.

   The Sounds

   I doubt that anyone is all that keen on the sounds, but if you haven't been to a dentist in a very long time, it might come as a relief to know that they're not quite as noisy as they used to be. Also, bear in mind that when noise is "inserted" into your mouth, it sounds much louder than it actually is. Your dentist should always demonstrate any instrument that makes a noise to you first, so that you know what it sounds like "in reality".
   
   Sounds are subjective experiences. I'm sure you're aware of how your voice will sound totally different if you cover your ears while speaking or humming a song.

6. Gag Reflex: Unlike the happy customer to the right, quite a few people have a sensitive gag reflex. This can be very upsetting when you want to have dental treatment. Gagging can be due to psychological factors, or physiological factors, or both. Psychological factors can include fear of loss of control and past traumatic experiences.

   A bad gag reflex is so common that all dentists will have experience with this and should have developed ways of helping you cope with it.

7. Can’t get numb: If you're one of those people who've had trouble getting completely numb with local anaesthetic in the past, here's the low-down on the causes of incomplete local anesthesia. Four possible causes of local anesthetic not working are anatomical variation, bad technique on behalf of the operator ( i. e. dentist), anxiety, and local infection.
8. Fear of panicking, fainting, or crying uncontrollably: If you're scared of fainting, or crying uncontrollably, or having a panic attack, it's probably because you're trying to be too brave! Don't try and suppress your fears, but express them openly instead. You may find that accepting the anxiety and just going with the experience actually reduces your sense of panic. Fighting anxiety tends to add fuel to the fire. Keep in mind that you're not dealing with a life-or-death situation, even though it might feel like that right now - the reality is that you're free to leave anytime should you not feel comfortable with the situation.

   Again - remember, you're the customer! Some people feel that "no dentist will want to treat me because I'm difficult" - and upon closer questioning, will describe their "being difficult" as simply being too scared to behave like the "normal" dental client. Frequently, dental phobia sufferers are under the impression that they have to "please" dentists by playing "the perfect patient". Not so! I don't condone aggressive behaviour, but you're perfectly entitled to have a panic attack, cry, or whatever takes your fancy - after all, you are paying for the service (either directly or indirectly).

   The more common pattern is one of overcompliance coupled with a reluctance to communicate your needs - a frustrating experience for both dental phobia sufferers and (willing) dentists. So - communicate! The communication doesn't have to be verbal, almost anything will do as long as you don't simply freeze. If you have a tendency to freeze, make sure you've got everything you want to communicate to your dentist written out.

   Dentists are not mind-readers - and the most common complaint from dentists regarding phobic patients is that they won't let them know what they're scared of, or when they're feeling scared. So whenever there's something you're worried or fearful about, no matter how mundane, please let your dentist know about it. Your dentist cannot put your fears at rest unless she/he knows what your fears are!