Managing Dental Anxiety

Fear of going to the dentist is a common health-care related anxiety. Patients often express a broad range of triggers, such as the fear of pain, claustrophobia, needles, sounds, or sensations. Unfortunately, long term avoidance of oral healthcare can lead to deeply debilitating problems that can be physically, psychologically and socially impactful. Our mouth represents a center point for our survival, by impacting our ability to eat comfortably and communicate. So, caring for this immensely important part of our bodies is crucial for both our general health and psychological wellbeing. 

Often minor dental problems can be easily ignored. Many people may be aware that something feels wrong or isn’t right in their mouths. It might be an area where food becomes stuck, it could be a sharp or rough part of a tooth, or it could be the experience of sensitivity to hot, cold or sweet foods. It may simply manifest as a general feeling of irrigation around the gums. Unfortunately, most minor dental problems tend to progress to major dental problems with time and ignoring small issues can culminate into a larger and more impactful concern. 

There are many aspects of dental treatment recognized as specific causes or triggers of anxiety. Undergoing dental treatment is a very multi-sensory experience. There is the feeling associated with having the teeth, lips, cheeks tongue and gums touched. There is the sound of the drill and suction. There is the taste of the gloves, instruments, and materials, the sight of the tools and instruments, and the smell that every dental practice seems to have. For some people, this can culminate in an overwhelming experience. 

For others, it is a specific part of the dental experience that induces their anxiety. The most common of these are the fear of needles or injections, the sound or feel of the drill, and the experience of people within their personal space. In many cases, a previous dental experience (often as a child) has become the nucleus of the anxiety. In these circumstances, many patients report that the experience of pain and the feeling of powerlessness are the areas of greatest concern. 

Unpacking common dental anxieties

It’s difficult to address something that can’t be identified. Exploring and unpacking the negativity associated with any previously difficult experience(s) is the first step. Sometimes this is best done with a counselor or psychologist, depending of the severity of the trauma. However, opening up to a friend or family member that is available to accompany and support you throughout any interactions with a dentist can also be very important. The outcome that you are trying to achieve is to be able to identify and articulate the components of dental treatment that you find difficult, so that these many be carefully minimized or avoided.

Anxiety associated with experiencing pain can be one of the easiest phobias to address. Often this has developed as a result of experiencing unexpected pain during a dental procedure. This may have been when a filling was being placed, or a tooth was being removed, and typically causes tense anticipation and fear during subsequent dental interactions.

The use of local anesthesia and local anesthesia placement techniques have developed considerably. There are many strategies and approaches that we commonly take to ensure “profound anesthesia” prior to undertaking a procedure. Clinically, it is often appropriate to take a trust-building approach with patients who carry this form of anxiety, where we aim to complete simple procedures in a pain-free manner in order to build a patient’s confidence and experience with the normal sensations associated with dental treatment.

Needle phobia can also be easily mitigated. Many dental procedures can be performed without the need of anesthesia, and there are new non-traditional forms of delivering local anesthesia that don’t involve a conventional syringe. Utilizing local anesthetic delivery devices can allow a patient to receive profound anesthesia painlessly. This technique is commonly combined with the use of a topical anesthetic that pre-numbs the area which needs to be anesthetized. 

Anxiety related to personal space and bring touched around the mouth can be very impactful and make even simple non-invasive dental care such as a check-up difficult. Phobias of this nature often derive from a feeling of helplessness, or not being in control. In many circumstances, the dental experience can be greatly improved by ensuring patients know they have the power to stop the procedure at any time, and that this will be respected under all circumstances. Many patients who experience this type of anxiety benefit from having the steps in a procedure verbally explained or narrated to them, so they can anticipate any sensations that they may experience. In my clinical experience, the core component of this anxiety relates to trust, and through familiarity with the dental team, and patient exposure to the dental setting this kind of phobia can be overcome.

Many patients suffer from anxiety related to the status of their oral health, the extent of treatment they may need, and the cost related to that treatment. This fear of the unknown can be remedied with clear and forthright communication. Every dentist is trained in clinical diagnosis and intervention, but the time and care taken to communicate in an effective way is subject to an individual’s personality. Some people can be told something once, and they’ll never forget it. Some of us need to be shown something visually, some of us just don’t get it until we experience it first-hand. As a result, finding a dentist capable of communicating your oral health status, quantifying the options available, and establishing an itemised treatment plan in a way that you can understand is essential. Identifying, and understanding is the first step towards owning your oral health, and quantifying a challenge is the first step towards solving it.

Finding a path forward:

1. Identify the aspect of dental treatment that is causing you anxiety. Understand that you are not alone, and dental anxiety is relatively common.
2. Communicate your concerns to friends and family and find someone who can accompany you during appointments. 
3. Communicate with the dentist, or dental practice you feel will be the best fit for you. For some people, prioritising quick appointments and availability is most important. For some, the gender of the doctor, their training, language or cultural background, or specific interest in managing anxious patients are more important. Dentists dedicate their professional lives to helping people through difficult procedures, and many find particular satisfaction in helping anxious or phobic patients overcome their fears.
4. Understand that dental treatment takes time, and it’s not in anyone’s best interest to jump into treating an anxious patient at the first appointment. Anxious patients often “just want it over with” and can further perpetuate their phobia by engaging in unplanned or sporadic treatment.
5. The first appointment is to meet and discuss. If an examination is possible, then this can be completed but discussing the type of anxiety, any possible triggers, and how you need to be treated is the most important outcome of this first visit. 
6. Find out the extent of any treatment that is required and ensure this is communicated to you in a way that you fully understand it. There are often a number of different options to solve a dental issue, and it is an important step in anxiety management to derive empowerment from making important decisions about the future of your oral health.
7. Taking the first step: By this stage you will have identified extent of your dental anxiety, found a suitable and sympathetic dentist, and identified the extent of your oral health needs. It’s at this stage that it’s appropriate to discuss the clinical approach that will best serve your needs, which may involve the experiential minimisation, or trust-building strategies outlined above. The adjunct use of sedation therapies may also be beneficial where appropriate.

Whether overcoming dental anxiety is to eat comfortably or is to strengthen the influential psychosocial components of self-esteem, the necessity for oral health is important for everyone. Developing an empathic and trustful relationship with an oral healthcare professional is possible and feeling empowered to approach this challenge on your own terms can become a source of strength which impacts across many aspects of our lives.

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