One of the primary reasons that most people avoid visiting the dentist and seeking dental care, is dental anxiety. Whether this stems from a previous bad experience, the media, or friends who have told them horror stories, the result is that they neglect to maintain their dental health by avoiding visits to the dentist, and in turn create more problems.

As we know, the key factor for good oral hygiene is prevention - stopping problems before they arise. Unfortunately, phobic patients who suffer from severe anxiety do not visit the dentist for regular care. This results in more complex problems.

• What is dental Phobia?
• Why do I fear the dentist?
• What can i do about my dental fear?
• Dental Anxiety Self-Test
• Fear In The Dentist's Chair

WHAT IS DENTAL PHOBIA?: Prevalence and Etiology by Dr. Michael Krochak

Dental phobia is the serious, often paralyzing fear of seeking dental care. It has been reliably reported that 50% of the American population does not seek regular dental care. An estimated 9-15% of all Americans avoid much needed care due to anxiety and fear surrounding the dental experience. This translates to some 30 - 40 million people so afraid of dental treatment that they avoid it altogether,

In terms of your dental health and overall well-being, this can have serious ramifications. Besides chronically infected gums and teeth which can affect your medical status, your ability to chew and digest can be seriously compromised. Without healthy gums and teeth, your speech can be affected as well. Your self confidence can be compromised if you are insecure about your breath and smile. This can lead to serious limitations in both your social and business environments.

WHY DO I FEAR THE DENTIST? by Dr. Michael Krochak

Dental phobias and anxiety stem from various sources. These can lead to a strongly conditioned fear response. The following are the most common origins of dental fear:

• Previously painful or negative experiences during visits to a dentist's office. This can even include careless comments made by a dentist or hygienist during a past examination.
• A severe discomfort with feeling helpless and/or out of control in the
  dental situation.
• A sense of embarrassment of your dental neglect and fear of ridicule and/ or belittlement when you present to the dental office.
• Scary anecdotes of negative dental experiences learned vicariously from family and friends.
• Negative, menacing portrayals of dentists in movies, TV, newspapers and
  magazines.
• A sense of depersonalization in the dental process, intensified by today's necessity for the use of barrier precautions, such as masks, latex gloves and shields.
• A general fear of the unknown.

WHAT CAN I DO ABOUT MY DENTAL FEAR? by Dr. Michael Krochak

The first thing you can do is to realize that your dental fear can be overcome. Fear is a learned behavior which, therefore, can be unlearned. Patient-centered behavior modification that treats you as a whole person, not as a set of teeth can help you overcome your fears. This will obviously take a team approach between you and your dentist and his/her staff. Communication is the key. You must feel comfortable expressing your fears and concerns and have a sense that you are being listened to. If you feel that the Dr. and/or staff is not genuinely concerned and listening, then absolutely feel comfortable with seeking out referrals to other offices. 

You should never compromise the level of communication that you feel is necessary to give you a sense of control over your situation in the dental office. Modern dentistry with a compassionate dental team can be truly painless. You can desensitize yourself to your fears if you take the first step and allow the right team to help you overcome your fears. (Look for a future article on "How to Choose the Right Dentist")

1. A Sense of Control
   • Explanation and clarification of any and all procedures proposed is your right as a patient. If you have a question about a particular procedure, ask it! 
   • Empower yourself with the knowledge to alleviate fear of the unknown. You should have input into treatment decisions and choices. You should be honest with your dentist regarding how much treatment you think you can tolerate at first. As you build confidence in yourself and trust in the team that is caring for you, the length of your appointment and the amount of work accomplished will increase.
   • A Signaling System should be established allowing you to stop for any reason, whether it be because you need more anesthesia, want to rinse out, or simply need a two second break. The most common signal is raising your hand.
2. Never be Embarrassed
   • If you have been ridiculed in the past for your behavior or if you are embarrassed by your present dental condition caused by your neglect, please express yourself honestly and give your present dentist a chance to understand your concerns and show you that they care. You will be amazed at the wealth of treatment options that you might not have thought were possible. With modern dentistry, it's never too late to recreate a new smile!
3. Relaxation Techniques
   • If you feel tense in the chair, the easiest way to relax is through forms of physical relaxation. A relaxed body promotes a clear and relaxed mind. The human body cannot be physically relaxed and mentally anxious at the same time! The brain won't process these feelings simultaneously. Physical relaxation methods are easier to accomplish at first as compared to cognitive ones, so practice forms of physical relaxation first.
   • Examples of physical relaxation are Diaphragmatic Breathing, Progressive Muscle Relaxation, and various methods taught in yoga . There are numerous books and sources for these methods. If you induce relaxation in the presence of the stimuli that normally induces your fears (the dental environment), the fear response will be greatly diminished over multiple exposures and you will gradually desensitize yourself to these fears as you build confidence. The memories of traumatic visits will be replaced with more innocuous ones and this less threatening environment coupled with your relaxation methods will help you eliminate your fears.
4. Distraction
   • As you get more comfortable in the dental environment, you can engage in various distraction techniques that many offices have. The use of a Walkman or Discman is a common technique. Many offices now are equipped with Virtual Reality-like glasses that provide both visual and auditory distraction by allowing you to view videotapes through these glasses while having dental work done. We only suggest using distraction techniques once you have established some trust and confidence because your ability to communicate will be compromised, although it is easy to stop any of these devices if need be.
5. Predictable Pain Control
   • Modern dentistry has many new techniques with regards to the administration of local anesthetics to block any possibility of pain. There are many people who have anatomical or biologic variations that do require more individualized techniques in order to predictably achieve proper local anesthesia. This variation must be respected and communicated to your dentist. All injections should be given slowly. The needle itself is not the major cause of discomfort, but in fact, it is the pressure and volume of the fluids being injected that causes the discomfort. There are also great differences in the types of tissue in various locations, anatomically and from person to person, that must be considered when administering injections. There are even computer-controlled machines that are now available to standardize the injection process and make it more predictable than the conventional hand-held syringe.

COMMUNICATE, EMPOWER YOURSELF WITH KNOWLEDGE AND TAKE CONTROL OF YOUR FEARS!

Dental Anxiety Self-Test

Many people have a high level of anxiety and avoid visiting the dentist. This can cause future dental problems. Below are some questions that, if answered yes, may signify that you have some form of dental anxiety. It is important to note, however, that many new, wonderful products and procedures are available that can make the dental visit a pleasant experience.

• Do you feel slight uneasiness and tension the evening prior to your dental visit, which makes you cancel your dental appointment?
• While waiting in the reception area of the dental office, do you feel nervous about the visit?
• Have you had a prior dental experience that was unpleasant?
• While in the dental chair, do you feel uneasy and anxious?
• Does the thought of having a dental injection make you feel physically ill and tense?
• Does seeing the dentist or dental hygienist's instruments make you anxious?
• Do you feel embarrassed that the dentist will say you have the worst mouth they have ever seen?
• Do objects placed in your mouth during the dental visit make you panic and feel like you cannot breath correctly?
• Do you feel that your dentist is unsympathetic only with you?

Fear In The Dentist's Chair

What is the cause of dental phobia? According to a recent study in the British Dental Journal, dental phobia is initiated by a bad experience that unknowingly has become associated with dentistry. 

The study has found that despite the advancement of modern techniques and the use of very effective anesthetics, patients still seem to maintain the same level of anxiety as they did years ago. The proportion was shown to be the same today as it was in the 1930's, 

Dr. Ruth Freeman of Queens University Dental School in Belfast, wrote the article and explains that if all dental phobia were related to painful experiences from a patient's life, the condition should have gotten better over the years because of all the advanced techniques available today. This however is not the case and it suggests that dental phobia is brought on by outside experiences which are then related to dental experiences.

There are some techniques for relaxation that a dentist can put into practice for people with such trauma. Patients may be given sedation and be informed about pain control and they may be given the advantage of being able to control their own pain by stopping and starting treatment using hand signals.

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