Some people don’t look forward to dental appointments any more than they look forward to visits to a physician. Most dental procedures aren’t painful. However, just being examined can make people feel stressed.

Most people can live with having some anxiety about going to the dentist. For those with dental phobia, however, the thought of a dental visit is terrifying. They may be so frightened, in fact, that they’ll do just about anything to avoid a dental appointment.

A phobia is an intense, unreasonable fear. People can fear a specific activity, object or situation. People with dental phobia often put off routine care for years or even decades. To avoid it, they’ll put up with gum infections (periodontal disease), pain, or even broken and unsightly teeth.

Dental anxiety and phobia are extremely common. It has been estimated that 9% to 15% of Americans avoid seeing the dentist because of anxiety and fear. That’s about 30 million to 40 million people. In a survey by the British Dental Health Foundation, 36% of those who didn’t see a dentist regularly said that fear was the main reason.

People often use the words “anxiety” and “phobia” to mean the same thing, but they are different.

Those with dental anxiety will have a sense of uneasiness when it’s time for their appointments. They’ll have exaggerated or unfounded worries or fears. Dental phobia is a more serious condition. It’s an intense fear or dread. People with dental phobia aren’t merely anxious. They are terrified or panic stricken.

People with dental phobia have a higher risk of gum disease and early tooth loss. Avoiding the dentist may have emotional costs as well. Discolored or damaged teeth can make people self-conscious and insecure. They may smile less or keep their mouths partly closed when they speak. Some people can become so embarrassed about how their teeth look that their personal and professional lives begin to suffer. There is often a serious loss of self-esteem.

People with dental phobia also may suffer from poorer health in general, and even lower life expectancy. This is because poor oral health has been found to be related to some life-threatening conditions, such as heart disease and lung infections.

There are varying degrees of dental anxiety and phobia. At the extreme, a person with dental phobia may never see a dentist. Others may force themselves to go, but they may not sleep the night before. It’s not uncommon for people to feel sick — or, in some cases, to actually get sick — while they’re in the waiting room.

Dental phobia, like other mental disorders, can be treated. Without treatment, dental phobia is likely to get worse over time. That’s partly because emotional stress can make dental visits more uncomfortable than they need to be.

People who are unusually tense tend to have a lower pain threshold. This means they may feel pain at lower levels than other people. They may need extra anesthetic or other pain treatments. They may even develop stress-related problems in other parts of the body. For example, they may have headaches or muscle stiffness in the neck or back.

Causes of Dental Anxiety and Phobia

People develop dental anxieties and phobias for many different reasons. When researchers interview patients, however, a few common themes emerge.

Pain — In a survey of people who had not seen a dentist for 12 months, 6% reported fear of pain as the main reason. The fear of pain is most common in adults 24 years and older. This may be because their early dental visits happened before many of the advances in “pain-free” dentistry.

Feelings of helplessness and loss of control — Many people develop phobias about situations — such as flying in an airplane — in which they feel they have no control. When they’re in the dental chair, they have to stay still. They may feel they can’t see what’s going on or predict what’s going to hurt. It’s common for people to feel helpless and out of control, which may trigger anxiety.

Embarrassment — The mouth is an intimate part of the body. People may feel ashamed or embarrassed to have a stranger looking inside. This may be a particular problem if they’re self-conscious about how their teeth look. Dental treatments also require physical closeness. During a treatment, the hygienist’s or dentist’s face may be just a few inches away. This can make people anxious and uncomfortable.

Negative past experiences — Anyone who has had pain or discomfort during previous dental procedures is likely to be more anxious the next time around.

Symptoms

There isn’t a clear boundary that separates “normal” anxiety from phobia. Everyone has fears and concerns and copes with them in different ways. However, the prospect of dental work does not need to fill you with terror. If it does, then you may need some help overcoming the fears.

Some of the signs of dental phobia include:

• You feel tense or have trouble sleeping the night before a dental exam.
• You get increasingly nervous while you’re in the waiting room.
• You feel like crying when you think of going to the dentist. The sight of dental instruments — or of white-coated personnel in the dentist’s office — increases your anxiety.
• The thought of a dental visit makes you feel physically ill.
• You panic or have trouble breathing when objects are placed in your mouth during a dental appointment.

If this describes you, you need to tell your dentist about your feelings, concerns and fears. He or she will help you overcome these feelings by changing the way you are treated. You also may be referred to a mental health professional.

09/18/2013
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