What is dental phobia?
A “phobia” is traditionally defined as “an irrational severe fear that leads to avoidance of the feared situation, object or activity” (however, 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 of the individual’s life, not just their 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.
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. However, in recent times, there has been a realization that the term “dental phobia” may be a misnomer.
The difference between anxiety, fear and phobia
The terms anxiety, fear and phobia are often used interchangeably; however, there are marked differences.
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 are about to have something done which they have 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-flight-or-freeze 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 is no way I’m going back if I can help it. I’m so terrified I feel sick”). Also, the fight–flight-or-freeze 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.
What are the most common causes of dental phobia?
- Bad experiences: Dental phobia is most often caused by bad, or in some cases highly traumatising, dental experiences (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 factors such as being humiliated by a dentist.
- Dentist’s behaviour: 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 itself 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 inflicted by a dentist who is perceived as caring and who treats their patient as an equal is much less likely to result in psychological trauma. Many people with dental phobia report that they feel they would have no control over “what is done to them” once they are in the dental chair.
- Fear of humiliation and embarrassment: 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.
- A history of abuse: Dental phobia is also common in people who have been sexually abused, particularly in childhood. 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.
- Vicarious learning: Another cause (which judging by our forum appears to be less common) is observational learning. If a parent or other caregiver is scared of dentists, children may pick up on this and learn to be scared as well, even in the absence of bad experiences. Also, hearing other people’s horror stories about painful visits to the dentist can have a similar effect – as can children’s movies such as “Horton Hears a Who!” which portray dental visits in a negative light.
- Preparedness: Some subtypes of dental phobia may indeed be defined as “irrational” in the traditional sense. 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 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 have 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.
This last reason is extremely important. Most individuals with dental phobia have had previous aversive or even highly traumatising dental experiences. They do not view their symptoms as “excessive” or “unreasonable”, and in that sense resemble individuals with post-traumatic stress disorder. True, innate dental phobias, such as an “irrational” fear at the sight of blood or a syringe, probably account for a smaller percentage of cases.
The impact of dental phobia on daily life
Dental phobia can have wide-ranging consequences on a person’s life. Not only does their dental health suffer, but dental phobia may lead to anxiety and depression. Depending on how obvious the damage is, the individual may avoid meeting people, even close friends, due to embarrassment over their teeth, or not be able to take on jobs which involve contact with the public. Loss of self-esteem over not being able to do something as “simple” as going to a dentist and intense feelings of guilt over not having looked after one’s teeth properly are also very common. Dental phobia sufferers may also avoid doctors for fear that they might want to have a look at their tongue or throat and suggest that a visit to a dentist might not go amiss.
What should you do if you suffer with dental phobia?
The first and most important thing to realize is that you are not alone! The most conservative estimates reckon that 5% of people in Western countries avoid dentists altogether due to fear. And many more are anxious about certain aspects of dentistry. Today, it has become much easier to find support via web-based support groups, such as Dental Fear Central’s Dental Phobia Support Forum. You are not alone, and you may find that sharing your experiences with people who really understand what you are going through helps. Most dental phobics who have overcome their fears or who are now able to have dental treatment will say that finding the right dentist – someone who is kind, caring, and gentle – has made all the difference.
It takes a lot of courage to take that first step and look up information about your biggest fear – but it will be worth it if the end result could be a life free from dental phobia!