Questions & Answers on Overcoming Dental Fears

An interview with clinical psychologist,

Dr. Philip Cardamone

How did you become interested in treating patients with dental fears?

During my training, I learned how to handle all types of unpleasant emotional responses. These anxious reactions included fears such as fear of flying, stage fright, and panic attacks.  I learned about effective ways to help people overcome needless fears. Dental fears are one class of anxious problems that are easily treated.

Is dental phobia a big problem?

I've heard that about 12% of the population has some degree of anxiety about dentistry. Of course, if you happen to have it that makes it a big problem for you. Oral health has many consequences. Besides the obvious effects on teeth and gums, it can affect a person's self-confidence. Sometimes people who neglect their teeth by avoiding dentists develop psychological difficulties. I remember one woman who constantly had her hand in front of her mouth and was afraid to laugh out loud. This kind of self-consciousness can really hinder a person.

How are dental fears linked to other fears?

Most people with dental fears just have a fear of dentistry. Other people have more general fears, and dental fear is just one aspect. A common related fear is a fear of medical procedures in general. Such people avoid injections, blood tests, and visits to any medical office unless it's a dire emergency. When people have related fears, the treatment approach requires a strategy to deal with all of the fears in a systematic way.

A small number of patients have had past experiences that influence how they think or react to dentistry. Events associated with strong emotions like fear are easily remembered. A person who gets into the dental chair and gets into a fearful mood, might recall past significant traumatic events. The dental experience in this way can trigger or speeds up physical reactions. Sometimes the person may not even make the link that past situations are being recalled. Once triggered, these emotional and physical reactions become closely linked to dentistry. If a person has generalized anxiety or panic attacks, they may need specialized professional assistance to overcome these conditions as well as dental fear.

Besides a bad experience at the dentist's office are there other causes of dental phobia?

It's usually due to a false belief. Sometimes a person had an experience that leads them to want to avoid related situations and it extends to the dental office. It's only natural. If we experience pain, we want to avoid the situation and ones like it too. Unfortunately, jokes, movies, and stories about someone's bad dental experiences can set us up for the same fears. Humans are like that. We learn things. So if we hear that a dental office is a place of pain, many of us will avoid it.

Since dentistry is now a relatively painless experience, what would cause a patient be so fearful?

Yes, dentistry is relatively painless -- but it is a patient's expectations that are the basis of anxious reactions. It's wrong to assume that pain is the main reason people avoid the dentist.  It is true for many, but not for all. There are people who endure all kinds of painful experiences, such as childbirth and contact sports, and yet avoid the dentist. The first step then is a careful analysis of exactly what the person fears.   It may be that confinement without an avenue of escape is the fundamental problem. Others are fearful that they won't be able to express themselves if they feel uncomfortable. Usually it's persistent troublesome thoughts that are the real problem. People have thoughts like, "I'm going to lose control" or "I won't be able to bear the pain."  These illogical thoughts motivate people to avoid dentistry. There is also the fact that while dentistry is relatively painless, dentists are human and may inadvertently do something to frighten a patient. If a dentist forgets to explain a procedure, for example, and the patient has an unexpected sensation it can affect the patient's fear level. Their expectation of pain is reinforced. They have body reactions that motivate staying away.

Does dental phobia cause other life situation problems?

Most people with dental phobia have what we call a specific phobia, and it's limited to this one area. It's easily treated. What I often see with people under the age of 30 who have dental phobia is that they heard horror stories from the older generation. We also see how parents can pass on misinformation and negative attitudes to their children.

What role does age and gender play in dental phobia?

Most studies have not found any consistent differences in frequency, but men tend to hide their fears more than women do. Some studies have suggested that dental anxiety decreases with age but that means many years of needless anxiety.

What should a phobic dental patient look for when choosing a dentist?

Most dentists are trained to help people feel relaxed. A good dentist makes you feel like he or she genuinely cares about you. They explain procedures and try to help you feel relaxed. The dentist should give you a way to communicate. Look for patience, trustworthiness, and competence. Ask for recommendations. The dentist should use all the modern anesthesia methods.

What techniques do you use to help patients overcome their fears of dentistry?

My approach is to address three areas:

• Bodily responses and sensations

• What and how the person thinks

• Behavioral avoidance patterns

Neglect one of these areas and treatment will not be as effective. Before you can get people to give up their avoidance, you have to address how they handle sensations that are actually present. After all, even in painless dentistry, the patient has to sit in a chair, mouth open, with things going on just below their noses, right under their eyes, next to their tongues, while hearing strange sounds. We need to deal with this reality. Thinking comes in when the person interprets these sensations. Messages are sent to the person's nervous system. The patient interprets (or misinterprets) and then reacts to bodily sensations. So it is not just the needle and instruments that trigger a phobic reaction, its things like a thumping heart and breathing changes.

The first step in helping a patient with dental fears is to do an assessment. I want to determine what aspects of the dental experience are most relevant. I want to know if something specific happened in the past that started it all. This discussion in itself is often helpful because for once the person can talk comfortably about what they fear. Talking itself has desensitizing properties.

Once the severity of the problem is established and the full range of avoidance behaviors is known, the approach becomes a gradual, step-by-step one.  The main technique is called Systematic desensitization. First, the person is taught relaxation and breathing techniques that counter physiological reactions. Then desensitization is conducted in imagination through visualization techniques if necessary, so that the person stops reacting to their own thoughts. After a while, the person learns to relax even while experiencing previously troublesome thoughts. The connection between the thought and fearful reactions gets severed. Eventually, we break down the dental office experience into small steps so that each one can be accomplished in real life. This builds confidence.

The desensitization process is usually organized around specific themes. For example, a major fear in dentistry is fear of dental syringes.  In an early phase of treatment, the patient is asked to visualize in their minds scenes involving needles while they are relaxed. Once the person handles the experience in imagination, we move on to real life applications. I might have a patient hold a syringe, noting how small the diameter of the needle really is. I might work with a patient's dental team to arrange brief visits to do a specific task. I might ask the patient to visit the dentist's office and practice having the needle in their mouth without it actually being used. Gradually, the patient builds up courage and confidence. In every case, the procedure is customized for each individual.

Patients are also taught other techniques such as mental rehearsal, coping skills, and distraction techniques.

How many sessions does it usually take Q to complete therapy?

Phobias are the easiest anxiety disorder to treat. Uncomplicated dental phobia is treated on a short-term basis. Most people are seen six to twelve times.

What are the costs and does insurance cover therapy for dental patients?

Fees are discussed up front. Patients are charged our usual fee per visit. It's affordable because its usually short-term, especially when you compare it to the cost of neglecting oral health.  Insurance often covers a substantial portion of the charges. Treatment of a specific phobia is usually considered medically necessary and covered by most insurance Plans.

Dr. Cardamone specializes in the treatment of anxiety disorders, including dental anxiety. He can be reached at 860 644 4472 and at providercareplus@SBCglobal.net