Dental anxiety is one of the greatest difficulties facing dentists. Some patients are so anxious that they delay or even cancel their appointments leading to poor oral healthcare, increased dental problems and symptom-driven treatment. We sat down with Dr Sarah Barker, a clinical psychologist from London, who explained to us why people are scared of the dentist and what they can do to manage this phobia.
How common is dental anxiety?
Figures based on surveys, such as the 1998 UK Adult Dental Health Survey, suggest that 64% of adults are ‘nervous of some kinds of dental treatment’ and around 45% ‘always feel anxious about going to the dentist’. This fear can lead patients to delay going to the dentist, which in turn contributes to poor oral healthcare and increased dental problems.
What causes a fear of the dentist?
Anxiety is a continuum, and there are some patients who are so anxious about receiving dental treatment that they delay or cancel appointments. Others have difficulty in tolerating treatment whilst in the dental chair, and some may not seek dental care at all. Patients who are anxious typically experience more pain, and reluctance to have procedures can result in the need for more complex procedures in the long-term, which further exacerbates the anxiety.
Dental anxiety can arise due to multiple factors, such as previous negative experiences of dental work or medical treatments which can impact the trust of health professionals. Negative experiences can be vicarious; traumatic narratives on treatments from anxious family members or peers can have a significant impact on certain individuals. Traumatic experiences, especially in childhood, can make the vulnerable position of lying back in a dental chair particularly difficult, and again can be linked to difficulties in trusting the professional carrying out a procedure.
There are some people who struggle with body image too. Specific cues in the dentist’s office can elicit fear in a patient, and the body goes into fight, flight or freeze mode. Dentists can find their patients crying, behaving aggressively or self-medicating.
What do you recommend to your patients with this condition?
Cognitive behavioural therapy (CBT) is a talking therapy that focuses on how thoughts, beliefs and attitudes affect feelings and behaviour, and teaches coping skills for dealing with different problems. More recently a third-wave CBT, Acceptance and Commitment Therapy is gaining a good evidence base. In the first assessment session, a clinical psychologist will work with you to develop a formulation of how your thoughts, physiological reactions, behaviour and feelings are linked. Future sessions help you to gain distance from upsetting thoughts, have specific techniques to calm your central nervous system and develop skills such as assertiveness so you are more able to communicate your needs to the dentist.
Do people ever overcome this fear?
The National Institute for Health and Care Excellence (NICE) gives a strong recommendation for the use of CBT for specific phobias as well as more general anxiety disorders. Newton et al (2017) discusses how CBT can help patients with dental anxiety to rehabilitate.
Seeing a specialist can definitely help to make the essential visits to the dentist much more bearable.
If you have a dear of the dentist and would like to see a specialist about it, Dr Sarah Barker is an expert consultant clinical psychologist based in London who specialises in dental phobia. Check her profile to see her availability.