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Overcoming dental anxiety

Published by BUPA's health information team, healthinfo@bupa.com, August 2007.

This factsheet is for people who are worried about going to the dentist, or who would like information about it.

If you are nervous about seeing a dentist, you aren't alone - many people feel anxious about dental treatment. This factsheet describes some of the techniques you can try to overcome this anxiety and that may help you receive any dental treatment you need.

What is dental anxiety?

People of all ages and backgrounds are affected by dental anxiety. This doesn't stop most people visiting the dentist, but for some, toothache is preferable to having dental treatment.

Why should I see a dentist?

If you don't go to the dentist, you can end up with serious problems. Tooth decay and gum disease don't get better without treatment. If you don't see your dentist, you may not know that you have these diseases until it's too late. This could result in you needing to have teeth taken out.

Dental problems can be very painful, and you may believe that you can make toothache go away by taking lots of painkillers rather than going to the dentist. This can have serious side-effects and may even be fatal.

If you are taking over-the-counter painkillers such as paracetamol or aspirin, it's very important that you follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice. It's also advisable to make an appointment with a dentist as soon as possible.

Teeth play an important part in physical appearance. If you have unsightly, uncared-for teeth, it can lead to problems with your confidence and self-esteem. Regular visits to the dentist will help you to keep a healthy, bright smile.

Also, dentists screen patients for mouth cancer, so regular check-ups can save lives.

Types of anxiety

Being nervous about going to the dentist affects people in different ways. You may be anxious about specific aspects of dental treatment, or you may dislike being in close contact with someone you don't know very well.

It's possible that you had unpleasant experiences as a child and are frightened that these will be repeated.

There are also different levels of dental anxiety, ranging from slight nervousness to phobia (when someone has an intense fear that may lead to panic attacks).

However anxious you are, it's likely there will be ways of dealing with the problem one step at a time.

Getting support

The first step is to get in touch with a dentist to discuss your anxiety. However, it may be that your dental phobia is so serious that you can't even consider approaching a dentist for support. If this is the case, you can seek help from your GP who may be able to recommend a counsellor.

Finding a supportive dentist

Dentists are aware that some patients are anxious, and are trained to take your fears seriously and deal with them sensitively. Some dentists specialise in treating nervous patients.

One way of finding a supportive dentist is by word of mouth. You may be able to get a recommendation from someone who has been to a dentist who was sympathetic to his or her needs.

If this isn't possible, you could try asking a friend to make some phone calls to find out which dentists specialise in treating nervous patients. Make a shortlist of suitable dentists, then call some yourself to see which one feels right for you. When you call, be open about your worries - by sharing them, the staff will be better able to arrange the support that you need.

It may be possible for you to book an appointment where no treatment is planned. This way you can meet the dentist and discuss your anxieties. If possible, arrange it for a time when you won't have to sit and wait at reception - perhaps first thing in the morning - as this may make you more anxious. You may find it helps to take a reassuring friend or family member with you.

A number of things that you may wish to bear in mind and raise with your dentist at your first appointment are described below.

  • Timing - ask your dentist to let you go at your own pace. For example, you might choose to just have an examination and then an X-ray at the next appointment. It may be that you only feel ready to try sitting in the chair. This way you are facing your fear and gradually overcoming it step by step. Once the first stage doesn't frighten you any more you can move on to the next, slightly harder one.
  • Control - you may find it helpful to discuss with your dentist about having some control over the amount of dental work that you are having done. It's important that you don't feel pushed further or faster than you can cope with. You may feel more in control if you have a signal that lets the dentist know you would like him or her to stop.
  • Specific concerns - if there are particular things that you are worried about or if you have had a traumatic experience, you should tell your dentist about them. If you have any questions, your dentist will be able to answer them. Dentistry has advanced a great deal in recent years and there are many methods of controlling and relieving pain.
  • Choices - there are other treatment options that may help you relax, such as sedation and hypnotherapy. Your dental practice may offer these services or it may be able to refer you to one that does.

If you don't feel comfortable with the first dentist you visit, you don't have to go back to them again. Instead, try another one from your shortlist.

Sedation

You may find treatment easier if you have some form of sedation. This relieves anxiety and causes temporary relaxation without putting you to sleep. You will feel very relaxed and probably won't be able to remember much about the procedure afterwards. There are two main types of sedation used in dentistry.

Inhalation sedation

This is also known as "gas and air". It's a mixture of nitrous oxide (laughing gas) and oxygen. You breathe it in through a mask that is placed over your nose. When your treatment is finished, the sedative will wear off after a few deep breaths and the gases leave your body quickly.

Intravenous sedation

If you have this sort of sedation, a sedative drug will be injected through a fine plastic tube (cannula) into a vein. This is usually on the back of your hand. This type of sedation is very effective. You will need somebody to take you home afterwards and you won't be able to drive or go to work until the following day. You probably won't remember the procedure.

General anaesthesia

There are risks associated with general anaesthesia, so it's not commonly used for dental treatment. However, it's an option for complex dental surgery, young children and people with special needs. Occasionally, people with severe dental phobia have general anaesthesia so that they can receive dental treatment, but on the whole it's thought that using sedation or hypnosis are better options.

If you have a general anaesthetic, it means you will be asleep during the operation and feel no pain.

Psychological techniques

There are some psychological techniques that you can use to reduce your levels of anxiety.

Psychotherapy and counselling

Both of these methods involve talking to someone about your feelings of anxiety or trauma. There are various types but they all work in a similar way.

Different types of therapy may involve:

  • talking about things that happened in the past and how they affect your thinking now
  • looking at the way you think about things and making them more positive
  • facing your fear gradually so that you learn to cope with it

Distraction techniques

You may find it helpful to distract your attention away from the treatment. There are many ways that you can do this.

  • Listen to music or audio books on a personal stereo.
  • In some dental surgeries, you may be able to watch a video or DVD.
  • Concentrate on relaxing each part of your body in turn.
  • Think about something you are looking forward to.

Hypnotherapy

Hypnotherapy is known to help people relax and can be used to treat anxiety. You may find this is something that works for you, although different people are more or less susceptible to its effects. You can't be made to do anything you don't want to while you are hypnotised. It also has the advantage of not involving medicines.

Further information

Sources

  • Wray D, Wray A. Understanding your teeth and mouth. Oxon: Family Doctor Series in association with the British Medical Association, 2000
  • Mitchell DA, Mitchell L. Oxford Handbook of Clinical Dentistry. 4th ed. Oxford: Oxford University Press, 2005:
  • British Medical Association, Royal Pharmaceutical Society. British National Formulary. September 2006. London: BMJ Publishing Group Ltd and RPS Publishing, 2006
  • Phobias. SANE
    www.sane.org.uk
    accessed 20 April 2007
  • Overcoming particular fears (phobias). Primary Mental Health Service. Gloucestershire Health and Social Care Community
    www.pmhtglos.org.uk
    accessed 20 April 2007
  • Psychotherapy. The Royal College of Psychiatrists
    www.rcpsych.ac.uk
    accessed 20 April 2007
  • FAQs. UK Council for Psychotherapy
    www.psychotherapy.org.uk
    accessed 20 April 2007
  • Are there any drawbacks to hypnotherapy? Mind
    www.mind.org.uk
    accessed 24 April 2007

Related topics

This information was published by BUPA's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Jason Leitch BDS FDRCS (Eng) FDSRCS (Ed) FDSRCPS (Glas) DDS MPH (Harvard), lecturer/honorary consultant at the University of Glasgow Medical School and fellow of the Health Foundation/Institute for Healthcare Improvement, and by BUPA doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: August 2007. Expected review date: August 2009.

 

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