Dental anxiety and phobia

Being scared to visit the dentist can lead people to delay or avoid dental treatment. Triggers such as needles, drills or the dental setting in general can bring on dental anxiety.

When dental anxiety becomes severe and involves an irrational fear that causes someone to avoid the dentist altogether, it can be classed as a dental phobia.

What dental anxiety is#

Dental anxiety is fear, anxiety or stress connected with a dental setting. A number of factors can increase the risk of experiencing it, including:

• a traumatic dental experience or other difficult healthcare experience
• previous trauma to the head and neck
• other traumatic experiences, including abuse
• generalized anxiety, depression or post-traumatic stress disorder
• the view that the head is a personal area and that reaching the mouth is an invasion of personal space
• fear of loss of control
• trust issues
• anxiety associated with other conditions such as agoraphobia (fear of being in situations you feel you cannot escape), claustrophobia (fear of closed spaces) or obsessive compulsive disorder

Some mental health conditions, including generalized anxiety disorder and post-traumatic stress disorder, may also increase the risk of anxiety disorders, including dental anxiety.

Signs and symptoms#

People with dental anxiety may show their distress in different ways. Some withdraw, while others use humor or aggression to mask how they feel. Many will routinely miss or avoid appointments, and may find any treatment difficult to face, whether it is simple or complex.

Physical and emotional signs can include:

• sweating
• a racing heartbeat (tachycardia) or palpitations
• low blood pressure and possible fainting (syncope)
• visible distress, crying or signs of panic

How dental anxiety or phobia can affect your oral health#

Avoiding the dentist can allow dental disease to develop and get worse, leading to a greater need for emergency care or more complex treatment. The longer treatment is put off, the harder it can feel to attend, which in turn feeds the underlying anxiety. This pattern is sometimes called the ‘vicious cycle of dental anxiety’.

Regular check-ups, cleans and X-rays of the teeth can prevent dental disease and help the dentist find problems early, so that simpler and less invasive treatments are needed.

During regular check-ups, dentists also look for signs of mouth cancer. This is especially important for people who smoke or regularly drink alcohol, and even more so for those who do both. If you notice a mouth ulcer that lasts longer than two weeks, have it checked by a dentist as soon as you can.

Most dental disease is lifestyle-related and preventable. By avoiding the dentist, you are not only more likely to need complex treatment when you do attend, but you also miss out on learning how to better care for your oral health, such as brushing twice a day and flossing once a day. The lifestyle factors that lead to dental disease (regularly consuming sugary food and drinks, smoking and regularly drinking alcohol) are similar to those that contribute to diabetes, obesity, heart disease, stroke and some cancers. So it helps to live a healthy lifestyle and care for your oral health.

Who can be affected#

Dental anxiety is common and can affect people of any age. Children who have had bad dental experiences can often overcome their fear if they are supported through later visits. Adults who are anxious about dental care tend to stay anxious throughout life, but many can find a dentist who supports them appropriately so they can cope with attending.

How to manage dental anxiety or phobia#

It is important to let the dentist know if you experience any level of dental anxiety. Open discussion about your individual triggers helps the dentist tailor a management plan with you.

Some psychological coping techniques include:

• deep breathing
• meditation
• distraction, such as listening to music or using a device
• guided imagery
• progressive muscle relaxation
• using a weighted blanket (bring your own)
• hypnosis
• agreeing on a signal to pause for a break during treatment, such as raising a hand or finger

Referral to a psychologist can also help. Short, targeted therapies, including cognitive behavioral therapy, can be useful.

Medical management and sedation#

Severe dental anxiety or phobia may need medical management. Options can include relative analgesia (happy gas), anxiety-relieving medication, conscious sedation (twilight sedation) or general anesthesia. Not all dentists offer treatment under sedation.

Some pre-existing medical conditions or medications may affect the type of sedation you can have, or may rule out certain types. Talk to your dentist and doctor for more information. You should avoid driving home after having any sedation.

Relative analgesia (happy gas)#

Also known as happy gas or laughing gas, nitrous oxide can help people relax during treatment. A mask is fitted to your face and you breathe a mixture of oxygen and nitrous oxide. It takes effect within a few minutes and wears off quickly.

You will feel relaxed but stay awake. You can talk to the dentist and hear what they say, but you may not remember everything once the visit is over. For most people the relaxed sensation is pleasant. Occasionally people dislike it, and other options can be considered.

Anxiety-relieving medication#

Oral anxiety-relieving (anxiolytic) medications, such as temazepam, are sometimes prescribed by dentists or doctors to help anxious patients relax. A short-acting, small, single dose is usually taken about an hour before the appointment. Medication should only be taken after discussion with your dentist or doctor.

Conscious (IV) sedation#

This involves medication given through a drip placed into a vein in the arm or hand. Intravenous (IV) sedation is provided by a dental sedationist (a dentist with advanced training in sedation) or an anesthetist. It can be done at a dental practice with the right equipment, or in a hospital. Under IV sedation, sometimes called twilight sedation, you are relaxed and may drift into a light sleep but can still respond to spoken prompts. Possible side effects include drowsiness and nausea afterwards.

General anesthesia#

Treatment under general anesthetic is carried out in a hospital by the dentist and an anesthetist. General anesthesia means the patient is fully asleep. Possible side effects include nausea and a longer recovery time than other forms of sedation. You will need a pre-operative visit to the dentist and may also need a post-operative visit. The anesthetist will also assess you beforehand.

Some dental treatments are better provided over several visits, which can limit your options if you want all treatment done under one general anesthetic. In some cases, treatment to prepare the mouth is carried out in the dental chair at a separate appointment before the general anesthetic session, to make best use of that session.

A general anesthetic can be a good option for some people, but it does not help you learn coping strategies or get used to attending the dentist. It works best alongside other strategies, so that some treatments can be done without it. That way, the general anesthetic session is kept for the treatments that are hardest to cope with.

Key points#

• Being scared to visit the dentist can lead to delaying or avoiding dental treatment.
• A history of post-traumatic stress disorder or head and neck trauma can increase the risk of dental anxiety.
• Other mental health conditions may also increase the risk of anxiety disorders, including dental anxiety.
• Avoiding the dentist can let dental disease get worse, leading to a greater need for emergency or complex care.
• Most dental disease is lifestyle-related and preventable.

Where to get help#