It has been estimated that more than half of all people in the Untied States will never see a dentist for regular care. Fear of the dentist, or in more severe cases, dental phobia, is the main reason that many people avoid the dentist. People with dental fears and phobias have many different reasons for their feelings. The vast majority will recall a past traumatic experience during a dental visit, and others fear being confronted by a dentist about the condition of their mouths. Negative dental stories told by family, peers, on the evening news and in advertisements can compound the fear and anxiety that these patients have.
Many of the patients that I treat who have a high level of dental fear often recount a frightening experience that they had years ago at a dental visit. The most common are stories of when the patient was a child, and that the dentist was either rough, insensitive, or caused them pain. These childhood memories are so vivid, that they cause anxiety and fear for years after the incident. Some patients fear being scolded by the dentist for neglecting their mouths. They will nervously say things like “I know I should have come earlier” or “Is this the worst mouth you ever saw” expecting the dentist to reprimand them like a disapproving father or a marine drill Sargent. It is no wonder that people with these preconceived notions fear going to the dentist. They should realize that the dentist is there to help, support and educate, not to browbeat. Most people have some level of anxiety when they go to the dentist. When the anxiety becomes so intense that the person will do anything to avoid going to the dentist, that is when it becomes a phobia. Dental phobics will virtually live on over the counter painkillers and other home “remedies” to alleviate the pain of untreated infected teeth. They will avoid eating on the side of their mouth that has painful or broken teeth, as well as make, and then break dental appointments at the last minute. These behaviors can have dangerous physical and emotional effects. Untreated dental infections can cause pain and swelling that can be life threatening if the swelling blocks the passage of air into the throat preventing it from getting into the lungs. The broken, discolored, and missing teeth of some dental phobics can cause social problems, especially a lack of self-esteem.
People with dental fears and phobias have a number of options available to help them get the dental care that they need. The dentist can prescribe a mild sedative such as Valium to take prior to the dental visit, and then give nitrous oxide (laughing gas) during treatment. As a resident at Mount Sinai Medical Center, we treated dental phobics with sophisticated methods of behavioral management. One technique was called systematic desensitization, where phobic patients where exposed to various dental instruments and devices over time, until they became more familiar and less threatened by the dental environment. Another technique involved breathing and relaxation. I have found that these techniques are rarely needed for most fearful patients. The single most important way for a dentist to help a patient overcome their fears is to have open communication, be sensitive to the fearful patient’s needs, and take those fears very seriously. Once trust is established, fear virtually disappears. In very rare instances with highly phobic patients, these methods may not be enough. For these patients, dental treatment under IV sedation or general anesthesia should be considered, despite the increased risks and expense.