Dental fear
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [16]
Overview
Dental fear refers to the fear of dentistry and of receiving dental care. A pathological form of this fear (specific phobia) is variously called dental phobia, odontophobia, dentophobia, dentist phobia, or dental anxiety.
It is estimated that as many as 75% of US adults experiences some degree of dental fear, from mild to severe.[1][2] [3] Approximately 5 to 10 percent of U.S. adults are considered to experience dental phobia; that is, they are so fearful of receiving dental treatment that they avoid dental care at all costs.[4] Many dentally fearful people will only seek dental care when they have a dental emergency, such as a toothache or dental abscess. People who are very fearful of dental care often experience a “cycle of avoidance,” in which they avoid dental care due to fear until they experience a dental emergency requiring invasive treatment, which can reinforce their fear of dentistry.[5]
Women tend to report more dental fear than men,[6] and younger people tend to report being more dentally fearful than older individuals.[7] People tend to report being more fearful of more invasive procedures, such as oral surgery, than they are of less invasive treatment, such a professional dental cleanings, or prophylaxis.[8]
Cause
Many people report that their dental fear began after a traumatic, difficult, and/or painful dental experience.[9] Dental fear may also develop as people hear about others' traumatic experiences or negative views of dentistry.[10]
Treatments for dental fear often include a combination of behavioral and pharmacological techniques. Specialized dental fear clinics, such as those at the University of Washington in Seattle and Göteborg University in Sweden, use both psychologists and dentists to help people learn to manage and decrease their fear of dental treatment. The goal of these clinics is to provide individuals with the fear management skills necessary for them to receive regular dental care with a minimum of fear or anxiety. Although specialized clinics exist to help individuals manage and overcome their fear of dentistry, many dental providers outside of such clinics use similar behavioral and cognitive strategies to help patients reduce their fear.
Treatment
Behavioral treatments include teaching individuals relaxation techniques, such as diaphragmatic breathing and progressive muscle relaxation, as well as cognitive, or thought-based techniques, such as cognitive restructuring and guided imagery.[3] Both relaxation and cognitive strategies have been shown to significantly reduce dental fear.[11] One example of a behavioral technique is systematic desensitization, a method used in psychology to overcome phobias and other anxiety disorders.[12] This is also sometimes called graduated exposure therapy or gradual exposure. For example, for a patient who is fearful of dental injections, the therapist first teaches relaxation skills to the patient, then gradually introduces the feared object (in this case, the needle and/or syringe) to the patient, encouraging the patient to manage his/her fear using the relaxation skills previously taught. The patient progresses through the steps of receiving a dental injection while using the relaxation skills, until the patient is able to successfully receive a dental injection while experiencing little to no fear. This method has been shown to be effective in treating fear of dental injections.[13]
Pharmacological techniques to manage dental fear range from mild sedation to general anesthesia, and are often used by dentists in conjunction with behavioral techniques.[14] One common anxiety-reducing medication used in dentistry is nitrous oxide (also known as “laughing gas”), which is inhaled through a mask worn on the nose and causes feelings of relaxation and dissociation. Dentists may prescribe an oral sedative, such as a benzodiazepine like alprazolam (Xanax), diazepam (Valium), or triazolam (Halcion). While these sedatives may help people feel calmer and sometimes drowsy during dental treatment, patients are still conscious and able to communicate with the dental staff. Intravenous sedation uses benzodiazepines administered directly intravenously into a patient’s arm or hand. IV sedation is often referred to as “conscious sedation” as opposed to general anesthesia (GA), In IV sedation, patients breathe on their own while their breathing and heart rate are monitored. In GA, patients are more deeply sedated.
Alternative care
People who are fearful of dental care may find dentists willing to work with fearful patients through recommendations by family and friends, dental insurance companies, and medical professionals. Often, dentists will advertise in telephone directories as being “gentle” or “catering to cowards.” Individuals are encouraged to make an initial appointment with a new dentist to discuss their previous experiences, concerns, and fears, without having any treatment done at the initial appointment. Some individuals have found online dental fear support resources to be helpful.[15]
References
- ↑ "Factor analysis of the dental fear survey with cross-validation." Kleinknecht, Thorndike, McGlynn, and Harkavy, 1984. [1]
- ↑ "Behavioral and cognitive-behavioral approaches to the reduction of dental anxiety." Getka and Glass, 1992. [2]
- ↑ 3.0 3.1 "Treating Fearful Dental Patients: A Patient Management Handbook." Milgrom, Weinstein and Getz, 1995. [3]
- ↑ "The prevalence of dental fear and avoidance: a recent survey study." Gatchel, Ingersoll, Bowman, Robertson, and Walker, 1983. [4]
- ↑ "The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear." Armfield, Stewart and Spencer, 2007. [5]
- ↑ "Dental fear in Australia: who's afraid of the dentist?" Armfield, Spencer and Stewart, 2006. [6]
- ↑ "Dental fear and anxiety levels of patients attending a dental clinic." Erten, Akarslan, and Bodrumlu, 2006. [7]
- ↑ "Dental anxiety among patients prior to different dental treatments." Stabholz and Perez, 1999. [8]
- ↑ "Negative dental experiences and their relationship to dental anxiety." Locker, Shapiro and Liddell, 1996. [9]
- ↑ "Cultural factors and children's oral health care: a qualitative study of carers of young children." Hilton, Stephen, Barker, and Weintraub, 2007.[10]
- ↑ "Relaxation versus cognitive therapies for dental fear--a psychophysiological approach." Lundgren, Carlsson, and Berggren, 2006. [11]
- ↑ Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford: Stanford University Press. [12]
- ↑ "Combining alprazolam with systematic desensitization therapy for dental injection phobia." Coldwell, Wilhelm, Milgrom, Prall, Getz, Spadafora, Chiu, Leroux, and Ramsay, 2007. [13]
- ↑ "Enhancing sedation treatment for the long- term: pre-treatment behavioural exposure." Milgrom and Heaton, 2007. [14]
- ↑ Accessing dental anxiety online support groups: an exploratory qualitative study of motives and experiences." Buchanan and Coulson, 2007. [15]