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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
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Going to the Dentist: Fears and Phobias

Allan N. Schwartz, LCSW, Ph.D. Updated: Jul 10th 2008

 Are you someone who fears going to the dentist and avoids going even if you have a painful toothache? Your are not alone. There are millions of Americans who avoid visits to the dentist's office out of deadly fear. This is an extremely serious problem because neglect of oral health can lead to things such as: gum disease, cavities, infections, loss of teeth, high blood pressure, heart disease and death. Yes, oral neglect can be deadly and oral care is much more than a cosmetic issue.

Why do so many fear the dentist?

People avoid the dentist for a variety of reasons. Some of these reasons are:

1. General anxiety disorder or panic attacks, so that the individual is fearful about doing much of anything about their health because of their fears.

2. Fear of pain and discomfort associated with being in the dentist chair.

3. Post traumatic stress disorder (PTSD), such as having been in combat in war or in some other disaster. The result is that the smells and sounds associated with dental treatment set off flashbacks to the original trauma.

4. Terrible past experiences at the dentist that were so painful that the experience was traumatizing.

Experience with Old Fashioned Dentistry:

For many of us older folks, there were some very bad experiences with old fashioned dentistry, before the age of fast drill and anesthesia. The drills were terribly slow, the entire process agonizingly slow and, for most of us, quite painful. I was a fortunate patient in having a very good dentist when I was a child. He took care go give me a sense of control by allowing me to raise my hand when the drilling became painful.

On the other hand, my wife had the misfortune of having a dentist with no concern or care about the emotional well being of the patient regardless of age. The result was that she experience excruciating pain and, very quickly, became phobic. To this day, and we are married forty years, it is difficult to trust a dentist and to motivate herself to go for visits.

Modern Dentistry: Still Fearful:

Modern standards of dentistry make the old days of my childhood seem like barbarism. Today, drills are extremely fast, anesthesias are excellent in preventing any pain and, many dentists offices are equipped with ear phones that allow the patient to listen to relaxing music while the work is being done. Also, dental work, that would takes weeks to finish when I was a child, is now done in one visit unless more complex root canal is involved.

Yet, despite all the modern conveniences those people, like my wife, are still extraordinarily fearful of going to the dentist.

The Nature of Phobias:

The nature of phobias are such that all the facts of ease and convenience make know difference when stacked up against deep fears. People like my wife have now had wonderful experiences at the dentist yet, are still fearful. In the case of my spouse, there is one dentist she trusts completely. However, her good experiences with him have not "generalized" to other dentists and, now that we have moved far away, she is again fearful of starting work with someone new.

Overcoming fear of the dentist:

Based on what I know about phobia, PTSD and my wife, I have a number of suggestions that could help those of you who are extremely fearful of going to the dentist:

1. Find a good dentist, done mostly by the reputation of family and friends. Make an appointment to talk with him, visit the office and become acquainted. If the dentist is unwilling to do this, find another dentist. It is vitally important to find someone who is warm, caring and is familiar with treating fearful patients.

Remember, today, there are dentists who specialize in treating those who are fearful.

2. On that first tour of the dentist's office ask if he specializes in treating people who are fearful and let him know that you are one of those people. Do not be ashamed, this is a common and serious problem.

3. On this first tour and on subsequent visits, make sure you are accompanied by a family member with whom you are comfortable and in whom you have confidence. I accompanied my wife on all of her visits to the dentist who she came to trust. In fact, I did all the driving and she reported to me that she found this very helpful and comforting.

4. Prior to the visits, practice all of the usual stress reducing techniques. If you do not know them, they can be found here at Mental Help Net.

5. Make certain that you work out, with the dentist, a way for you to feel in control during the procedures. He should know about these but you need to take responsibility because it will further enhance your sense of control. Like my old dentist, be certain you and he have a signalling technique whereby he knows you are in pain or discomfort and he will stop.

6. Put on the ear phones and listen to music.

7. Make sure he has explained to you all he is going to do, how long it will take and what types of anesthesia he will use. The more you know the more in control you will feel.

8. Make certain you are seeing a dentist who is using sedation. I would not recommend general anesthesia in the dental office because it can have serious consequences. In dentistry, general anesthesia is usually reserved for the more serious surgeries and this can be done in the hospital where this is lots of help should anything go wrong with the sedation.

However, most dental procedures do not use general anesthesia. Instead, the sedation is relatively light so that there is no pain but you are fully conscious. I can report that the whole thing can be quite pleasant.

9. Lastly, I would suggest that, if you need extra help in overcoming your fears, that you see a psychotherapist, especially a clinical psychologist, who specializes in training people to over come fears through the use of Cognitive Behavioral Therapy and Behavior Modification.

Your comments are welcome and encouraged

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    Trauma and the dentist - AJ - Oct 21st 2012

    When I started researching dental trauma, I found injured teeth from car accidents, water fountains, football, etc. How to make injured, cracked or loss teeth pretty again. No one seem to put sexual or physical abuse as a child together as a reason why adults can not get into the dentist office.

    All the steps - you know deep breath, listen to music, etc. - don't work for major anxiety and fear - and it is not the pain or the dentist. I love the one about waving your hand in the air to the dentist when things get tough. How about a flash card for a flash back.

    At some point, someone needs to put the ph.d. and the dentist together. Unfortunately, I don't think the dental profession gets it. And, why should they? Dental care needs to be included in primary health care and the private practice dentist eliminated. Dental care should be covered in a regular primary health care insurance policy in whole body treatment. In some cases of severe dental trauma caused by mental health issues, the insurance would be used to treat dental crisis.

    My summary to the last dentist who assured me he was the dentist of my dreams: A person is put supine in a chair that is uncomfortable at best with one's head lowered below your feet; Your mouth is wide open and in some cases full of all kinds of hardware and paper; people are leaning on you, pressing on you, and asking you questions in what they think is a soft gentle voice and you can not answer; you can not move, you can not breath, you can reach. At some point in this process, the people in the room begin to carry on conversations with each other about the weekend, the card game, the golf game, etc. And, there you are with the noises in your mouth growing louder in your head, water all over face, unable to help yourself, unable to move, pinned down, trapped on your back with people all around but not helping. Think about it .... oh, and then give us a little wave if you get it.

    Afraid in ND - Allan N. Schwartz, PhD - Apr 11th 2011

    Hi Afraid,

    Your comment made me smile even though its quite serious. Yes, probably the greatest fear of the dentist is the bill. Too many people have no dental insurance at all or a totally inadequate amount. What is especially troublesome about this is that we now know that dental health impacts directly on physical health.

    Dr. Schwartz

    Afraid in ND - - Apr 11th 2011

     I too fear going to the dentist. However, the fear for me is based primarily on the cost of the bill. As a single, self-supporting adult, money is always an issue. To allay my fear somewhat, I have always carried dental insurance, yet have still been left with some hefty sums in the past,and fear this happening again. As I am lying in the chair and hearing the dental jargon, I cannot help but tense up as I wonder about the final cost. I do agree, though that music has been VERY helpful for me during dentist appointments, as it not only blocks the sound of the drill (in itself quite nervewracking) but the "dental chatter" as well. Good luck to all out there who struggle with this very same issue.

    Dental Phobia - Debi - Aug 31st 2010

    My teeth are in horrible condition. I'm even missing teeth.   Had sev horrific episodes as a child. I don't think they can give sedation because of the meds I'm on (Also have PTSD) I've gone to a dentist that said he dealt with pts like me (fearful) and he lost any compassion he claimed to have the moment I comlained to much. It is also bad for women who have been raped (going to a dentist) The loss of control and someone having their hands on your face or mouth. Don't know what else to do, it is embarassing and looks terrible.  People don't understand, have no idea how bad it is.

    Origins of Phobias - - Jul 11th 2008

    Many people with histories of sexual abuse also have an aversion to the dental work.

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