Introduction

 

The word Phobia comes from the Greek word phóbos that means fear or morbid fear. This is defined as a persistent, abnormal, irrational fear for a specific thing or condition that makes the person to avoid the feared situation, object or activity. A person subjected to this feared stimulus becomes terribly anxious and this could lead to panic attack. The dental phobia not only causes a lot of distress but also affects drastically all aspects of his life in addition to oral health. It is quite likely that dental phobics spend a lot of time thinking about teeth or dentists or dental situations; or alternately they may try their best to avoid thinking about them. Continue to read for knowing more about this phenomenon.

Overview

 

My experiences with dentists in my young age were pretty bad; because of this I always was afraid of taking dental treatment from any dentist. - Carol Seaton - U.K

After growing up with a fear of dentists my only visit would be when I was in pain and would have the tooth extracted. - Rosemary Ferguson - U.K

The above statements were made by two of the patients who visited our dental clinic, Vignesh Dental Specialty Center at Bangalore. This is not something new; a large number of people are reluctant to visit a dentist because they are of fear for dentists and their equipments and such people suffer either from dental anxiety or fear or phobia and if these conditions are serious they cancel or avoid their appointments.

The differences between the above three conditions are as given below.

  • Dental Anxiety – can be defined as a reaction to an upcoming danger that is not clearly known. People become anxious when they want to get some dental work done that they have never undergone before. This in short is the fear of the unknown.
  • Dental Fear – this reaction occurs on people who are aware of the imminent danger of dental treatment and this involves fight-or-flight response when forced to face the threatening stimulus.
  • Dental Phobia – is similar to dental fear but its intensity is very strong; people affected by dental phobia try to avoid dental treatment at any cost until they face a physical or psychological problem that is unbearable. Dental phobia is a more serious condition. The affected persons are terrified or panic stricken.

The risk of Gum Diseases and tooth loss is high on persons with dental phobia. Avoiding the dental treatment also will affect the patient emotionally. Because their teeth are discolored or damaged these patients feel insecure and self-conscious. They hardly smile and keep their mouth partially closed while speaking to avoid displaying bad teeth. This affects both their personal and professional lives and they lose their self-esteem.

Poor oral health can cause certain life-threatening conditions – heart disease and lung infections and they will have poor life expectancy.

What happens when an individual has severe dental phobia?

 

Many patients affected by dental anxiety suffer from severe dental phobia and they find it horrifying to go for dental treatment. Such people avoid seeing dentists or avoid dental appointments because they are terrified as well as panic-stricken. If they have no other alternative than going to the dentist they might not sleep for the whole night prior to appointment or they might become sick in the dentists’ office when they wait for treatment.

These persons will have poor oral health. They might suffer from infected gums and decayed teeth because of which they find it difficult to chew food and digest it properly. All these things could lead to halitosis or unattractive smile which will make them lose self-confidence and make them feel insecure.

How do you treat children having dental fear?

 

Many children are terribly afraid of dental treatment and it is very difficult to take them for dental treatments.It is highly essential that children are exposed to regular dental checkups.

The following suggestions will be of some use for children who have dental anxiety or severe dental phobia:

  • Dental checkups must be started at an early age to familiarize the child with dental appointments and treatments so that it feels comfortable.
  • Make sure that the child has good oral maintenance so that it can go to the dentist less number of times.
  • You should avoid discouraging your child by conveying your own fears about the dental treatment.
  • Take the child to a dentist who is specialized in pediatric care; these dentists are trained to handle children better and their offices are friendly to children.

How do you measure dental anxiety?

 

Instruments such as Corah's Dental Anxiety Scale (DAS) and Modified Dental Anxiety Scale (MDAS) are used for measuring the extent of fear. Your score might be high if you suffer from dental phobia.

What are the common reasons for Dental anxiety, fear and phobia?

 
  • Fear of Pain – Most of the dental procedures are not painful; however, It has been found in a survey that 6% of the persons who had not visited dentists for a period of 12 months have expressed ‘fear of pain’ as the main reason for not visiting the dentist. The pain was more common in adults 24 years and older. This could be for the reason that these people had bitter experience in their dental visits because the pain-free dentistry has advanced only in the recent years.
  • Bad or negative experience in the past – it has been found that about 80% to 85% of the cases of dental phobia have been mainly attributed to bad or negative experiences. This could be either due to painful dental visits or psychological behaviors. Anyone who has had pain or discomfort during previous dental procedures is likely to be more anxious the next time around.
  • Embarrassment – many people are self-conscious about how their teeth look and find it embarrassing when a stranger looks inside their mouth. They find it Dental treatments also require physical closeness. The distance between the dentist’s face and the patient’s mouth is very close during the treatment and this makes them feel anxious and uncomfortable.
  • People having a history of abuse – Dental phobia occur commonly in persons who have been subjected to physical or emotional or sexual abuse – in particular in childhood; this is all the more true if the above experiences are combined with horrified experiences with dentists.
  • Caring VS Uncaring dentist – many people including the dental professionals believe that because of the pain involved in dental treatment people are averse to visit a dentist. In reality this is not true because if the pain is from toothache even a person having dental phobia will not avoid going to a dentist. If the dentist is uncaring the psychological pain inflicted on the patient is much more than that of a caring dentist.
  • Humiliation – sensitive people are likely to be affected by dental phobia when subjected to humiliation.
  • Secondary learning – a person could be affected by secondary learning e.g. children could become scared of dentists in case their parents are scared to visit dentists. People can also be affected if they hear horror stories about going to a dentist.
  • Post-Traumatic Stress – people who had horrific dental experiences show symptoms similar to that shown by a person having post-traumatic stress disorder. These people have nightmares about dentists or dental situations.

What are the Symptoms for Dental anxiety, fear and phobia?

 

People with dental phobia might show the following symptoms:

  • Might become tense or find difficulty in sleeping in the night prior to dental checkup
  • Become terribly nervous in the doctor’s waiting room prior to dental checkup
  • Increase in anxiety by seeing dental instruments or dental professionals
  • Become physically sick even with the thought of visiting a dentist
  • During the dental examination you might panic or find it difficult to breathe when an object is inserted inside the mouth

Persons having such problems must have a discussion with the dentist who will allay their fears. He might make necessary adjustments to the treatment procedures to overcome the feelings and fears. He may also refer the patient to the psychiatrist.

What are the treatments for Dental anxiety, fear and phobia?

 

It is possible to treat dental phobia just like treating any other mental disorder. It will become worse if it is not treated because the patient will find more discomfort emotionally during the dental visits.

Patients who are tense more than normal are likely to have a lower pain threshold. These persons require additional anesthetic or other methods of pain treatments. They may also suffer from side-effects such as headaches, muscle stiffness in the neck or back.

Treatments for dental phobia can be any of the following.

  • Pain Control - Fear of pain is the main reason for people not going for dental treatment. A number of medications and techniques have come up in the recent years which either reduce or eliminate the pain from most of the dental procedures..
    • Topical anesthetics — are applied using a Q-tip; these are administered to numb an area of the gum or mouth before injecting the local anesthetic
    • Electronic anesthesia — in this, electrodes are put on the cheeks of the patients and electric current is passed into the jaw
    • Deep breathing or Pranayama — is a diaphragmatic breathing wherein you breathe deeply and slowly. While breathing in you inhale oxygen and other chemicals that relax the central nervous system thereby reducing discomfort.
    • Cranial electrotherapy stimulation — is another type of electronic anesthesia. In this, electricity is passed to the brain thereby creating a feeling of relaxation and heaviness. The current intensity is controlled by the patient.
    • Electronic anesthesia delivery systems – are attached to a syringe and adjust the anesthetic flow through the tissues thereby causing least amount of discomfort.
    • Intravenous sedation – is given to patients who undergo lots of dental procedures. The dentist injects a tranquilizer into a vein in the arm or hand. During the procedure the patient remains awake and deeply relaxed.
    • Laser drills — are approved by FDA and causes less pain than mechanical drills. Useful for preparing cavities for fillings.
    • Laughing gas or Nitrous oxide – is used commonly in office pain control. The patient feels relaxed by inhaling it and the effect wears off once the gas supply is cut off. Used in conjunction with other drugs.
    • General anesthesia – in this the patient is put to sleep for the period of the dental procedure. This requires the necessary equipments and staff and is normally carried out in a hospital environment. There are side effects – BP, irregular heartbeat – and hence this should be resorted to only when all other methods fail.
  • Communicate With Your Dentist - Dentistry has advanced to a large extent and with today’s technology it could be least painful. By discussing your fears and treatment options with your dentist you could overcome your fear psychosis. Participating in decision making at each stage will make you feel less anxious.
  • Sedation - Analgesics normally block pain; on the other hand sedatives such as diazepam or Valium relax the central nervous system which makes people feel calm and more relaxed. Oral sedatives take a minimum of 30 minutes to work and the resultant drowsiness stays for hours together. Hence, Dentists avoid oral sedatives. However, they may use it in the overall treatment plan.
  • Therapy - People neglecting their dental health because of dental phobia must take help from a mental health professional. The technique of systematic desensitization is used by psychologists and psychiatrists for curing different types of phobias. In this they expose the patient in a gradual and careful manner to the things that they are afraid of. Cognitive therapy is another method of overcoming dental phobia; psychotherapy is used to determine the reasons for the fear. Dentophobia clinics help people having severe anxiety.
  • Acupuncture and Acupressure - These techniques have originated 4000 years back in China. In acupuncture, needles are inserted on the acupoints in your body; on the other hand, in acupressure pressure is applied on the acupoints without needles. Application of needles or pressure might cause the body to release endorphins that are pain-relieving chemicals. These practices are being accepted by westerners nowadays.Dentists are yet to make full use of these techniques.
  • Support Groups - Support groups exist in most of the communities and these groups help people suffering from anxiety or phobia. These groups not only provide emotional support but also help in giving you practical tips and coping skills.
  • Distraction - In order to de-stress yourself during a dental appointment you should divert your mind with something pleasant. You can listen to music to keep yourself pleasantly occupied. Nowadays, dentists use virtual-reality goggles which provide lifelike images and sounds. This will provide necessary distraction during treatment.
  • Hypnosis - The technique of hypnosis creates considerable relaxation. Hypnosis gives the same effects that one can get from meditation and can be practiced on your own. Hypnosis can be practiced with the assistance of a therapist, dentist or you can practice self-hypnosis
  • Relaxation Techniques - Whenever you are upset or feel tense, your body will release stress chemicals like adrenaline. These chemicals are likely to give various physical responses such as muscle tightening and faster breathing; it also makes the pain receptors in your brain more sensitive. All these reactions cause anxiety and fear.

    It has been found that you can reduce the stress levels of the hormones, pain and anxiety by using certain relaxation techniques. If you practice these relaxation techniques you might be able to reduce the fear responses.

    The following are some of the relaxation technique that you could follow for reducing your stress levels, anxiety and fear.

    • Guided imagery — is a simple mental technique wherein a health care professional helps you to imagine having a pleasant experience. This will occupy your mind fully and you will not be aware of any pain during dental treatment.
    • Progressive relaxation — is a technique wherein you relax your body consciously starting with the toes and moving all the way up to the head. This reduces muscular tension and helps in pain reduction.
    • Deep breathing or Pranayama — is a diaphragmatic breathing wherein you breathe deeply and slowly. While breathing in you inhale oxygen and other chemicals that relax the central nervous system thereby reducing discomfort.