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Dental Phobia
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| Phobia |
Overcome Dental Phobia--A “phobia” is traditionally defined as “an irrational severe
fear that leads to avoidance of the feared situation, object or activity” (even
though the Greek word “phobia” simply means fear). Exposure to the feared
stimulus provokes an immediate anxiety response, which may take the form of a
panic attack. The phobia causes a lot of distress, and impacts on other aspects
your life, not just your oral health. Dental phobics will spend an awful lot of
time thinking about their teeth or dentists or dental situations, or else spend
a lot of time trying NOT to think of teeth or dentists or dental situations.
Which is pretty hard in today’s society, which is saturated with ugly reminders
such as toothpaste commercials.
The Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV) describes dental phobia as a “marked and persistent fear that is excessive
or unreasonable”. It also assumes that the person recognizes that the fear is
excessive or unreasonable. Conclusion? The DSM-IV criteria were obviously not
decided upon by a representative group of dental phobics (read on to see why).
Having said that, there is a new revised version coming out soon, so maybe the
definition will have changed. You might be interested to learn that DSM-IV’s
predecessor, DSM-III, defined homosexuality as a mental disorder :roll:… I’d
hazard a guess that many if not most dental phobics would object to being
labeled as having a mental disorder.
This is not to say that dental phobia cannot co-occur with
mental health conditions – of course it can. Dental phobia appears to be more
common in people who suffer from another mental health problem, notably
Generalized Anxiety Disorder, panic disorder/agoraphobia, depression, and
emetophobia. Research suggests that about 20% of dental phobics have a
concurrent mental health problem. Then again, 25% ofall British
adults experience at least one diagnosable mental health problem in any one
year :cool:…
The main problem with defining “dental phobia” is that there
isn’t just ONE type of dental phobia, but many types – some rational, and some
which seem more “irrational”.
Bracha and others (2006, HI Dental Journal) have suggested that
the term dental phobia is typically a misnomer, for much the same reasons I’m
outlining here (you can find the abstract of their article at the bottom of
this page).
Whether the fear is “unreasonable”, “excessive”, or “irrational”
is debatable… certainly not if you end up in the hands of the wrong dentist!
Which, incidentally, is one of the reasons why people end up as dental phobics
in the first place…
Overcome Dental Phobia--The
difference between anxiety, fear and phobia
A distinction has been made between dental anxiety, dental fear,
and dental phobia.
- DENTAL ANXIETY is a reaction to an UNKNOWN danger.
Anxiety is extremely common, and most people experience some degree of
dental anxiety especially if they’re about to have something done which
they’ve never experienced before. Basically, it’s a fear of the unknown.
- DENTAL FEAR is a reaction to a known danger (“I know
what the dentist is going to do, been there, done that – I’m scared!!”),
which involves a fight-or-flight response when confronted with the
threatening stimulus.
- DENTAL PHOBIA is basically the same as fear, only much
stronger (“I know what happens when I go to the dentist – there’s no way
I’m going back if I can help it. I’m so terrified I feel sick”). The
fight-or-flight response occurs when just thinking about or being reminded
of the threatening situation. Someone with a dental phobia will avoid dental
care at all costs until either a physical problem or the psychological
burden of the phobia becomes overwhelming.
There are other classification schemes; for example, Weiner and
Sheehan (1990) distinguish two types of dental anxiety: exogenous (from the
outside) and endogenous (from the inside). Exogenous dental anxiety is defined
as anxiety due to traumatic dental experiences. Endogenous dental anxiety is
thought to have originated from other anxiety disorders.
Similarly, the University of Washington Categories of Dental
Fear distinguishes between 4 categories of dental fear:
- Fear of Specific Stimuli
- Distrust of Dental Personnel
- Generalized Anxiety
- Fear of Catastrophy (fear of a medical emergency)
The first two of these would usually have been caused by
previous bad experiences (“exogenous”), whereas generalised anxiety and fear of
catastrophy could be classed as endogenous. These distinctions aren’t always
helpful, though. For example, someone may have experienced a real medical
emergency in the past during dental treatment (exceedingly rare, but not
impossible, e. g. in the case of a genuine severe allergic reaction). In this
case, the fear of catastrophe would be due to a previous bad experience. Also,
when someone is asked what they fear about the dentist and their answer is
“everything”, dentists may assume that this is a sign of generalised anxiety,
even though the person may not be particularly anxious in everyday life.
Of course, people may fall into more than one category.
Exogenous dental anxiety may be perceived as being more “irrational” than fears
caused by bad dental experiences. But in my experience, once we know a person’s
history and the causes of their anxiety, there is usually a very rational
explanation behind it (although where childhood trauma is concerned, people may
not remember the events that led up to their anxiety).
It is always safest to assume that “irrational” fears are not
irrational at all, but caused by very real events.
How is
dental phobia measured?
There are various instruments for researchers which attempt to
measure the degree of the fear, such as Corah’s Dental Anxiety Scale (DAS) and
a shorter version, the Modified Dental Anxiety Scale (MDAS). Click here for a PDF download. However, if you
suffer with dental phobia, you won’t find it too hard to beat the high score,
never mind being scared enough to qualify!
Alternatively, ask yourself the following question: “Am I
terrified of dentists and avoid them at all costs?” If the answer is yes, this
is a good indicator of dental phobia! Even seemingly innocuous reminders of
anything dental-related may produce a panic-attack if you suffer with dental
phobia, such as people talking about dentists or teeth, toothpaste commercials,
or “dental words” (such as words starting with de-, or words like accidental).
Problems
with Defining Dental phobia
One problem with defining dental phobia is that “dental anxiety”
(a reaction to an unknown danger) may feel just as frightening as a “phobia” to
a person, and they may well be defined (or define themselves) as phobic. From
what little research there is available, this may be more common in people who
are generally anxious. Also, some people who’ve never had a bad experience with
a dentist or a dental procedure can develop dental fear or phobia – this is
usually the result of vicarious learning (that is, hearing or reading
scare-stories from other people including parents, or media portrayal).
I like to think that “dental phobia” is simply useful short-hand
for “terror at the thought of dentists and/or dentistry and/or anything
dental-related”. Some people feel that their fear is justified and rational,
while others feel they’re being silly for getting so upset over something which
“everyone else” seems to have no problem with. “Dental Phobia” is really an umbrella
term which covers a wide range of different fears, as you’ll see on
the Common Fears pages. It would also appear
that there are some fairly distinct subtypes of dental phobia, such as needle
phobia or terror at the thought of gagging and being sick.
What
are the most common causes of dental phobia?
- Bad experiences: Dental
phobia is most often caused by bad, or in some cases horrific experiences
at a dentist’s (studies suggest that this is true for about 80 -85% of
dental phobias, but there are difficulties with obtaining representative
samples). This not only includes painful dental visits, but also
psychological behaviours such as being humiliated by a dentist.
- A history of abuse: Dental
phobia is also common in people who have been sexually abused. A history
of bullying or having been physically or emotionally abused by a person in
authority may also contribute to developing dental phobia, especially in
combination with bad experiences with dentists.
- Uncaring dentist: It
is often thought, even among dental professionals, that it is the fear of
pain that keeps people from seeing a dentist. But even where pain is the
person’s major concern, it is not pain per se that is necessarily the
problem. Otherwise, dental phobics would not avoid the dentist even when
in pain from toothache. Rather, it is pain inflicted by a dentist who is
perceived as cold and controlling that has a huge psychological impact.
Pain caused by a dentist who is perceived as caring is much less likely to
result in psychological trauma (Weiner et al, 1999).
- Humiliation: Other
causes of dental phobia include insensitive, humiliating remarks by a
dentist or hygienist. In fact, insensitive remarks and the intense
feelings of humiliation they provoke are one of the main factors which can
cause or contribute to a dental phobia. Human beings are social animals,
and negative social evaluation will upset most people, apart from the most
thick-skinned individuals. If you’re the sensitive type, negative
evaluation can be shattering.
- Vicarious learning: Another
cause of dental anxiety is observational learning. This appears to be of
only minor importance, judging by our forum and by the available research
(e.g. Townend, Dimigen and Diane, 1999). If a parent or other caregiver is
afraid of dentists, children may pick up on this and learn to be afraid as
well, even in the absence of bad experiences. Hearing other people’s
horror stories about visits to the psychodentist can have a similar
effect. Also, the depiction of “the dentist” in the media (especially
children’s films/cartoons and comedies, and of course horror movies) can
cause people to develop dental fears. Examples include “Horton Hears a
Who” and “Nick at Night”.
- Preparedness: People
may be inherently “prepared” to learn certain phobias, such as needle
phobia. For millions of years people who quickly learned to avoid snakes,
heights, and lightning (and sharp objects, such as needles, which would
not have been sterilized in those days, apart from giving you a nasty
sting!) probably had a good chance to survive and to transmit their genes.
So it may not take a particularly painful encounter with a needle to
develop a phobia.
- Post-Traumatic Stress: Research suggests that people who’ve had horrific
dental experiences (unsurprisingly) suffer from symptoms typically
reported by people with post-traumatic stress disorder (PTSD). This is
characterized by intrusive thoughts of the bad experience and nightmares
about dentists or dental situations.
How Do You Look Your Dentist?
There are some simple
things that you can do to try to overcome your dental phobia and feel positive
about your visit to the dentist. These include:
·
Distraction techniques. There are many ways that you can distract yourself away from the
surgery during treatment. Many surgeries play soothing music to relax their
patients anyway, but you could take a personal music player to play whatever
you wish to take your mind off the treatment. You could also try to concentrate
on relaxing each body part in turn and try to focus your mind on other things,
such as something in the future which you are looking forward to.
·
Hypnotherapy. Although hypnotherapy
is more effective for some people than others, it can be a great way to treat
dental anxiety. You are safe in the knowledge that you cannot be made to do
anything against your wishes whilst hypnotised, and you can relax knowing that
this technique does not involve taking any medication.
·
Therapy and counselling. These both include sitting down and talking to somebody face to
face about your fear. You could try to talk about why you have this fear,
perhaps events in the past that have triggered it, and learn to accept your
fear and face it gradually, to try and see things in a more positive light.
Many patients may be put off by what they see as a social taboo against
counselling, but this is far from the truth. Counselling helps people from all
over the world overcome all sorts of different fears, and is proven to be a
very effective way of overcoming a phobia.
·
Make sure you visit a supportive dentist. Make sure your dentist knows before the
treatment how you feel. Visit beforehand and ask any questions that you wish,
they will be more than happy to help. Make sure that you get a detailed step by
step guide of exactly what the procedure involves from your dentist, so that
you can mentally prepare yourself beforehand and do not get any nasty surprises
during the treatment.
·
Stay in control. One of the hardest things for sufferers of dental phobia is the
lack of control that they have during their dental treatment. Make sure that
you ask your dentist to go at your pace and not theirs. It may be that you
spread the treatment out over a number of visits. To help build your confidence
and overcome your fear, during the first visit you may just want to sit in the
dental chair to experience to take in your surroundings and to get a feel for
the situation. This way you can overcome your fear step by step and overcome
each hurdle one at a time before going on to the next, slightly more difficult
one. It is important that you do not undergo any treatment that you are not
completely comfortable with, and talk beforehand with your dentist about your
signal to stop if you feel that it is getting too much.
·
Establish a healthy relationship with your dentist beforehand. It is likely that you will feel much more
comfortable during your treatment if you have visited your dentist and got to
know them before your treatment. To ease your fears during these pre-visits,
the dentist might carry out some pain free procedures on you such as tooth
cleaning to try to build your confidence up. Make sure that you are completely
open with your dentist about your anxiety and discuss your medical past with
them. Building a trusting relationship is vital, your dentist will be more than
happy to help. Do not suffer in silence!
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