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High Anxiety in the Dental Office

It’s Not All in Your head…But A Lot of It Is
A patient comes in with a full sleeve of tattoos on his arm and proceeds to confide his fear of dental needles and instruments. Another patient asks the hygienist to “please be gentle,” as if her name badge proclaims her as “The Butcher.” The nervous businessman insists on nitrous oxide and continually asks to “turn it up” like it’s a radio he can’t quite hear.
What are they so afraid of? Studies say that most patients are afraid of three things at the dental office:
Fear of loss of control – Loss of control is when patients can’t see what’s being done to them, can’t help do it, or can’t anticipate what will happen next.
Fear of embarrassment – People may have fear of embarrassment because dental professionals work inches away from patients’ faces and are in their personal space. Some people lack self-confidence or are ashamed of how their teeth look, and they’re afraid they’ll be judged or ridiculed.
Fear of pain – Fear of pain is probably the most common issue that keeps people from the dental office. A study at the University of Toronto, Canada, gathered data about patients’ pain expectation when they’re having dental treatment. The report says that sensation of pain was more likely to be reported by people who had past painful dental experiences or expected it to be painful. The report concluded by stating that pain is as much a cognitive and emotional experience as a physiological experience.

Dental Phobia vs. Dental Anxiety

A dental phobic may be so panicked and full of dread he or she can’t even think about entering a dental office.
An anxious patient is uneasy or fearful and probably has unfounded or exaggerated concerns about the appointment.

No One Is Born Being Afraid of Dental Visits
Everyone who has dental fear learned somewhere that dental treatment is something to be afraid of. Some people learn this because they’ve had previous bad dental experiences. The sense of loss of control in the dental environment may be enough to avoid dental treatment forever. And still others may be afraid due to stories they’ve heard, movies they saw or other indirect experiences. The message conveyed to a child from a scared parent might be that going to see a dentist is something to be afraid of. Such messages may cause individuals to avoid treatment and not have any opportunity to learn that things can be different.
Fear and anxiety can also be reinforced inadvertently. Think about it this way; try to remember a time when you were really afraid of something, do you remember how your body felt? Was your heart beating quickly, palms sweaty, stomach in a knot? Those and other symptoms of being afraid are all unpleasant feelings. So, if someone who is already afraid forces themselves to go have dental treatment and re-experiences those same bad feelings during the appointment, then what they will remember afterward is those same unpleasant feelings. It doesn’t matter how friendly the dentist is or how pain free and pleasant the treatment is. What you remember is the feeling of being afraid, thus reinforcing the idea that there is something to be afraid of.
In fact, dental fear begins at the subconscious level. People have what we call an automatic fear response. Take example patient Jane who says, I feel like something just takes over and I begin to sweat and my stomach tightens up. I don’t really have any control over it. Since this automatic fear response is subconscious, it won’t go away using logic or reason. Telling Jane that there is nothing to be afraid of won’t help. In fact, it might make things worse because it could sound like the dental professional is saying there is something wrong with her. So, how do patients and health practitioners work together to change this pattern of fear and reinforcement? Let’s find out.

Getting to Calm and Safe
It is possible, even for those people who are the most fearful, to reduce their fear and to learn to have dental treatment in a way that feels calm and safe. The basic idea is really very simple. In order to counteract past bad experiences you need to have new positive experiences which lead to the development of improved feelings and attitudes. The more bad experiences you have had or the longer they have gone on, the more good experiences you need before you will have different reactions to the same situation. Dental health professionals know that your mouth is a very personal place and trust is a big part of allowing them to partner in your care.

How Do You Have A Good Experience With Dental Care?
Tell your dentist you are afraid, even when setting up an appointment and make sure the dentist is prepared to listen. If you can’t talk about it you can’t get over it.
The patient must know that the dental professionals in the office understand their fear and are committed to working with them to help her overcome it. The best way for a dentist to convey that they care is to listen, not to provide explanations. The patient should feel confident that they are not being judged.
Of course, some people are better at this than others. If you are afraid, find a dentist who listens to you and who cares about working with you to get over your fear. Some dentists have made themselves quite expert in this area. Work with a dentist who understands and can follow the principles involved in reducing dental fear.
When working to reduce fear, only do things that you can do with mild or no anxiety.
The dental professional should reassure the patient that they are in control of the situation at all times. The patient needs to tell them exactly what they are afraid of since it’s different for everyone. It’s critical to understand what brings on the persons particular fear reactions. Start trying to do things that you feel you can do fairly easily. The goal for the person is to be able to leave each visit saying that was OK; I could certainly do that again if I needed to.
If you are afraid, work with your dentist and make a specific plan to reduce your fear. Don’t just concentrate on fixing your teeth!
It’s critical that both the dentist and patient agree that becoming comfortable with dental procedures is something that they are going to work on. Understand that you and your dentist must consider your internal anxiety feelings by working at a pace where you will be more comfortable and trusting. Set up an agreement with your dentist to talk about the time and fees associated with treatment so you can comfortably overcome your fear and not be rushed to do things you are not ready to do. This may result in a procedure taking a little longer than usual to complete or spreading out appointments over the course of time.
Remember, if you push yourself to do something you are really afraid of, you will remember how unpleasant your fear is and reinforce the fear rather than diminish it. The goal for each visit is for you to have a good experience rather than getting a particular procedure finished.

Other Tips to Deal with Dental Anxiety So You Can Get the Care That You Need:

Establish a signal for when you need a break.  Let the dentist know if you raise your hand, it means you need him/her to stop for a minute.
Listen to music. Bring an iPod and headphones, close your eyes, and concentrate on your favorite songs instead of the sounds of the dentist’s office.
Bring a friend. It can help to know you have someone you trust sitting in the waiting room and keeping you calm.
Wear your own sunglasses. Typically, your dentist will supply protective eyewear, but the one-size-fits-all model may not be comfortable for you.
Have something to hold.   Kids may want to cuddle a teddy bear. Adults may choose to have a worry stone, a stress relief ball or a hand grip to squeeze during treatment.
Picture yourself somewhere else. Visualization techniques such as imagining you’re on the beach watching the waves can help relax you.
Silently repeat a mantra. You know how people always say think good thoughts? It’s true. Telling yourself simple mantras like I am okay or I am safe can help keep you calm.
Consider medication. Before your appointment, call your dentist about your fears and discuss whether you should take a prescription.  Make sure you follow your dentist’s instructions regarding any medication.
Consider sedation dentistry. In extreme cases, there are some patients whose anxiety has reached the point of becoming a phobia.  In these cases, talk to your dentist about whether anesthesia may be the best option.

Imagine a relationship with your dentist where you feel you have the time you need to go at your own pace, the listening relationship that you need to feel safe, and the sense of control you need to reduce any automatic anxiety responses. It might take some faith in the beginning to realize that this is possible, but you really do have the opportunity to have a Lifetime of Dental Health.
At Personal Care Dentistry we have 40 years of experience helping patients overcome their fear or anxiety through gentle, compassionate dentistry. Take a look at what recent patients wrote about Personal Care Dentistry and then give us a call to make an appointment. You’ll find a warm, caring, gentle dental care team who will work with you to alleviate your dental fears.

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