What Is Dentophobia?

Overview

The term “dentophobia” might seem strange and unfamiliar to the majority, but most people are well acquainted with the fear and anxiety that comes with an approaching dental appointment. Dentophobia, or odontophobia, is the fear of dentists, dental procedures or a dental setting (such as a dental clinic).¹ It is one of the most common phobias to have: it is estimated that up to 80% of the global population has some degree of fear and anxiety about dentists.²

As normal as it is to have fear, dentophobia becomes a problem once it gets in the way of getting proper care for oral diseases and conditions that significantly impact your quality of life.² Going to the dentist does not have to be a cause of stress and trauma: let’s discuss some strategies to make your appointment more pleasant and relaxing, including strategies you and your dentist can implement to make your life easier.

Causes

Dentophobia, like many other types of phobias, is a complex condition to understand. Sometimes, the causes can be easily identifiable, like a history of previous traumatic appointments during childhood; other times, it can be challenging to understand where it comes from. A few common causes that have been discussed in scientific literature are:³

Conditioning 

Conditioning is the most common cause of dentophobia.³ An individual who has had a bad experience once during a dental appointment may associate visiting the dentist with pain, fear and anxiety.³ This is called a Pavlovian response; whenever the individual experiences something that triggers their memory of the traumatic event (like seeing needles or dental drills), they relive the same fear as before, and their minds make a simple association: “If I go to the dentist, it will hurt”.³ 

This will cause avoidant behaviours to take place through operant conditioning: if going to the dentist hurts, then not going will not hurt; they remove the punishment (the fear and anxiety caused by going to the dentist) and instate a negative reinforcement (not going to the dentist will reduce the unpleasant feelings) to reinforce their behaviour.³

Other cognitive patterns end up supporting the dentophobia: probability (“Going to the dentist will definitely hurt”), severity (“If I go to the dentist, there will be unbearable pain”), or even self-doubt (“If I go to the dentist and it hurts, I won’t be able to take it”).³

Vicarious fear 

Whenever a family member or friend portrays the dentist in a negative light, or the media portrays dental professionals as scary and dental appointments as torturous, this information might become ingrained into a person’s mind and create a phobia.³ 

Unfortunately, many people have had bad experiences with dentists, especially elders. Until relatively recently, dental techniques weren’t as developed to be painless and more comfortable to the patient, and there was no concern with reducing fear and anxiety during visits. Eventually, the fear is transmitted to younger generations.³ Children are especially susceptible to suggestion and can develop fear and anxiety of dental settings because of this, even if they never had a traumatic experience in the first place.³

Vicarious fear can be caused by seeing, as well as getting the verbal threat: by hearing an account of a terrible experience, someone (especially a child) can infer that visiting the dentist will always be painful and unpleasant without ever experiencing the fear themselves.³ This is very common for young children who have not yet had their first dental appointments but already fear it by being threatened by their parents to be “taken to the dentist” whenever they act naughty, for example.

Genetic vulnerability

Though there isn’t strong evidence found to prove this theory, it has been proposed that individuals with specific phobias inherit these traits genetically.³ These inherited traits make them more susceptible to developing fears and phobias; however, this only means that a person who has a family history of phobias of any pathological kind is more likely to react strongly to stimuli than others who don’t.³

Signs and symptoms

Signs and symptoms can vary drastically from person to person, and they can present before, during, or after a dental appointment.⁴ Common presentations include:

• Emotional symptoms: fear, anxiety, worry, agitation, and, in some cases, even violent or aggressive behaviour.⁴
• Physical signs: increased heart rate (tachycardia), high blood pressure (hypertension), increased respiratory rate, tremors, nausea.⁴

Impact of dentophobia on oral health

Dentophobia commonly leads to avoidance of dental appointments and poorer oral health.³ These are the patients who will consistently miss appointments and only seek treatment when they present with symptoms, usually pain.³ Common consequences can include:⁵

• Tooth decay (cavities): Patients with dentophobia usually have a greater need for fillings and crowns when compared to patients without phobia.⁵
• Toothache: severe cavities can cause inflammation of the pulp or abscess formation, both very painful conditions that may lead to root canal treatment or dental extraction.⁵
• Dental loss: patients with dental fear may seek treatment only when it’s too late, and the only option left is extracting the affected tooth, leading to significant loss and the need for bridges and dental prosthetics.⁵
• Periodontal (gum) disease: this disease affects the gums and tissue that support your teeth, leading to dental mobility and dental loss in more severe cases, and it’s caused by the build-up of dental plaque (which contains harmful bacteria that destroy the tissue).⁶ Gum disease can be prevented through adequate brushing and flossing, but also through the removal of dental calculus (hardened, mineralised plaque) by a dentist through scaling: patients with dentophobia often avoid scaling and cleaning their teeth, leading to gum disease.⁵

Diagnosis of dentophobia

There are many tests and questionnaires used to identify whether or not a patient has dental fear and to which degree.³ Some of them are:

• Index of dental anxiety and fear (IDAF-4C+): is a questionnaire applied to adults analysing their response to dental fear using a 1 to 5 scale, in which 1 is a “strongly disagree” and 5 is a “strongly agree”.³
• Anxiety Sensitivity Index (ASI) and Spielberger State-Trait Anxiety Index (STA): both are questionnaires applied to adults that evaluate their level of anxiety.³
• Modified Child Dental Anxiety Scale (MCDAS): is applied to children and evaluates how worried they are in a dental setting.³

As for classification, the most widely used system is the Seattle System³:

Coping strategies and management

Currently, many strategies can be implemented to overcome or at least mitigate dentophobia.⁴ Management is tailored to each individual, and a combination of techniques can be used by a dentist or in conjunction with a psychologist to improve the patient’s outcome. Here are some of them:⁴

• Distraction therapy: with music, virtual reality, or hypnosis, the patient can be distracted from the source of fear (usually sounds like a dental drill).⁴
• Aromatherapy: the use of pleasant scents with essential oils has been linked to reduced stress, anxiety, and fear.⁴ It is an interesting, non-pharmacological approach: oils such as lavender, chamomile, lemongrass, and orange have been used to manage anxiety and fear with a low cost and high effectiveness.⁴
• Acupuncture and laser acupuncture: Both methods have been utilized to restore a healthy balance of chemicals in the brain called neurotransmitters. When these chemicals are out of balance, it can lead to feelings of anxiety.⁴ Moreover, special cells in the brain that make a calming neurotransmitter called GABA get activated. GABA helps calm down overactive neurons, leading to more serotonin being released. This process makes you feel more relaxed and happy.⁴ Though effective, it should be applied only with proper training.⁴
• Dog-assisted therapy: support from animals still needs more research, but current literature states that dogs can improve blood pressure and promote relaxation.⁴
• Muscle relaxation: relaxation exercises, deep breathing, and meditation can be done to ease anxiety.⁷
• Environmental changes: presenting the clinic as a more welcoming environment is effective in reducing stress.⁷ Soft music, dimmer lighting, and a welcoming team can aid in relaxation in the waiting area.⁷ 

Psychocognitive

This approach has been widely used in paediatric dentistry.⁷ Some examples are:

• Modelling: in which a procedure is shown in a simulated scenario, like a short video or the procedure being done on a guardian.⁷
• Tell-show-do: this technique involves explaining what a procedure is, showing how it works, and then doing it to the patient, alleviating the fear of the unknown.⁷
• Behaviour techniques: giving the patient control over their situation, like asking them to raise their hand if they want the procedure to be stopped, gives autonomy and mitigates fear of losing control.⁷
• Cognitive behavioural therapy (CBT): if necessary, a patient should seek psychological advice in the form of therapy to understand what’s causing fear and to better equip themselves to deal with anxiety and stress.

Medication 

This is a valid approach to more severe cases of dental phobia, and usually in conjunction with non-pharmacological strategies as well to increase their efficacy.⁷ Sedation can be minimal, moderate, or deep.⁷

• Premedication: The patients will be more relaxed, but they still can normally respond to commands, with normal cardiovascular and respiratory control. Minimal sedation is done with oral medication like benzodiazepines or by using nitrous oxide.⁷  
• Conscious sedation: although still conscious, their response is slower and harder to get, but cardiovascular and respiratory functions are still normal in moderate sedation.⁷ This can be achieved with nitrous oxide inhalation as well.⁷
• General anaesthesia: Able to achieve deep anaesthesia. Recommended when the patient cannot undergo milder forms of sedation because of comorbidities or disabilities or when they have very severe forms of dentophobia;⁷ rarely done in regular dental appointments. It requires a hospital environment, as the patient loses consciousness completely and requires artificial ventilation for breathing and monitoring of the cardiac rhythm.⁷    

Prevention of dentophobia

Prevention of dentophobia is possible, although difficult. Parents and family members should be encouraged not to present dental appointments as torturous, painful or stressful to children in order to not incite fear in their minds.³ Ideally, children should be introduced to dentists in a paediatric dental setting, in which the professional is more equipped to deal with them and leave a positive impression instead of a traumatic experience.

Summary

Dentophobia is the fear of dentists and dental procedures, and it can vary from mild to debilitating, being one of the most common phobias. Common signs and symptoms are stress, anxiety, fear, high blood pressure, high heart rate and breathlessness, nausea, and tremors. Diagnosis is made through assessment of the patient’s anxiety and fear via questionnaires, and four levels of dental fear have been identified and classified under the Seattle System. It is possible to prevent dentophobia through positive presentations of dental appointments and dental professionals, and treatment and management are complex, often involving a combination of psychological techniques and even medication in some cases.