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For The Independent
October 17, 2006
Are You Afraid of Dentists?
By Dr. Tareq Khalifeh, DDS

Is the mere thought of going to the dentist enough to make your heart pound, your palms sweat, and your mouth go dry? You might be surprised to discover that you’re not alone. People of all ages and backgrounds are affected by anxiety about dental procedures. The degree of anxiety can vary widely, from basic nervousness to downright terror. People who suffer from the most extreme form of dental anxiety are truly terrified at the prospect of sitting in the dental chair, let alone opening their mouths and letting the dentist do even standard preventive care procedures.

 

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Such pronounced fear often leads people to avoid dental care. As the health of the teeth and gums deteriorates, people with severe dental phobia endure pain and loss of self-esteem rather than face the prospect of visiting the dentist. Paradoxically, this often leads to oral health problems that can only be remedied with highly invasive procedures. Tooth decay left untreated will eventually destroy teeth and gums, requiring difficult oral surgeries, tooth extractions and replacements. Without regular screenings, early signs of oral cancer go undetected, leading to life-threatening illness.

It may be helpful to distinguish between different levels of dental fear, and the possible causes. Then you can identify steps you can take to deal with the problem.

1. Dental Anxiety. Most people experience some degree of nervousness about dental procedures, especially if they're about to have something done which they've never experienced before. You may be anxious about specific aspects of dental treatment. You may dislike being in such close contact with someone you don't know very well. Small children are usually very frightened by the sight of the dental chair, the bright lights, and the idea that someone they don’t know is going to put their fingers into their mouths. But adults can experience this same phenomenon, particularly when facing the prospect of injections, drilling, or other procedures.

2. Dental Fear. Dental fear is what you feel when your nervousness is pronounced enough to evoke the fight-or-flight response. Your body releases adrenaline, which increases your heart rate and dilates your blood vessels. Your mouth gets dry, your hands get clammy, and you become consumed by your anxiety. Dental fear often comes from a prior experience that was unpleasant, and the fear that it may be repeated. You have a pretty clear idea of what to expect and are frightened of it.

3. Dental Phobia. This is a much stronger form of dental fear, in which the mere thought of a dentist evokes the fight-or-flight response, often so strongly that you will avoid dental care at all costs until either a physical problem or the psychological burden of the phobia becomes overwhelming. Phobias can become so intrusive that patients obsess about their teeth and the mere sight of a toothpaste commercial can produce a pronounced reaction.

Dealing with Dental Fear
Whatever degree of fear you are experiencing, you should first understand that you are not alone. Dental fear is a widespread phenomenon long recognized and monitored by the dental profession. Scientific studies into its causes and treatment have helped dental professionals develop helpful approaches to minimize the discomfort and fear of their patients.

In fact, a study reported in 2003 even found that overall dental fear levels in the American population have declined, despite overall increases in anxiety in our society as a whole. The study, reported in the Journal of the American Dental Association, reported that 63 percent of adults surveyed in 1997 felt that less pain was involved during a dental visit as an adult than it was as a child. The authors postulated that advancements in less-invasive dental procedures in the past three decades-- lasers, bonding procedures, and other less technically threatening treatments—have had a positive impact on the problem of dental fear in our society.

The authors reviewed more than 200 articles. They examined and compared 19 studies involving more than 10,000 adults to assess any mean anxiety scores for college students and general adult samples. They used four measures of dental anxiety. “ The fact that dental anxiety is not rising when dentists are treating increasingly anxious patients is a tribute to advances made in dental technology and patient management skills,” wrote investigators from the University of Kentucky’s College of Medicine.

This good news may not make you feel better if you are one of the people who get very frightened about going to the dentist. In this case, you should know that there are many resources available to help you, including online information and chat resources where you can find advice, counsel, and camaraderie with fellow sufferers. (See, for example, http://www.dentalfearcentral.org.)

There are also specific steps you can take. First, you need to find a caring, supportive dentist. If you are afraid of even approaching a dentist for support, either because you’ve had a bad experience in the past or you’re mistrustful of the profession as a whole, talk to your friends and neighbors for recommendations of dentists they trust. You might even ask a friend to make some calls for you to find dentists who specialize in treating nervous patients. You may want to verify the licensing status of a dentist you’re considering by visiting the State Dental Board online. (In New York, you can easily look up the licensing status of any dentist at http://www.op.nysed.gov/opsearches.htm.)

Make an appointment just to discuss your anxiety. Ask if you can book an appointment just to talk, preferably at a time when you wont have to wait in the reception area. Take a friend or relative with you. Be open about your fears and ask how the dentist and his or her staff can help you deal with them. Dentists who have recently begun their practices may have benefited from modern dental school curricula, which include specific training on dental anxiety and dental phobia.

Some of the strategies your dentist might be able to offer include:
Going slowly. You might need to ease into dental visits by setting up a first visit where you just sit in the chair, waiting until the next visit to have an X-ray and examination. This phased approach can give you confidence and will help to reduce your anxiety.

Agree on signals. Nobody feels much control when sitting in a dentist’s chair with his or her mouth open. To restore a sense of control, you and your dentist can agree on a signal - such as a raised hand - that tells the dentist you need to stop for a break.

Help with specific fears. Maybe you’re particularly afraid of the drill, or have had a bad experience with Novocain. The more your dentist understands about your fear, the more he or she can be sensitive to your needs.

Having choices: In cases of extreme fear, some dentists will agree to use sedation to temporarily relax you. Sedation can be administered using a gas and air mixture through breathing mask, intravenously, or with sedative tablets or syrup.
As a result of this discussion, your dentist may recommend psychotherapy and counseling to help you deal with your anxiety. This is often helpful to patients suffering from post-traumatic stress disorder related to a prior dental experience or other traumatic event, or from obsessive disorders, generalized depression, or generalized anxiety. Such treatment can help you face your fear gradually, so you can cope with it.

Your dentist may recommend other techniques. For example, some people find it helpful to distract themselves with music, focused concentration, or deep breathing exercises. Hypnotherapy can help some people to receive dental treatment, too, although it doesn't work for everybody.

Whatever you do, don’t put off getting the help you need. Dental problems can be very painful, and will not go away on their own. Untreated oral health problems not only diminish your confidence and self-esteem, but also can severely impact your overall health. Regardless of the level of fear you experience, know that you can get help to keep a healthy, bright smile.

Dr. Khalifeh owns Philmont Family Dentistry, located on Rte. 217 in Philmont. You can reach him at 518-672-4077.

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