What Every One Wants to Know About Dental Anxiety and is Afraid to Ask

February 2008

By: Dr. Scott R. Harden

Nothing is more overwhelming or otherwise more rewarding than treating patients that experience dental anxiety. It’s a challenge? It’s a reward? In the last several weeks, we have helped an unusually high number of patients that presented with dental anxiety. Therefore, I thought it appropriate to dedicate this article to this topic, and provide information that can help patients, and their family members that support them, to better cope with dental anxiety.

Julie, a very nice twenty-eight year old woman, sat in our dental chair, was ready to start her dental treatment, and suddenly burst into tears. In the reality of the moment, logic came head-to-head with emotion, and emotion won. Julie had mustered up all her courage to come into our office because she knew she needed dental care, but her psychological needs were unresolved. From the moment Julie sat down, her face was red, she did not respond well to questions, and her emotions were rising up inside her just like acid reflux. Julie felt scared, not in control, and ultimately embarrassed because she had cried. This is an important time for the dentist and staff to stop and create quality time with their patient. Julie simply needed to be reassured that her treatment would be comfortable and we would take small breaks every 30 seconds or so to help her stay calm. We empowered her by letting her know she could raise her hand at any time during the treatment and have us stop. It is important to make a personal connection with the patient, clearly define their needs, and gain back their confidence. Julie regained her composure and actually directed us to begin her treatment with a sense of self-confidence that was very admirable.

Patients can experience many emotions: anxiety, loss of control, panic attack, and anger to name a few. Patients can further display many actions: tears (as in Julie’s case), verbal outbursts, kicking their feet, sitting up suddenly, standing up, or just not responding to questions at all. I’ve seen them all through the years. Each emotion and each action must be efficiently interpreted by the dentist and staff to develop an approach that will best help that patient at that moment.

Many factors must be considered to optimally cope with a dental anxiety patient, including age, dental needs, patient willingness, and level of anxiety. Thus, four-year-old Jennifer with a small cavity that doesn’t want to open her mouth is dealt with differently than 40-year-old Paul with a large tooth abscess causing facial swelling and severe pain that presents making unreasonable demands because he’s in pain. Can pain affect a patient’s emotions? It most certainly does. Sometimes, the best action is to create pain relief for a patient, (i.e. with antibiotics), so they can return another day and think in a more rational manner.

As in the example of Paul above, very often phobia patients let their treatment needs progress to more serious levels such as extractions or root canals, which creates more psychological challenges for that patient. These are procedures that instill apprehension in almost all patients, and especially in dental phobics. In these patients, pain is the motivator for them to complete treatment, however, it is a challenging time to rationalize with them and remedy their psychological needs.

I have worked with thousands of patients exhibiting mild to severe dental anxiety over the last several decades, and the highest majority of their dental phobia stems from three basic issues:
(1) Difficulty swallowing
(2) Bad childhood dental experience
(3) Bad adulthood dental experience

Difficulty swallowing can create anxiety in many dental patients because they feel like they are choking and cannot breathe. This is very important to recognize, and has become an issue I’ve really focused on helping the patient overcome. It is often related to a patient having a large tongue (“macroglossia”), or sometimes tonsils, which will partially occlude the back of the throat. The solution I have worked out is to have the patient hold our small suction and give them the ability to place this suction in their mouth every 20-30 seconds. This does three things. First, frequent breaks in treatment physically help them feel comfortable and as though they can swallow and breathe. Second, it gives the patient a sense of control and third, it involves them in the procedure to get their mind off the problem.

Bad childhood and adulthood dental experiences are psychological issues that vary significantly. Childhood experiences can be worse because they have manifested longer. Both age groups require a thorough discussion to identify the problem and lend the ability to talk about it and identify ways to avoid repeating the original experience. Technology offers most of the answers to these patients. They can identify with new innovative procedures that will provide comfort and confidence.

Guidelines for a dental anxiety patient should as follows:

  • Admit you have dental anxiety and that you need regular dental checkups because if you ignore your dental care, your problems will only get worse.
  • Be honest with the dentist and discuss your phobia so positive notions can replace the negative emotions.
  • Request as much visual clarity regarding your diagnosis through intra-oral photographs, x-rays and from patient education software to provide mental images. These will get you through the entire treatment plan and help you stay motivated.
  • Choose to follow through with your treatment plan in small steps that don’t overwhelm you, but stay consistent to minimize anxiety from waiting too long.
  • Seek out a dentist and staff that can offer you the personal-care you need and provide an amazing dental experience you deserve.