Dental Phobia

Dental phobia refers to an extreme fear of visiting the dentist and receiving dental care. The phobia may also include other dentistry-related circumstances or concerns. This acute fear, which can also be described as dentophobia, odontophobia, or dentist phobia, may affect individuals of any age, gender, ethnicity, and socioeconomic background.

Understanding Dental Phobia

Between 9 and 15% of Americans are believed to avoid the dentist due to anxiety and fear.

Dental phobia, dental fear, and dental anxiety are related but separate conditions:

• The intense fear felt by a person experiencing dental phobia may appear excessive or even irrational to others. A person with dental phobia may prefer to endure pain rather than make a dental appointment and may only choose to visit the dentist in extreme circumstances.
• An individual who has never had a dental check-up before may experience dental anxiety—feelings of apprehension regarding what is not yet known about the dentist or dental care in general.
• Dental fear typically involves prior knowledge of the dentist. With dental fear, however, the feelings of distress are not as intense as those occurring with dental phobia.

Good dental hygiene has been linked to overall good health. Avoiding the dentist may contribute to the development of cavities and other oral health concerns, but dental conditions can also have a negative impact on overall health. Diabetic complications, dementia, pneumonia and other respiratory infections, and heart disease have also been linked to poor oral health.

Dental Phobia in the DSM

While dental phobia falls under the rubric of anxiety, the description and classification of the condition has evolved with subsequent editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM-III and DSM-III-R, for example, describe dental phobia as one of many “simple phobias.” 

The term simple phobia, which was replaced by “specific phobia” in the DSM-IV and DSM-IV-R, is used to describe “irrational” or “unreasonable” object-specific and situation-specific fears. Dental phobia–an intense fear of objects and situations related to dentistry–would therefore be categorized as a specific phobia in these publications.

However, some critics have expressed their dissatisfaction with this description, as people who are affected may have a logical and reasonable explanation for their phobia. In the DSM-5, dental phobia is described as a specific phobia related to a clinical procedure.

What Causes Dental Phobia?

Dental phobia may develop from one or a combination of certain factors. One or more of the following may influence the likelihood of a person experiencing dental phobia:

• Previous negative experiences (due to physical pain, humiliation, or perceived apathy from the dentist)
• Learning of the bad experiences of others (via social interaction or the media)
• Comorbid health issues (such as posttraumatic stress, substance dependency, or anxiety)
• An abusive past (due to bullying, sexual abuse, physical abuse, etc.)

While the above factors may contribute to the onset of dental phobia, some mental health experts believe the primary reason for distress is the lack of control people experience during dental procedures.

How Is Dental Phobia Treated?

Dental anxiety and dental fear can often be reduced by the employment of interventions, such as listening to soothing music or watching television during the procedure, setting early appointment times to decrease waiting time, and speaking to the dentist before an exam or procedure.

Some dental clinics also offer sedation for any dental procedure. Nitrous oxide (laughing gas) may be offered to those who would simply like help relaxing during dental exams as well as to those who express significant anxiety or concern regarding dental procedures. Oral sedation or IV sedation may also be offered to some individuals.

These strategies may be less effective in treating people with dental phobia, however. Due to the level of emotional distress and impaired functioning often experienced, individuals with dental phobia may require the assistance of a trained mental health professional.

A variety of treatment options are available for people affected by dental phobia. One typical therapeutic approach is exposure therapy, which involves gradually exposing those with phobias to the items, thoughts, or situations triggering the fear response. Over time, the fear response typically decreases as individuals become desensitized to the stimuli presented.

Therapists may also use systematic desensitization techniques to reduce distress. This form of treatment involves the use of phobia-related objects, ranked in terms of fear factor. After being taught relaxation techniques, those experiencing phobia gradually work their way through the list of items until they are comfortable with each one.

Behavioral approaches, one such of which is cognitive behavioral therapy, are also often effective. These treatment modalities help affected people reduce catastrophizing, develop more positive and realistic thought patterns, and respond to fear-inducing situations in a more productive manner.

References:

1. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
2. Kvale, G., Raadal, M., Vika, M., Johnsen, B. H., Skaret, E., Vatnelid, H. & Oiamo, I. (2002). Treatment of dental anxiety disorders. Outcome related to DSM-IV diagnoses [Abstract]. European Journal of Oral Sciences, 110 (2), 69-74.
3. LeBeau, R. T., Glenn, D., Liao, B., Wittchen, H.U., Beesdo-Baum, K., Ollendick, T. & Craske, M.G. (2010). Specific phobia: A review of DSM-IV specific phobia and preliminary recommendations for DSM-5. Depression and Anxiety, 27, 148-167. Retrieved from http://www.dsm5.org/research/documents/lebeau_sp.pdf
4. National Health Service. (2015). Fear of the dentist. Retrieved from http://www.nhs.uk/Livewell/dentalhealth/Pages/Fearofthedentist.aspx
5. Pena, W. (n.d.). How poor dental care can affect your overall health. Retrieved from http://www.colgate.com/en/us/oc/oral-health/conditions/gum-disease/article/sw-281474979066921
6. Sedation dentistry. Retrieved from http://www.dentalfearcentral.org/help/sedation-dentistry
7. University of Pennsylvania. (n.d.). Specific phobias. Retrieved from https://www.med.upenn.edu/ctsa/phobias_treatment.html
8. What Is Dental Anxiety and Phobia? (2013, September 18). Retrieved from http://www.colgate.com/en/us/oc/oral-health/basics/dental-visits/article/what-is-dental-anxiety-and-phobia

Last Updated: 04-8-2016