Dental phobia: The fear of dentists

What is a phobia?

In medical terms, a phobia is an exaggerated, unfounded, and persistent angst or panic of particular situations, objects, activities, or persons, generally known as the phobic stimulus. It is expressed as an excessive and inappropriate need to avoid the cause of the fear. Well-known examples of phobias are for example the fear of flying, the fear of spiders, and claustrophobia. The term phobia however is also used in the general sense for aversions of any kind.

 

Who is afraid of the dentist?

Almost everybody has at some point experienced some kind of fear before going to the dentist, but most of the time this does not stand in the way of a regular dental check-up or treatment. In cases of real dental phobia, which is also called dentophobia or odontophobia, the situation is different: In these cases the feeling of panic is so strong that the person suffering from it will try anything to avoid the visit to the dentist. Often, dental treatment will only take place when it can no longer be postponed because the pain becomes unbearable.

 

 

In contrast to a “normal” fear of the dentist, the person suffering from a true phobia may also experience physical symptoms before the treatment. In descending frequency the following is possible:

• Sleep disorders during the night before the treatment day
• Heart throbbing (palpitations)
• Heart racing (tachycardia)
• Dry mouth
• Elevated blood pressure (hypertension)
• Trepidation (tremor)
• Feeling of suffocation
• Hyperventilation (rapid breathing)
• Nausea
• Urge to urinate
• Urge to gag / vomit
• Fainting and hypotension

In general, dental phobias can be found in all age groups, however more often in women than in men.

Factors that may favour dental phobias::

• A generally timid disposition
• Presence of another phobia or psychological illnesses
• Depression
• High level of stress
• Drug consumption and / or alcoholism

According to our experience, anxious patients are also more frequently smokers than the average population. Whereas on average 25% of the adult population smokes, we found that dental phobia patients have a smoking rate of 64%.

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Causes of dental phobia

About 30% of all of our anxious patients reported to have experienced traumatic dental treatments during childhood dental visits as a cause for their dentophobia. Reasons are thought to be pain experienced during these treatments and/or brutal and insensitive conduct by the dentist. Another third of the interviewed patients refer to scary accounts of others, frequently their own parents, as the starting point for their fears. For the remaining third, there do not seem to be any obvious causes for their dental phobia.

The percentage of the latter is most likely much higher. Dental phobia is often a form of primal fear that is rooted deeply in the unconsciousness without any obvious rational causes, similar to the fear of spiders or mice. From our observations it is hard to explain why the number of patients afraid of the dentist has rather increased in the last 20 years, despite the fact that dental medicine today is significantly more “humane” than it used to be in earlier times.

Most frequently named reasons for dental phobia

It is not surprising that almost half of the interviewed patients stated that pain is the main cause for their dental phobia. It goes along with the conventional stereotype idea which associates dental medicine with pain, though most dental procedures performed today are painless.

Fear of shots, or injection phobia, is also a reason often given by dental phobia patients. Today, an injection of local anaesthetics belongs to many dental treatments as a matter of course. It is accepted by most patients as a necessary evil, since it prevents pain during treatment. In cases of injection fears, the extreme fear often displaces these rational considerations. For many patients, these fears are however limited to dental injections, whereas injections by other physicians are accepted without problems.

The fear to lose control and the fear of being helpless also play a part when looking for reasons for dental phobia. From a psychological point of view, the oral cavity is for many people an intimate area, into which the dentist intrudes with his instruments. A considerable number of patients is afraid to lose self-control, even if only partially, during dental treatments.

A gagging or vomiting reflex during dental treatments is commonly associated with the fear of dentists. In many cases dentophobia develops only secondarily, triggered by the patient’s expected fear of the gagging reflex during the treatment (with subsequent loss of control).

Frequently, different sensations contribute to the triggering or amplification of feelings of anxiety in the already predisposed patient, for example:

• Drilling sounds: Especially the high-frequency sound of the so-called “turbine”, a fast running drill operated with compressed air, triggers panic attacks in many dental phobia patients.
• Dentist smell: The typical odour in many dental practices originates from eugenol, an artificial clove oil contained in dental cement and medicines. In the predisposed patient the perception of this smell can cause involuntary panic attacks.
• White coats and dental instruments: The visual perception of the instruments or other attributes associated with former treatment experiences can lead to an anxiety increasing effect in the sense of a conditioned reflex.

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Impacts of dental phobia

People who suffer from an exaggerated fear of dentists avoid appointments as long as they possibly can. Consequently both, regular professional cleanings with a dental hygienist and regular dental check-ups, which are essential for the prevention of dental and gum diseases, are omitted. As a result of poor dental hygiene, a bacterial lining is formed, that can lead to gingivitis and periodontitis, which then makes it easy for cavities to spread. Subsequently, chronic inflammations of the gums and periodontium as well as acute ulcerations can develop. As a result, this leads to a vicious cycle for the pain suffering dental phobia patient: The stronger the complaints and the more psychological strain, the greater becomes the fear of the inevitable visit to the dentist.

Many times these fears are not taken very seriously by friends and family. They are even made fun of. Unfortunately, many dentists also do not have sufficient sympathy. This isolates fearful patients who frequently do not have a trusting person to confide in. Also, increasing tooth damage results in aesthetic impairments and bad breath (halitosis) which adds to the problem. Often the patient is aware of it and is ashamed, dares not to laugh and in general avoids socialising and social activities. Therefore, the danger of social isolation is not to be discounted.

 

Vicious Cycle of dental phobia

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