Overcoming Dental Fear & Anxiety

Comfortable Dentistry in the 21st Century

   

By Dr. Paul Glassman

Do you feel relatively calm before your dental appointment or are you a little nervous about a visit to the dental office? Do you worry about it days or weeks before the appointment? Are you someone who is actually terrified about dental treatment and worries about it all the time? Do even those things that are supposed to make visits more comfortable just seem to increase the apprehension or feeling of anxiety and being out of control — like anti-anxiety medication, nitrous oxide (laughing gas) or local anesthesia — numbing the treatment area (injections, needles, shots)? Whichever end of this spectrum you might be on, it may be helpful to know that you are not alone.

Actually, having a little or even a lot of nervousness about dental visits is common. Some studies have concluded that up to 75% of people surveyed have at least a little fear about dental visits. In addition it appears that 10%-15% of people have a great deal of fear — so much so, that it prevents them from having any dental treatment at all. There are people who have frequent dreams about dental treatment; some will only eat soft foods because they are afraid that they might chip a tooth and then need dental treatment. As a consequence these individuals who put off having dental treatment suffer for years with toothaches, infections and poor appearance.

It's possible, even for those people who are the most fearful, to reduce their fear and to learn to have dental treatment in a way that feels calm and safe.

While dental fear can result in stress and avoidance of care, it can also have more wide-reaching consequences. For some it affects their whole identity and sense of self worth. They may see other people who don't seem to have the same reactions to dental treatment and begin to feel that something is wrong with them. “Why can't I do this thing that other people seem to do so easily?” In fact, untreated oral conditions may result in even worse general health complications.

In the end, it's in everyone's interest to find ways to overcome dental fear and make dental treatment a calm and safe experience.

Good News

Now for the good news! First, it's helpful for many people who are fearful to know that they are not alone. It's also important to realize that help is available. Actually, experience has shown that even people who have extreme fear about dental procedures can get over their fears and learn to have dental treatment in a manner that feels calm and safe. If you have been afraid for a long time you may have difficulty believing this, but even people with long standing fear can be helped. Before we describe how it's possible to get over dental fear, let's first review some things about what makes people fearful.

How do people become afraid of dental visits?

No one is born being afraid of dental visits. So everyone who is afraid has learned somewhere that dental treatment is something to fear. Some people learn this because they've had previous bad dental experiences. The sense of loss of control in the dental environment may be enough to avoid dental treatment forever. And still others may be afraid due to stories they have heard, movies they saw or other indirect experiences. The message conveyed to a child from a scared parent might be that going to see a dentist is something to be afraid of. Such messages may cause individuals to avoid treatment and not have any opportunity to learn that things can be different.

Fear and anxiety can also be reinforced inadvertently. Think about it this way; try to remember a time when you were really afraid of something, do you remember how your body felt? Was your heart beating quickly, palms sweaty, stomach in a knot? Those and other symptoms of being afraid are all unpleasant feelings. So, if someone who is already afraid forces themselves to go have dental treatment and re-experiences those same bad feelings during the appointment, then what they will remember afterward is those same unpleasant feelings. It doesn't matter how friendly the dentist is or how pain free and pleasant the treatment is. What you remember is the feeling of being afraid, thus reinforcing the idea that there is something to be afraid of.

In fact, dental fear begins at the subconscious level. People have what we call an “automatic fear response.” Jane says “I feel like something just takes over and I begin to sweat and my stomach tightens up. I don't really have any control over it.” Since this automatic fear response is subconscious, you can't make it go away using logic or reason. Telling Jane that “there is nothing to be afraid of” won't help. In fact it might make things worse because it could sound like you are saying there is something wrong with her. So, how do we change this pattern of fear and reinforcement? Let's find out.

Getting to Calm and Safe

As we said earlier, it's possible, even for those people who are the most fearful, to reduce their fear and to learn to have dental treatment in a way that feels calm and safe. The basic idea is really very simple. In order to counteract past bad experiences you need to have new positive experiences which lead to the development of improved feelings and attitudes. The more bad experiences you have had or the longer they have gone on, the more good experiences you need before you will have different reactions to the same situation. Dental health professionals know that your mouth is a very personal place and trust is a big part of allowing us to partner in your care.

Imagine a relationship with your dentist where you feel you have the time you need to go at your own pace, the listening relationship that you need to feel safe, and the sense of control you need to reduce any automatic anxiety responses. It might take some faith in the beginning to realize that this is possible, but you really do have the opportunity to have a “Lifetime of Dental Health.”

Patient Profile

Jane is 33 years old. She hasn't had any dental treatment in 10 years. She is worried that she has dental problems and should have them taken care of. She has even made some dental appointments in the past decade. She cancelled or just didn't show up to most of them. Twice she did go and have an examination, but didn't go back to have any treatment performed. She changes the channel on the TV if a show has any dental treatment in it and she won't go to movies that show anything about dentistry. Her smile embarrasses her and has led to poor self-esteem. Jane feels bad about herself. She wants to change both the way she feels and reacts to dental treatment but she doesn't know how.

If you are very fearful, how do you have a “good experience” with dental care?

1. Tell your dentist you are afraid, even when setting up an appointment and make sure the dentist is prepared to listen. If you can't talk about it you can't get over it.
   I am very careful to listen to what Jane says and try to understand her “story.” I ask Jane to tell me about her fear of dental treatment. “I'm glad you asked” she says. “I always felt that dentists didn't really want to know.”
2. The dentist must listen carefully to you in an accepting and non-judgmental way.
   I avoid telling Jane that things will be different, that there is nothing to worry about, or that there is anything wrong with her being afraid. I also avoid any explanations about dental disease or dental procedures until I'm sure that Jane knows that I understand her fear and am committed to working with her to help her overcome it. I know that the best way for me to convey that I care is to listen, not to provide explanations. Jane should feel confident that she is not being judged.
   Of course, some people are better at this than others. If you are afraid, find a dentist who listens to you and who cares about working with you to get over your fear. Some dentists have made themselves quite expert in this area. If you start your work with a psychologist, make a transition from working with the psychologist to working with a dentist who understands and can follow the principles involved in reducing dental fear.
3. When working to reduce fear, only do things that you can do with mild or no anxiety.
   I reassure Jane that she is in control of the situation at all times. I need Jane to tell me exactly what she is afraid of since it's different for everyone. It's critical that I understand what brings on her particular fear reactions. We will start by having Jane try to do those things that she feels she can do fairly easily. The idea is for her to have the goal of being able to leave each visit saying “that was OK; I could certainly do that again if I needed to.”
4. Set up an agreement so you can take whatever time you need to get over your fear and not be rushed to do things you are not ready to do.
   Let's stop to emphasize the last point, since this can be a significant shift in expectations. In order to help someone get over their fear of dental procedures, the goal for each visit is for you to have a good experience rather than getting a particular procedure finished. Remember, if you push yourself to do something you are really afraid of, you will remember how unpleasant your fear is and reinforce the fear rather than diminish it.
5. If you are afraid, work with your dentist and make a specific plan to reduce your fear. Don't just concentrate on “fixing your teeth!”
   It's critical that both the dentist and patient agree that becoming comfortable with dental procedures is something that they are going to work on. Understand that you and your dentist must consider your internal anxiety feelings by working at a pace where you will be more comfortable and trusting. Set up an agreement with your dentist to talk about the time and fees associated with treatment so you can comfortably overcome your fear and not be rushed to do things you are not ready to do. This may result in a procedure taking a little longer than usual to complete or spreading out appointments over the course of time.

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