Dental anxiety and phobia

Dental anxiety

Dental anxiety is fear, anxiety or stress associated with a dental setting. Being scared to visit the dentist can result in delaying or avoiding dental treatment.

Things like needles, drills or the dental setting in general can trigger dental anxiety.

When dental anxiety is severe, causing irrational fear and avoidance of the dentist, this can be classified as a dental phobia.

Some mental health conditions including generalised anxiety disorder and post-traumatic stress disorder (PTSD), or a previous history of head and neck trauma can increase the risk of a person experiencing dental anxiety. Other conditions such as depression, bipolar disorder or schizophrenia may also increase the risk of anxiety disorders, including dental anxiety.

Signs and symptoms of dental anxiety

People with dental anxiety may experience:

• sweating
• racing heartbeat (tachycardia) or palpitations
• low blood pressure and possible fainting (syncope)
• visible distress, crying or signs of panic
• withdrawal, or using humour or aggression to mask anxiety.

Some anxious people will routinely miss or avoid dental appointments and may find it difficult to undergo dental treatment, regardless of whether it is simple or complex.

How dental anxiety or phobia can affect your oral health

Avoiding the dentist can result in dental disease getting worse, and a greater need for emergency care or more complex treatment. It can also feed the underlying problem of dental anxiety; this is known as the 'vicious cycle of dental anxiety'.

Regular dental check-ups, cleans and X-rays of the teeth can prevent dental disease and help the dentist find any problems early so that simpler and less invasive treatments are needed. During regular check-ups, dentists also check for signs of mouth cancer. This is especially important for those who smoke or regularly drink alcohol, and even more so for those who do both. If you notice a mouth ulcer that lasts for longer than 2 weeks, get it checked by a dentist as soon as you can.

Most dental disease is lifestyle-related and preventable. By avoiding going to the dentist, not only are you more likely to need more complex treatments when you do finally attend, but you are also missing out on learning how to better care for your oral health.

The lifestyle factors that lead to dental disease (regularly consuming sugary food and drinks, smoking and regularly drinking alcohol) are very similar to those that lead to diabetes, obesity, heart disease, stroke and some cancers. So, it is important to live a healthy lifestyle and to take care of your oral health by brushing your teeth twice a day and flossing once a day.

Causes of dental anxiety and phobia

Some causes of dental anxiety are:

• a traumatic dental experience or other healthcare experience
• previous trauma to the head and neck
• other traumatic experiences, including abuse
• generalised anxiety, depression or post-traumatic stress disorder
• the view that the head is a personal area and accessing 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 where you feel you cannot escape), claustrophobia (fear of closed spaces) or obsessive compulsive disorder.

Who can be affected by dental anxiety

Dental anxiety is common and can affect people of any age.

Children who have had bad dental experiences can likely overcome their fear if they are supported during further dental visits. Adults who are anxious about dental care tend to remain anxious throughout life.

Many anxious dental patients can find a dentist who can support them appropriately to cope with going to the dentist.

How to manage dental anxiety or phobia

There are many ways to help people manage dental anxiety or phobia. It is important to let the dentist know if you experience any level of dental anxiety. Open discussion around the individual triggers of anxiety can help the dentist work with you to tailor a management plan.

Some psychological coping techniques include:

• deep breathing
• meditation
• distraction (such as listening to music or the use of devices)
• guided imagery
• progressive muscle relaxation
• agreeing with your dentist on a signal to stop during the treatment for a break (such as raising your left pointer finger or hand)
• using a weighted blanket (bring your own)
• hypnosis.

Referral to a psychologist can be helpful too. Short, targeted therapies including cognitive behavioural therapy can be very successful.

Severe dental anxiety or phobia may require medical management with relative analgesia (happy gas), anxiety relieving medication, conscious sedation (twilight sedation) or general anaesthesia. 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 prevent you from having some types of sedation. Talk to your dentist and/or doctor for further information. You should avoid driving home after having any sedation.

Relative analgesia (happy gas)

Known as happy gas or laughing gas, nitrous oxide can help people relax during dental 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 will still be awake. You can talk to the dentist, and hear what they say to you, but you won’t necessarily remember everything once the visit is over.

For most people, the relaxed sensation created by nitrous oxide sedation is very pleasant. Occasionally people don’t like the sensation it creates, and you can consider other options.

Anxiety relieving medication (oral anxiolytic tablets)

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 one hour before the dental appointment.

Medication should only be taken following discussion with your dentist or doctor.

Conscious sedation

This type of sedation involves receiving medication through a drip placed into a vein of the arm or hand. Intravenous (IV) sedation is provided by a dental sedationist (a dentist with advanced training in sedation) or an anaesthetist. It can be undertaken at a dental practice that has additional equipment, or in a hospital.

Under IV sedation (sometimes known as twilight sedation), you are relaxed and may drift off into a light sleep, but can respond to verbal prompts. Possible side effects include drowsiness and nausea after the procedure.

General anaesthesia

Treatment under a general anaesthetic is carried out in a hospital setting by the dentist and an anaesthetist. General anaesthesia involves patients being 'fully asleep'. Some possible side effects include nausea and a longer recovery time than other forms of sedation.

You will need a pre-operative (before treatment) visit to the dentist, and may also need a post-operative (after treatment) visit. The anaesthetist will also need to assess you before the general anaesthetic.

Some dental treatments are better provided over several visits. This means that your treatment options may be more limited if you want all your dental treatment under general anaesthetic.

In some instances, treatment to prepare the mouth will occur in the dental chair in a separate appointment before the general anesthetic session. This is to make best use of the general anaesthetic session.

A general anaesthetic can be a good option for some people, but it doesn’t help you learn coping strategies or get you used to going to the dentist. General anaesthetic works best when used in conjunction with other strategies, so that some treatments can be done without it. This way, the general anaesthetic session time is kept for the treatments that are most difficult to cope with.

Where to get help

• Your dentist
• A specialist in special needs dentistry
• Australian Dental Association – ‘Find a dentist’ Tel. (03) 8825 4600
• Oral Health Victoria – provides public dental services through the Royal Dental Hospital of Melbourne and community dental clinics, for eligible people.
• Psychologist

The Australian & New Zealand Academy of Special Needs Dentistry helped create and review this content.