If I had a dollar for every time someone told me they disliked attending an appointment with the dentist, I might now be a millionaire, several times over. Fortunately for my mental health and ego, I never take it too personally. I can sort of relate to this sentiment about not liking the dental office or the dentist; I have a sister that used to scream through her dental appointments. If my memory serves me well, I recall at the time that the dental office smelled weird, and there were high-pitched sounds intermittently spaced between my sister’s screams and wails. It was not something for me to look forward to, as I was usually next in line. For some unknown reason though, despite all the drama preceding my dental appointment, I do not recollect having a bad dental experience myself. I think I either really liked my dentist or was too daft to put two and two together regarding my sister’s screams and the dentist sitting before me. I vote for the latter.
Many years on, I now recognise that foreboding feeling while I was waiting for my turn at the dentist to be a form of dental anxiety, even though it was a relatively mild one. Dental anxiety is a term loosely used to describe fear or heightened stress levels in the dental setting and can come in many forms. It can range from mild irritation of having to be at the dentist, to a full-blown panic attack that can start from the very moment the conscious mind registers the thought of attending a dental appointment. For most people, the anxiety is manageable, but for a small fraction of the population, the fear is very real and can be irrational. Dental anxiety can stem from many factors. These can include:
- The smell of the dental office
- Sounds or equipment related to dental treatment
- The subjective feeling of loss of control
- Fear of pain/needles
- Previous bad dental experience (personal, or that of friends and relatives)
- Too many horror movies (or even cartoons) depicting dentists in a bad light
- Frequent threats from parents to their children about “how the dentist will pull out all your teeth.”
- Embarrassment about the state of their oral health
- Having little to no understanding of what is coming
- Having trust issues, usually secondary to mental or physical trauma
Additionally, I think back in the day; several other factors contributed to the fear of dental treatment or dentists; this includes:
- Use of dental instruments that hailed from the Medieval times
- Lack of effective pain management during and after dental treatment
- Relative impatience of dentists due to unfavourable dentist to patient ratios (i.e. the dentists were just overworked)
- Less available treatment options resulting in early (and sometimes unnecessary) removal of teeth
What are the tell-tale signs?
Frequently, the symptoms of dental anxiety will include distress and a heightened state of mind, but it can also show in the following ways:
- Increased heart rate or heart palpitations
- Visible distress (e.g. crying, hyperventilating, sweaty and cold palms, frequent wringing of hands, talking much faster than normal, etc.)
- Withdrawal, or using humour or aggression to mask anxiety
- Gagging, or inability to swallow when the dentist tries to place any dental instrument near the mouth.
- Uneasiness about the upcoming dental appointment
How dental anxiety can affect you
Minor dental anxiety usually results in minor apprehension or irritation when at the dentist; patients easily surmount this. However, severe dental anxiety, typically irrational, can result in delays in seeking dental treatment, or complete avoidance of going to the dentist until something goes wrong; this usually comes in the form of severe pain or extensive facial swelling.
Misconceptions about dental treatments and over-thinking the whole event can exacerbate this fear and make the dental visit much more than the patient can mentally cope. I kid you not, I have seen grown men reduced to a shivery puddle as they crawled through the doors of the dental office, usually with a concerned chaperone making sure that they made it to the appointment.
Studies have shown that many patients with dental anxiety end up losing their teeth earlier on in life. Early loss of natural teeth can result in poorer nutrition, reduced quality of life, increased general health problems, and diminished self-esteem. The financial burden of complex dental work or tooth replacement options can also be debilitating to some.
Some tips on how you can deal with dental anxiety
- Verbalising your concerns and fears to the dental staff
- Book for the first dental appointment of the day, so that you are not kept waiting (sitting around in the dental waiting room can increase your anxiety levels), and no other plans can conveniently get in the way (so that you don’t have an excuse to reschedule your dental appointment)
- Bring earphones and your favourite music (on your phone) along for the appointment
- Practice meditation or controlled breathing
- Bring a friend with you to the dental appointment to give you emotional support
- Using a stress ball
What other options are available to manage dental anxiety?
- Hypnosis by a certified practitioner
- Anti-anxiety medications (e.g. Valium) from your medical doctor
- Relative analgesia (nitrous oxide, aka laughing gas)
- IV sedation by a certified anaesthesiologist
- General anaesthesia by the certified anaesthesiologist in a hospital setting
The above options are used as appropriate to the patient’s level of dental anxiety, but not all options are available to every dentist, and some pre-existing medical conditions can result in the exclusion of some options for the patient.
How now, brown cow?
Over the years that I have successfully managed patients with dental anxiety, I have found that open communication between the dentist and the patient is essential. It is critical for the dentist to listen to and acknowledge the patient’s concerns and fears, and not just offhandedly dismiss them. Frequent breaks for the patient between steps of the dental procedure, and verbalising the next step to the patient, can help them manage their expectations and anxiety levels. Without a doubt, the above management tips are not foolproof and may have to be used in conjunction with appropriate medications or some form of sedation.
Prevention is better than cure. Yes, it is cliché, but this is still the advice I give most of my patients, especially to patients with severe dental fear. In simple terms, if you don’t like coming to the dentist, take extremely good care of your teeth and gums; this would generally reduce the need for complex (and sometimes painful) dental treatment, and also curtail the chance of unplanned dental visits. There is one piece of bad news I have for patients with dental anxiety: To reliably avoid unpleasant dental visits, you have to plan frequent visits to the dentist, so that we can institute preventive dental care, and also detect any problems at initial stages; this would allow us to deal with any issues early on, affording the possibility of minimal intervention.