This week's topic is an important one for many people.  Fear of dental visits and procedures affects a significant portion of Americans in differing degrees, and left untreated, can have serious health effects.

Did You Know?

• It is estimated that as many as 75% of US adults experience some degree of dental fear, from mild to severe.
• According to studies, women and younger people tend to more fearful than average.
• Approximately 5 to 10 percent of U.S. adults are so fearful of  receiving dental treatment that they avoid dental care at all costs.
• Many of these fearful people will only seek dental care when they have a dental emergency, such as a toothache or dental  abscess.  This leads to a cycle of dental problems since they don't take proper care of their dental health.

Neglecting your oral health because of dental fears may lead to chronically infected gums--which may seriously compromise your ability to chew and digest. You may lose teeth--which may affect your speech and create an unattractive smile. You may develop consistent bad breath. All these things are likely to create social and psychological barriers in your relationships.  It is also well documented that poor oral health can have resounding effects on your general health--including heart problems and overall immune function problems.  The good news is that there are many ways to combat dental fears, and the success rate in managing these fears is extremely high.

Given the seriousness of the problem, we need to understand it more, and know what can be done.  Here is what you need to know.

What is the problem?

There can be several levels of fear about dental visits and procedures, and there is a  difference between anxiety, fear and phobia.

• Dental anxiety is a reaction to an unknown danger. Anxiety is extremely common, and most people experience some degree of dental anxiety especially if they're about to have something done which they've never experienced before. Basically, it's a fear of the unknown.
• Dental fear is a reaction to a known danger ("I know what the dentist is going to do, been there, done that - I'm scared!!"), which involves a fight-or-flight response when confronted with the threatening stimulus.
• Dental phobia is a more intense form of dental fear.  It may occur when simply thinking about an upcoming visit or procedure, and can be so intense as to cause a person to feel sick and/or overwhelmed.

How does the problem develop?

Any of these levels of dental phobia can come about for many different reasons, including the list below described most often by people and researchers:

• A previously unpleasant visit to a dental practice. This could be for many reasons, including a painful procedure or even careless remarks made by a dentist or hygienist that adversely affected the patient's dental experience.
• Uncaring dentist and dental staff.  Research (Weiner et al, 1999) has shown that a dentist who is perceived as cold and controlling can have a huge psychological impact on a patient. Pain inflicted by a dentist who is perceived as caring is much less likely to result in psychological trauma.
• Stories from friends and family regarding visits to the dentist.
• A sensationalized and frightening depictions in the media of dentists.
• A history of abuse.  People who have been physically, mentally, or sexually abused (particularly in childhood) report a higher incidence of dental phobia than average.
• The feeling of a lack of control in the dental chair that makes the situation uncomfortable.
• Self consciousness about the poor state of one's teeth, and the resulting embarrassment that prevents the patient from discussing the fact with the dental staff.
• A negative feeling at the thought of visiting a dentist due to the use of dental gowns, masks, and latex gloves.

Symptoms

There isn't a clear boundary that separates "normal" anxiety from phobia.  Some of the signs of dental fear in general include:

• A feeling of tension or having trouble sleeping the night before a dental exam.
• Increasing nervousness while in the waiting room.
• A feeling like crying when thinking of going to the dentist. The sight of dental instruments — or of white-coated personnel in the dentist's office — increases the anxiety.
• The thought of a dental visit makes one feel physically ill.
• Panic or difficulty breathing when objects are placed in the mouth during a dental appointment.

If this describes you or a loved one, you need to tell your dentist about these feelings, concerns and fears. He or she will help determine the level of fear, and help overcome these feelings by changing the way treatment is provided.

How can the problem be treated?

Dentists have learned many techniques to help patients overcome their fears.  Treatments for dental fear often include a combination of behavioral and pharmacological techniques.  (A patient also may sometimes be referred to a mental health professional for severe cases.)

Treatments provided by your dentist can start with providing a caring, nurturing environment.  Many if not most people who've suffered with dental fears and phobias and overcome these fears believe that having found the right dentist made all the difference.  A caring, compassionate dentist will use "behavioral" strategies such as positive reinforcement (e.g. praising the patient), the use of non-threatening language, and tell-show-do techniques.  This technique involves verbal explanations of procedures in easy-to-understand language (tell), followed by demonstrations of the sights, sounds, smells, and tactile aspects of the procedure in a non-threatening way (show), followed by the actual procedure.  Other more advanced techniques include teaching individuals relaxation techniques, such as diaphragmatic breathing and progressive muscle relaxation, as well as cognitive, or thought-based techniques--which teach the patient to change his/her approach to thinking about the issue.

Dentistry can also be pain-free.  Pharmacological techniques to manage dental fear range from mild sedation to general anesthesia, and are often used by dentists in conjunction with behavioral techniques.  Dentists may prescribe an oral sedative, such as a benzodiazepine like temazepam (Restoril), alprazolam (Xanax), diazepam (Valium), or triazolam (Halcion). 

Also, one common anxiety-reducing medication used in dentistry is nitrous oxide (also known as “laughing gas”), which is inhaled through a mask worn on the nose and causes feelings of relaxation and dissociation.  Most patients feel no discomfort whatsoever and after treatment they have little or no memory of their visit.  "Oral Sedation Dentistry" protocols have been used safely for over 30 years with millions of dental procedures.

Your dentist can discuss the appropriate approach with you in consultation, and help you overcome your fears.

Summary

While fears of dental procedures can seem overwhelming to a significant portion of the population, there are many ways to treat the problem successfully.  Successful treatment starts with finding a caring, gentle dentist who is aware of the latest techniques for treating dental fears.  The second step is communicating openly about the fears and feelings.  The dentist can then provide both behavioral and/or pharmacological approaches as appropriate for the individual patient.

As the problem is treated, and the patient is made to fell safer and more confident, he/she will gain the benefit of better oral and overall health, as well as increased sense of confidence and well-being from overcoming an obstacle.

Here's wishing you good luck in dealing with your fears, and the good oral and dental health that you deserve.

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