How can dental anxiety or phobia affect your oral health?

Dental anxiety is fear, anxiety, or stress related to the dental environment. Fear of going to the dentist can lead to delaying or avoiding dental treatment. Tools such as needles, anesthetics, or the dental environment in general can cause dental anxiety.

When dental anxiety is severe and causes irrational fear and avoidance of going to the dentist, it can be classified as dental phobia. Certain mental health conditions, including generalized anxiety disorder and post-traumatic stress disorder (PTSD), or a previous history of head and neck trauma can increase the risk of dental anxiety. Other conditions such as depression, bipolar disorder, or schizophrenia may also increase the risk of developing an anxiety disorder.

Signs and symptoms of dental anxiety

People with dental anxiety may experience:

sweating

Palpitations (tachycardia) or heart palpitations

Low blood pressure and possible fainting (syncope)

Visible distress, crying, or signs of panic

Withdrawing or using humor or aggression to mask anxiety.

Some anxious people routinely miss or avoid dental appointments and may find it difficult to undergo dental treatments, whether simple or complex.

How can dental anxiety or phobia affect your oral health?

Avoiding the dentist can lead to worse dental disease, more need for emergency care, or more complicated treatment. It can also feed the underlying problem of dental anxiety. This is known as the “vicious cycle of dental anxiety”.

Regular dental checkups, cleanings, and dental X-rays can prevent dental disease and help the dentist find any problems early so that simpler, less invasive treatments are needed. During regular checkups, dentists also check for signs of oral cancer, which is especially important for those who smoke or drink alcohol regularly, and even for those who do both. If you notice a mouth sore that lasts more than 2 weeks, get it checked out by a dentist as soon as possible.

Most dental diseases are related to lifestyle and can be prevented. By avoiding the dentist, not only are you more likely to end up needing more complex treatments, but you’re also missing out on learning how to take better care of your oral health.

The lifestyle factors that lead to dental disease are very similar to those that lead to diabetes, obesity, heart disease, stroke, and some cancers (consumption of sugary foods and drinks, smoking, and drinking alcohol). Therefore, it is important to take care of general oral health and remember to brush twice a day and floss once a day.

Causes of dental anxiety and phobia

Dental anxiety can be caused by the following:

• A traumatic dental or other healthcare experience
• Previous blow to the head and neck
• Other traumatic experiences, including abuse
• Generalized anxiety, depression, or post-traumatic stress disorder
• The view that the mouth is a private area and access to the mouth is an invasion of personal space
• Fear of losing control
• Issues related to trust in the dentist

Anxiety with other conditions such as agoraphobia (fear of being in situations from which you feel you cannot escape), claustrophobia (fear of closed spaces), or obsessive-compulsive disorder in which there is an obsession with cleanliness.

Who can be affected by dental anxiety?

Dental anxiety is common and can affect people of any age. Children who have had bad dental experiences can often overcome their fear if the situation is managed well and they are well cared for and supported during subsequent dental visits. Adults who are anxious about dental care remain anxious throughout their lives.

Many anxious dental patients can find a dentist who is sympathetic to their situation, so they can cope with going to the dentist.

How to manage dental anxiety or phobia?

There are many ways to help people manage dental anxiety or phobia. It is important to let your dentist know if you experience any level of dental anxiety. An open discussion about your anxiety triggers can help your dentist develop a management plan with you.

Some psychological coping techniques are:

• deep breath
• Distractions (such as listening to music or using gadgets)
• Progressive muscle relaxation
• Agree with your dentist about stopping during treatment to rest (such as raising your index finger or left hand)
• hypnosis

Seeing a psychologist can also be helpful. Short-term and targeted treatments, including cognitive behavioral therapy, can be very successful. Severe dental anxiety or phobia may require medical management with partial anesthesia (happy gas), anxiety medications, conscious sedation (twilight sedation), or general anesthesia.

Use of nitrous oxide

Nitrous oxide, also known as happy gas or laughing gas, can help people relax during dental treatment. A mask is placed over your face and you breathe in a mixture of oxygen and nitrous oxide. It takes effect within minutes and wears off quickly.

You will feel relaxed but still awake. You can talk to the dentist and hear what they tell you, but you won’t necessarily remember everything after the visit.

For most people, the feeling of relaxation produced by nitrous oxide sedation is very pleasant. Sometimes people don’t like the feeling it creates and other options can be considered.

Anti-anxiety drugs (oral anti-anxiety pills)

Oral anxiety relievers (such as temazepam) are sometimes prescribed by dentists or doctors to help calm anxious patients. A short, small, single dose is usually taken one hour before a dental appointment.

The drug should only be taken after consulting a dentist or doctor. You need someone to accompany you to and from your dental appointment because you cannot safely drive while under the influence of a sedative.

Conscious sedation

This type of sedation involves receiving medication through a drip that is placed in a vein in the arm or hand. Intravenous (IV) sedation is given by a dental anesthesiologist (a dentist with advanced training in sedation) or an anesthesiologist. It can be done in a dental office that has additional equipment or in a hospital.

Under IV sedation (sometimes known as twilight sedation), you are relaxed and may go into a light sleep, but you can respond to verbal requests. Possible side effects include drowsiness and nausea after the procedure. You should not drive yourself home after IV sedation.

Not all dentists offer treatment under sedation. Some medical conditions or medications may affect the type of sedation you can have or may prevent IV sedation. Talk to your dentist for more information.

general anesthesia

Treatment under general anesthesia is performed in the hospital by a dentist in Ottawa and an anesthesiologist. General anesthesia involves the “complete sleep” of patients. Some possible side effects include nausea and a longer recovery time than with other forms of sedation.

A general anesthetic can be a good option for some people, but remember that it won’t help you learn coping strategies for anxiety or get used to going to the dentist.

You will need a pre-operative (pre-treatment) visit to the dentist and may also need a post-operative (post-treatment) visit. The anesthesiologist should also evaluate you before general anesthesia. You cannot drive yourself home after general anesthesia.

Some dental treatments are better delivered over multiple visits. This means that if you choose to have all of your dental treatment under general anesthesia, your treatment options may be more limited. In some cases, performing certain treatments in the dental chair at a separate appointment before general anesthesia will help prepare the mouth for the treatment provided so that you can make the most of the general anesthesia session.

General anesthesia works best when used in conjunction with other strategies so that some treatments can be performed without general anesthesia. In this way, general anesthesia session time is saved for treatments that are the most difficult to tolerate.