Dental Fears - This Won't Hurt (or Will It?)

Last Editorial Review: 7/7/2004

Although nobody loves a trip to the dentist, most of us go because we want to preserve our health as well as the luster of our pearly whites. However, the American Dental Association (ADA) estimates that 35 million adults have so much anxiety about dental visits that they worry, postpone or avoid seeing their dentist.

Studies conducted by faculty at the University of Washington Dental Fears Research clinic in Seattle indicate that the prevalance of dental fear throughout the world is about 20 percent. Peter Milgrom, DDS, director of the clinic, said that the level of dental fears peaks around middle age.

How do you know if you've crossed the line from just disliking the dentist or what the dentist is doing to dental fear?

Dr. Milgrom answered that: "The issue is whether a person can maintain their dental health, use a dentist if needed, without terrible foreboding or running away."

Dental Fears from History of Sexual or Physical Abuse

The most common dental fears relate to pain, fear of allergic reactions to local anesthetic or drilling. About two-thirds of dental fears come from direct experience, usually during childhood.

Sometimes dental fears are associated with other mental health conditions. "For example, patients with a history of sexual or physical abuse will often be afraid of being tipped backwards, losing control," said Milgrom.

There is evidence that fear of pain actually hurts. Researchers at Oxford University monitored the brain activity of 12 test subjects who felt a series of painless warm and painful hot sensations on their left hand. Each experience was signaled ahead of time by a colored light. The researchers reported in the June 18, 1999 issue of the journal Science that they discovered subjects' brain sites activated by the expectation of pain were distinct from, but located close to, those activated by the actual encounter with pain. As for Milgrom, he says "people who are afraid are not good estimators of pain. They tend to overestimate it."

Drugs Don't Cure Dental Fears

Overcoming dental fear is more effectively done through behavioral changes rather than drugs, Milgrom said. "There is no evidence that drugs cure fear," he said. Dentists need to give patients a safe, step-like introduction to the things they are afraid of much the way that parents help children overcome fears of, say, swimming.

The first step for patients is to share feelings with the dentist. Sometimes, it's helpful to schedule a pre-treatment appointment to talk about specific fears. Dentists can explain each step of a procedure or examination. The more you know about what will be done, the more relaxed and confident you will be. Most dentists will agree to take breaks during a procedure if they can through a pre-arranged signal.

Practicing distraction or relaxation techniques to take your mind off of the procedure can help reduce tension. Milgrom suggested that these skills can be transferred from other aspects of life such as childbirthing classes or techniques previously learned to control muscle tension.

If pain is the issue, Milgrom recommends extra local anesthetic and nitrous oxide. Being friendly and sociable, having regular visits to the dentist can also improve feelings of trust and reduce fear.

Dental fear can be overcome. You may not leave the dentist's office smiling and joyous, but you can rout fear and take care of your dental health.

Acknowledgment: On behalf of, we thank Peter Milgrom, DDS, Director, The Dental Fears Research Clinic at University of Washington for his assistance in preparing this article.

Reference: The citation to the Oxford article mentionned above is: Alexander Ploghaus, Irene Tracey, Joseph S. Gati, Stuart Clare, Ravi S. Menon, Paul M. Matthews, and J. Nicholas P. Rawlins. Dissociating Pain from Its Anticipation in the Human Brain. Science 1999 June 18; 284: 1979-1981.


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