Understanding Dental Anxiety: Breaking the Cycle of Fear and Avoidance
- Amiytha Vasanthan
- 43 minutes ago
- 5 min read
Racing heart, sweaty palms, feelings faint, and nausea, are just some of the physiological manifestations of dental anxiety experienced by patients and witnessed by dental professionals every day. Working in a general dental practice, I have encountered countless individuals who begin their appointment by declaring, "I hate the dentist," before anything else is said. For many, these feelings extend far beyond simple nervousness.
What is Dental Anxiety?
Dental anxiety is highly prevalent in the UK, with more than half of adults reporting some degree of fear towards dental treatment. This has significant consequences for patients, and influences whether they seek care and how they experience treatment, contributing to poorer oral health outcomes. Specifically, up to 20% of individuals avoid dental care completely due to dental anxiety.
It is important to understand the psychology behind dental anxiety and the ways it can be managed, as an important step towards improving both oral health and overall wellbeing.
The Causes of Dental Anxiety
Dental anxiety can manifest in several ways, including avoidance of dental visits, distress during the appointments, and clear physical symptoms. It exists on a spectrum, ranging from mild apprehension to severe dental phobia or odontophobia (an extreme, persistent and irrational fear of dentists and dental procedures).
The origins of this fear are often complex and multifactorial. For some, it may develop following a negative experience, such as a previous painful procedure. Childhood experiences are particularly influential, as pain or perceived trauma can create lasting negative associations that persist into adulthood and contribute to the development of a phobia. These fears may then be reinforced for the individual themselves by avoiding the dentist, but also across generations through a process known as vicarious learning, whereby parents unintentionally convey their own anxieties to their children, perpetuating a cycle of fear and avoidance.
Another reason for dental anxiety is the anticipation of pain associated with procedures, despite the use of topical numbing gels and anaesthetics. In these cases, behavioural management techniques, such as distractions or controlled breathing exercises, may be useful to help patients manage their anxieties and fear before and during procedures.
Moreover, a trip to the dentist can be overwhelming as it introduces a plethora of sensory stimuli, such as the whirring of drills, the sound of suction devices, the smell of the clinic, bright lights, and unfamiliar metal instruments. These experiences can be particularly intimidating for children and may contribute to dental anxiety later in life.
Popular culture has not always helped either. Many children grow up watching films and television shows that portray dentists as frightening or unpleasant, such as scenes from ‘Finding Nemo’ and ‘Charlie and the Chocolate Factory’. While these portrayals are intended to be humorous, they can reinforce negative stereotypes and shape how children view dental care from an early age.
How Dental Anxiety Affects Oral Health?
Feelings of shame and embarrassment about oral health can play a major role in dental anxiety. People who are worried about the condition of their teeth may postpone seeking dental care due to fears of being judged, creating a cycle in which avoidance leads to further deterioration of oral health and increased anxiety. Many patients hold misconceptions that dentists will criticise their oral health, particularly if they have delayed attending appointments because of their dental phobia.
This issue has become more relevant in the years following the COVID-19 pandemic, during which routine dental attendance was disrupted for many individuals, potentially exacerbating both oral health problems and anxiety.
Once dental anxiety takes hold, it can be difficult to break. Avoiding or cancelling a dental appointment often brings an immediate sense of relief, which can make avoidance feel like the easiest option. However, this can result in the need for more invasive dental treatment in the future due to deteriorating oral health over time, creating a vicious cycle: whereby fear leads to avoidance, avoidance leads to worsening oral health, and the prospect of more extensive treatment increases anxiety about future visits.
Assessing Anxiety in Clinical Practice
As dental clinicians, we can use assessments such as the Modified Dental Anxiety Scale (MDAS) to ascertain the level of anxiety in patients, in order to tailor care plans. This is also a useful method to monitor anxiety, as it may decrease over time if the patient’s experience in the dental setting improves and they become desensitised or acclimatised, thus lessening the anxiety felt.
Quantitative markers of dental anxiety can aid clinicians to adopt a holistic, patient-centred approach to dental care, and help consider non-pharmacological techniques, such as behavioural management, and pharmacological methods where appropriate.
Behaviour Management Techniques
There are several non-pharmacological techniques that dental professionals can use to help reduce anxiety and make appointments feel more manageable.
One approach is graded exposure, which involves techniques such as desensitisation or acclimatisation.
Desensitisation is defined as exposure to anxiety-provoking stimuli with a focus on relaxation techniques, whereas acclimatisation is gradually getting the patient used to the dental setting with the use of dental equipment. For example, a patient might first be introduced to the sights, sounds, and equipment used in the dental surgery before progressing to more anxiety-provoking procedures. In some cases, a dentist may apply numbing gel during one appointment and administer a local anaesthetic at a later appointment, allowing the patient to become familiar with each stage of treatment.
Another commonly used technique is “Tell-Show-Do”, which involves talking the patient through the procedure, demonstrating what will happen, and then carrying it out. This aims to reduce the fear of the unknown and help the patient understand what to expect.
Dentists may also encourage patients to use stop signals, such as raising their hand, to indicate when they need a pause. These regular breaks can help patients feel more in control and remind them that treatment will only continue when they are comfortable. Dentists may also use simple aids, such as noise-cancelling headphones, stress balls, or fidget toys, to support patients’ self-regulation.
Although these techniques may increase the number of visits needed, they can help to address patients’ fears and alter their overall attitude towards dentistry into a more positive one.
For severe anxiety and phobias, individuals may consider Cognitive Behavioural Therapy (CBT), which is an evidence-based psychological treatment where individuals collaborate with therapists and psychologists to reframe negative thoughts and emotions into more rational outlooks.
For people with more severe dental anxiety, additional support may be needed, and pharmacological techniques can be explored, such as sedation and general anaesthesia. Despite the long waiting lists in NHS settings, many prefer to proceed with these interventions for more complex treatments such as extractions.
Promoting Prevention
In modern dentistry, clinicians should strive to offer holistic, patient-centred care to reduce the stigma surrounding dental anxiety and help those who suffer overcome fears and perceive dentistry in a positive manner. Moreover, dental phobia should be seen as a common but manageable condition, with multiple strategies to do so.
Oral health prevention remains a key public health message that should be promoted more effectively. Many individuals only seek dental care when they experience pain, often because dental anxiety or phobia discourages them from attending routine check-ups. Addressing these barriers and encouraging regular dental visits could improve oral health outcomes and help reduce the demand placed on emergency dental services.
It is essential that dental healthcare professionals collaborate with patients to understand the origin of their dental fears. Through effective communication, empathy, and evidence-based interventions, clinicians can support patients in accessing care, improving oral health, and ultimately enhancing their overall wellbeing.