subject: Understanding Dental Phobia [print this page] A recent study showed that dental phobia may make up 25% of adult population. It is quite common and nothing to be ashamed of.
Given the frequency of dental fear in the population and the adverse effects on both patients and dentists, it is surprising that more research is not being done in this area of dentistry.
Some dentists have categorized dental fear into four categories.
Specific Fear. These individuals have one or two specific issues that bother them.
Sometimes the problem is physical or procedural. Examples include fears of needles, forceps, rubber dams, root canals, and extractions.
In other instances the specific fear is abstract. Separation anxiety (children) and fear of being criticized for negligence (adults) are examples of abstract fear.
Once identified, patients with specific fears are often the easiest to treat. Progressive desensitization works well if the fear is a repeatable procedure. In other instances, medications offer a better alternative.
Loss of Control. Some individuals have an innate need to always control a situation.
Others, sexual abuse victims for example, have experienced significant events that have taught them it is in their best interest to preserve a sense of control. Some patients describe it as "smothering," "trapped," and "claustrophobic".
Loss of control patients rarely do well with minimal sedation such as nitrous oxide, as this merely elevates their anxiety. When cognitive approaches fail, stronger levels of sedation are required.
Catastrophe. A relatively small percentage of dental fear patients do not actually fear dentistry.
Rather, they fear the consequence of dental care. These individuals fear that some catastrophic event will occur at or as a result of their dental appointment.
In some instances the fear may be rational. An older patient who takes a morning diuretic and also has bladder control problems may fear that a long, late morning appointment could develop into an accident.
Far more frequently, however, the patient's catastrophic-fear concerns are irrational. A case in point would be the patient who has previously experienced a heart attack. Now the patient fears that administration will lead to a fatal heart attack and that the dentist would be incompetent to address the problem.
A hallmark of these individuals is that they feel their bodies are out of control. A cognitive approach can be helpful when this problem is present.
However, identifying these patients is a major challenge. Many of these people, who sense their fear is irrationally based, are hesitant to reveal their feelings and discuss them openly.
General Anxiety Disorder (GAD). Unlike the other groups, GAD is a recognized medical disorder.
Simply stated, these individuals have difficulty coping with the stress of everyday life. These patients do not have an issue with dentistry per se.
Rather, a dental appointment is nothing more than one more problem in a day already crowded with problems. Although they are different conditions, on some occasions these individuals may be clinically depressed as well as anxious.
This is reasonable to expect because many of these patients are frustrated that they cannot cope with the strains of life as efficiently as everyone else appears to do. To tolerate the stress of dental care, minimal to moderate sedation may be required because there is little the dentist can do to address the underlying cause. Consideration should be given to a medical referral to help the patient with their fundamental problem.
Sadly, one important consideration that has not been thoroughly examined academically involves the intensity of a patient's fear. Two patients might be fearful of injections, but if one is mildly anxious and the other is truly phobic, the clinical approach should be different.
Although there are a limited number of written self-assessment tests that include fear intensity, they were developed for academic settings. Sometimes these can be too intrusive for a dental setting.
There are many ways that you and your dentist can handle your fear of treatment. It is imperative that you be open and honest with them about what your real worries are and when answering any questions.
If your dental staff is not very compassionate, then seek another dental care provider. You are not obligated to go to the same dentist that everyone else in your family does, or to keep going to the dentist you have seen in the past.
