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Dec 17, 2005

December 14, 2005

Dental Fears and Phobias
Do you have a fear of the dentist? According to Dr. Gary Stough, the most common fears of going to a dentist include:

  • Fear of injections and other pain
  • A sense of not being in control
  • A sense of being smothered by having their comfort zone invaded
  • Financial loss, often including missed time from work
  • Embarrassment of their dental conditions
  • Dental Office Sounds

Questions and Answers About Dental Fears and Phobias

Question: What are the most common fears and phobias patients experience when going to the dentist?

Answer: In my national survey on dental practice stress sent to dentists in 2001, we found the number five cause of practice induced stress among dentists was dealing with patient anxiety. Therefore a patient's fears and phobias are passed onto the dentist who has to treat them.

The most common fears of going to a dentist include:

  • Fear of injections and other pain
  • A sense of not being in control
  • A sense of being smothered by having their comfort zone invaded
  • Financial loss, often including missed time from work
  • Embarrassment of their dental conditions
  • Dental Office Sounds
    Question: Doesn't a dentist have to accept this as part of doing business?

    Answer: Of course a certain percentage of patients will be anxious, to varying degrees, no matter who the dentist is or what he/she or the other staff does and often no counseling or rational approach will overcome it.

    Question: What can a dentist do in these cases?

    Answer: First they should not assume responsibility or incur guilt for a patient's anxious state.

  • Often it stems from past experiences, perhaps as a child, and in the case of adults, is difficult to overcome. There are people in this world who are simply scared or anxious about most everything in life. Driving from home to the mall may seem traumatic. Psychologically such problems go beyond what your friendly dentist is prepared to handle.

    Naturally, fear of injections, reactions to dental office smells and sounds, feelings of lost control and the intimacy of the treatment area along with others we’ve already mentioned are stressors to most all patients in varying degrees. I experience some similar when I'm in the dental chair. People find that amusing but I assure them a surgeon no more wants surgery than I want to have a crown done. I know all will work out but I'm still human. Still there is so much we can do to minimize fears and anxiety in most cases.

    There are a number of medications taken by mouth or intravenously that are safe and effective by trained professionals in extreme anxiety cases. There is increased cost to the patient but it may be worth it. There is always Nitrous Oxide gas which is safe and also effective except in extreme cases of anxiety. In all three instances, awareness of the patient's health history and current medications is very important. I recommend and use these as a last resort because in most cases I consider them a crutch and would prefer overcoming fears by methods of trust, touch, reassurance, humor, reminding them that they are in control, providing information and by gentle dental care. Obviously in some few cases, none of this works and other means is necessary.

    Relieving anxiety begins even before the patient steps into your office. The friendly, caring voice and concern of your staff when the patient calls to make an appointment is a good start. This is just the beginning of trying to satisfy all five of the senses. Is the exterior of your office inviting and/or professional looking? Once inside, is the reception area warm, inviting and friendly concerning colors, decor and furnshings? Are they immediately warmly greeted by your receptionist? Have efforts been made to mask or eliminate dental office odors by using air purifiers or other methods of pleasant odor enhancement? Does the person seating the patient greet them with a smile and escort them to the treatment room (not walking 20ft in front)?, place a hand on their shoulder or arm once they are seated with the words “Are you comfortable? Do you have any questions before we get started? Would you like to watch T.V or read a magazine? The doctor will be with you in a moment.” It never hurts to apologize if the patient has been made to wait. They appreciate this and it lets them know you consider their time valuable.

    If the doctor is already in the room as the patient is seated, he or she should begin with a smile, a handshake or welcoming touch and say “Hello Jim (Mr. Smith). It’s so good to see you today. Hope the family is well,” or another of many friendly greetings and inquiries. All this is done to make each patient feel special and appreciated and more comfortable. Before beginning treatment it is always best to explain what will be done in laymen’s terms never assuming people know. This can be a great anxiety reliever. Informing the patients they have but to raise their left hand should they feel any pain, need to rinse out, go to the restroom or simply rest, gives them a sense of control.

  • Questions and Answers About Dental Fears and Phobias

    Eliminating distasteful sounds is often a problem, but they be can minimized. Some of the newer hand pieces, (drills) are very quiet. We have a T.V. and a water fountain in the reception area. I've found most patients prefer the T.V. off and consider the trickling water sounds more soothing. An automatic door closure keeps the sounds in the treatment areas from reaching people in the reception room. Some offices play calming music throughout and we do this in treatment areas. Televisions in treatment rooms, which can also be used in conjunction with an intraoral camera and video education, are common today. The use of headphones, where patients can listen to music of choice, is also gaining popularity. Calming color combinations, artwork depicting serene scenes and large windows to reduce the feeling of confinement are also important treatment room additions.

    I personally do not like the open bay layout of some offices where at best simple partitions do little to block out surrounding unpleasant sounds Separate treatment rooms with insulated walls and doors are my personal preference.

    Fear of injections is at the top of the list of fears and phobias for most patients. Once a dentist helps a patient overcome that fear, most of the other things take care of themselves. In truth 90% (if not more) of the injections should not be painful. If the dentist uses topical anesthesia application properly, goes slowly, uses smaller caliber needles when possible, infiltration methods rather that block injections when feasible, mepivacaine which is less acidic and thus less painful followed by stronger anesthetics. Also, by speaking in calmling and sincere tones, most patients have virtually no discomfort and soon overcome most injection fears. Giving an injection is no time to be in a hurry!

    Question: What can a dentist do if none of this works?

    Answer: Refer when in your and the patients best interest. Where general dentists get into trouble is being unwilling to admit that a procedure or circumstances are out of their area of expertise or control. Refer to someone who has specialized training, equipment and staff and walk away feeling relieved and satisfied you did your best. Believe it or not, the patient will think no less of you and will be happy to be referred. The dentist will also live longer not having undergone unneeded stress. Questions and Answers About Dental Fears and Phobias 

  • Question: What can anxious patients do to prepare themselves for dental treatment?

  • Answer: Obviously, if a person has a phobia of dentists, they should minimize the need for anything but routine dental visits by practicing good oral hygiene. A person can not drink numerous sugar flavored soft drinks or sports drinks, chew gum, suck on mints containing sugar, not brush or floss, fail to use fluoride and then be surprised if they have dental problems. Regular dental check ups help catch small problems before they become big problems.

  •  Not withstanding, if one has a problem and must see the dentist, they want to practice a little positive psychology. If one has had a negative dental experience in the past, especially in the distant past, be aware much has changed in dentistry in a short time. New and older dentists are using more modern equipment, better materials and up to date methods to insure better patient comfort.
  • Secondly, patients who presently don't have a dentist should ask around for referrals, especially from people who share similar fears. Don't always depend on yellow page advertisements offering gentle dental care. A satisfied dental coward is a pretty good recommendation source.

    Thirdly, for those who currently have a regular dentist, inform them of your fears. Don’t expect them to know your fears by mental telepathy. Most dentists try hard to be kind, caring, gentle and painless, but I assure you they will try even harder if they are aware of your fears.

    Fourth, if a patient considers their dental fears beyond normal help, they shouldn’t hesitate to ask for a referral to someone who can administer conscious or I.V. sedation or uses Nitrous Oxide if their dentist isn't trained in theses areas.

    Fifth, patients should never self medicate prior to dental treatment without informing their dentist. It could pose a danger if the dentist administers anesthesia or other medications.

    Sixth, think positively! Once a patient convinces themselves that treatment is necessary, and the dental problem will only worsen if gone untreated and may require more difficult procedures which could cost more, they often accept the situation begrudgingly and overcome some of their initial hesitations.

    Seventh, the patient must remember that the dentist is their partner in achieving good oral health. Never consider your dentist an adversary, but rather a friend.

    In Review

    Most Common Dental Fears and Phobias

      1. Fear of injections (needles)
      2.Fear of other pain and intimate area of treatment
      3. Sense of lost control
      4. Sense of confinement (claustrophobic)
      5. Embarrassment of dental condition
      6. Financial factors (cost of treatment, missed work time)
      7. Previous dental experiences (often as a child)
    About the Author: Gary Stough, D.M.D., has maintained a highly successful family dental practice since 1978. He has also held numerous seminars, conducted research studies and published a number of articles nationally. Dr. Stough resides in Cornelia, Georgia and is currently writing a book about stress in the dental office.   

  •   Further information can be founf at t his Link:                                      

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    Posted: Saturday December 17, 2005, 5:02 am
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    Sunshine R. (375)
    Tuesday January 3, 2006, 5:06 pm
    thank you. I have been horrified by dentists adn their drills since a child. Had to be held down phsically in the chair. Given valumn, gas, the gas didn't work and the dentist yelled at me saying it was my fault my tolerance level and anxeity was so high. I am still fearful to this day and think it may be something from my childhood. I found out that many abused children find it to be invasive and horrific, also pain levles vary in people and those who have been tramatized before. Good Blog, needs more sharing.
    Thank you


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