Past Traumas or General Discomfort
One never hears an individual say “I am so excited about my dental appointment tomorrow”. But in some there are varying degrees of fear or discomfort about dental appointments. There is often a reason for this whether is it a past personal experience or the fear is part of others’ tales of bad experiences. Very often though our discomfort comes from a place we don’t think about, that is simply just the feeling of not being in control of a situation.
There are many ways your family dental team can help no matter the source of this problem. To identify the extent of the fear it’s best to look at different exiting over all levels of anxiety and possible causes.
True dental phobia cases are rare and would be considered the most problematic. The causes vary from bad past dental chair experiences to post-traumatic stress disorder (PTSD) from other sources. This last is something often overlooked by the patient themselves unless they are victims of frequent panic attacks in other forums. Severe dental phobia extends so far as to a patient feeling fear and anxiety at even the reminder of the need for dental care and can even impact daily life. This is a serious situation, as there are reports that between 5% and 8% of people in the U.S. alone completely avoid dental care with dire consequences. As we have seen in research for past articles the result of deferred care can entail much more than pain and loss of teeth. Gum disease and the resulting serious infections that now link it to heart disease and stroke are all reasons to address this problem head-on. While pharmaceuticals, anesthesia or nitrous oxide gas can be of great help to a consenting patient, many of the truly dental phobic patients will need counseling to even get them even that far. Some of the documented cases of this disorder have causes such as a history of abuse of any kind, previous uncaring dental caregivers, humiliation due to negative evaluations or thoughtless remarks, and even what is referred to as “vicarious learning” which can be supplied by a number of sources, from family and friends to media. Unfortunately most cases of true dental phobia (80% to 85% suggested by studies) are caused by painful dental visits.
The term Dental Anxiety (DA) is often used when referring to any level of fear of dental treatment. To dental professionals, however, there is a vast difference between patients who are truly “phobic” (as they rarely get a chance to see those patients) and people who will willingly come to the dental office but still have some level of fear. Studies tell us that up to 20% of patients fear the dentist enough to go only when their situation is very serious. This problem then creates a viscous cycle of fear, due to this reluctance; the treatments to fix the problems are much more invasive. They are more likely to be more painful, not just during the office visit, but it’s also likely the recovery time will be extended. To make matters worse the association of the pain previous to treatment is added to the mental category “dentistry”. Talk to your family dental team and explain your exact level of anxiety, they will listen and help with a solution that is right for you.
There are many ways in which your family dentist can help you avoid the traps of dental anxiety. First of all, of course, you want to carefully choose your dentist and team. Make sure that there is a caring environment present and that you feel free to discuss your fears openly without fear of humiliation.
Appropriate questions to ask are:
- Do you give your patients short explanations about what they may feel at a given time?
- Is it possible to take short breaks as needed?
- Can the patient be given an opportunity to give a signal if there is any reason he/she feels the need to stop?
If you are very fearful (or especially in the case of children who are fearful) ask if a trusted friend or relative can be close by during the procedure. Talk to your dentist about sedatives available by prescription for the purpose of dispersing fears. For the very fearful some dentists are now prescribing Halcion (Triazolam) pre-appointment and using nitrous oxide gas during a procedure. However, this option requires a little more support both in the office by dental assistants and requires a designated driver. For some who can get themselves to the dental office but only have fears in the chair, nitrous oxide gas has shown to be very helpful and the patient can even drive themselves home afterward if no other sedatives are required.
There are also things you can do as a patient to help yourself. Self relaxation techniques such as deep breathing or counted breathing are good to know for many reasons and are very helpful in this application. Distracting oneself with music through headphones can be helpful, a good hint is to find a new CD that you know you will enjoy and will distract you even more than music you listen to all the time.
Remember the following tips when dealing with Dental Anxiety:
A true phobia may be addressed only with counseling. If there is fear sufficient to completely keep a person from even discussing care with a dentist they will most likely need to seek that counseling elsewhere until the time is appropriate for a visit to carefully chosen dental team.
There are many options open to help you with Dental Anxiety. Talk you your family dentist first about his understanding of your issues. Ask appropriate questions and talk about help with pharmaceuticals or gas if you think it will be needed.
Try some of the self relaxation techniques available if you have only mild anxiety. You may be surprised how much they can help.
Above all, don’t let your anxiety keep you from regular dental care. Much more is at stake than just your oral health.
