Dental Anxiety and Phobia

In the general population, psychological problems relating to receiving dental treatment are common. It is reported that about half of all dental patients experience some anxiety towards their dental visit. This fear can lead to a delay in seeking necessary dental care, cancellation of appointments and poor cooperation in the dental chair. Dental fear is one of the most troublesome patient management problems for a dental team. It causes distress for the patient and results in high stress levels in dentists.

An anxiety and a phobia are quite different and the words should not be used synonymously. They are managed and treated differently by your dental practitioner. An anxiety is a normal state of apprehension, uncertainty, and fear resulting from the anticipation of a realistic or fantasized threatening event or situation. It often impairs physical and psychological functioning. A phobia is an abnormal intense and irrational fear of a given situation, organism, or object. A dental anxiety is a normal state of mind and a dental phobia is an abnormal state of mind.

Dental phobia is classified in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) as a specific phobia, which involves a marked and persistent fear of a specific object, activity or situation that results in anxiety on confronting the phobic stimulus. People with dental phobia commonly describe two types of experiences: a painful or traumatic dental procedure or a negative personal interaction with dental staff. It is common for the experiences to first occur in childhood or in adolescence autonomously. However, fearful attitudes and feelings of lack of control in dental situations can also be learnt from others.

The 'blood-injection-injury' type of specific phobia includes fear of needles, injections, drills and fear of blood in the dental situation. In the 'situational' type of specific phobia, there may be fear of the dental room, dental personnel or the smells and sounds associated with dental treatment. In the 'other' type of specific phobia, the person is anxious about occurrences such as gagging and retching. It is worth noting that gagging and retching result from a combination of psychological and physiological factors. The gagging and retching response can be so intense that some persons cannot wear dentures or take dental impressions.

Dental practitioners have a responsibility to avoid subjecting patients to traumatic dental experiences, but may not always be aware when they are occurring. It is sometimes not advisable to perform several extractions or complete large amounts of conservation work in different areas of the mouth at a single office visit. These types of procedures can create or exacerbate anxieties (normal) which can grow into phobias (abnormal). The practitioner must be especially careful, if there is poor patient cooperation or if there is patient distress.

Dental practitioners can treat dental phobias themselves or enlist the help of the patient's general practitioner or psychologist. It is very important for dentists to understand patients’ fears and to explain the proposed dental treatment.

People with specific fears such as gagging and needle phobia may respond best to empathetic patient care, with the addition of relaxation techniques. Relaxation techniques can sometimes last up to four hours prior to the procedure. Patients may also be offered a mixture of nitrous oxide (laughing gas) and oxygen to inhale, which can reduce pain experienced and produce relaxation. Tranquilizers injected directly into the veins can also help. Some practitioners will in addition, play soothing music to promote patient relaxation. Only a few patients will require this type of specialist care.

Those with severe symptoms should have a thorough assessment by an experienced psychologist or psychiatrist and a carefully structured treatment programme. A psychiatrist is sometimes needed because dental anxiety may be part of a greater type of anxiety disorder e.g. generalized anxiety disorder, panic disorder or agoraphobia (a pathological fear of being in public places).

It is crucial that if you suspect you have a dental phobia, to set up a meeting with your dental healthcare provider. He will ensure you get the help you need. What you consider a phobia (abnormal) may be just an anxiety (normal). Do not delay in seeking necessary dental help because of a possible dental anxiety. It can be managed successfully and you can enjoy excellent oral health.

This article is for informational purposes only. It is not intended and may not be treated as, a substitute for professional medical/dental advice, diagnosis, or treatment. Always seek the advice of a physician or dental professional with any questions you may have regarding a medical/dental condition. Never disregard professional medical/dental advice or delay in seeking it because of a purely informational publication. Copyright © 2012 by Dr. Andre R. Clarke. All rights reserved. Reproduction of this article, in whole or in part, is prohibited without written permission. If you have questions, please send email to dr_andreclarke@hotmail.com.

Dr. André R. Clarke, DDS, MBBS Special Care Dentistry