About dental fear and "What can I do as a patient? "

Why do patients develop dental fear?

The most common way patients develop fear and avoidance of dentistry is through direct negative experience in the dental office. Research shows that about 80% of fearful patients develop their fear through direct experience. This can be for instance an overwhelming painful experience or fright, or through negative interpersonal interactions with the dentist. Either way, the patient forms an association between some aspect of dentistry and unpleasant experiences. These profound associations can develop from a single dental experience.

The other type of events that can lead to dental fear are indirect experiences. Most commonly these come about in children watching parents and how they relate to dentistry as children can pick up their parents’ fear. Then there is also the mass media and for instance cartoons that depict dentists as “inflicters” of torture.

Finally, the two other sources contributing to the development of dental fear are extremely important, and both involve more thinking and interpretation of situations by patients. The first is when patients experience a sense of helplessness in the dental chair when there is a situation that can potentially cause them discomfort or pain. Feelings of helplessness often accompany perceptions of lack of control.

So the key here, is that when patients believe and know they have a sense of control over their situation at the dentist, the fear lessens.

 

At the Dentist

How do we treat dental fear?

There are four categories of how to treat dental fear.

The first one is through addressing past negative experiences, direct or indirect, as they are stored as traumatic experiences in the nervous system. This allows for the patient to come to terms with and “discharge” any past dental traumas that they carry in their bodies, which in turn empowers them to approach the dental setting with a decreased fear response and more inner calm and understanding of their particular dental fear.

The second is through direct positive experiences at the dentist, which shows patients that his or her expectations of the situation can be changed. Several exposures are required for this to be effective, and the more positive experiences, the more the patients expect they can cope and handle treatments, and the better the long-term results.

The third category is the reduction of dental fear through indirect experiences that communicates to patients that their negative expectations of dentistry are possibly exaggerated. This can be through talking to others with positive experiences or learning more about modern dentistry to develop a more realistic picture of what can be expected.

Finally, there is the development of coping skills, which directly is aimed at altering patients’ perceptions of their ability to cope in the dental setting. Examples include:

  • Learning to relax in dental treatment

  • Learning to pace and breathe deeply

  • Learning positive self-statements

  • Avoiding negative “catastrophising” statements

  • Learning to distract self

  • Learning to talk to dental personnel and exercise control if needed

A theme across all four categories is the empowerment of the patient and the patient feeling an increased sense of control and ability to impact their experience as a patient.

Female Hypnotherapy Patient

The 4 Types of Control a patient can exercise when seeing the dentist

  1. Behavioural control

    • Which is when the patient knows they can take action to positively impact the dental treatment and the course of any unpleasant or painful event at the dentist. Examples include:

      • Signals: Raise their hand during treatment – to stop or start treatment

      • Dentist planned rest breaks – where patients can ask the dentist to carry out treatment in short segments

      • Physical strategies:

        • Relaxation breathing

        • Muscle relaxation

        • Bio feedback

  2. Cognitive Control

    • What the patient can do mentally to lessen the distress in any situation at the dentist. As negative thoughts about the dental experience can be like “mental horror movies”, taking cognitive control means actively challenging your ways of thinking as a patient. Examples include:

      • to find a strategy to keep the thoughts from focusing entirely on any worries about the feared situation

      • addressing realistic expectations

      • distractions: games, music, relaxation audios, distracting thoughts

      • guided imagery, imagining pleasant images

      • focussed attention on other objects than the dental treatment

      • focussed attention on the dental treatment – notice how it is going differently than what the patient expected

      • thought stopping

  3. Informational Control

    • Which is when a patient learns about the steps of a procedure, warnings that an aversive event is about to occur, and what sensations they are likely to experience.

    • Some patients prefer to not have any information, so this is good to clarify as a patient if this is the preference

  4. Retrospective Control

    • When the patient in hindsight looks back at a situation at the dentist and get to understand what actually happened and why etc. This can also give a feeling of control that will change the meaning of the event, and it will make it easier to receive dental treatment the next time.

Image by Quang Tri NGUYEN