Drilling Into Our Fear Of The Dentist — And What To Do About It

(AP Photo/Michael Probst)

For the estimated ten percent of Americans with dental phobia, research suggests therapy and other options may help. (Michael Probst/AP)

When I arrived at the dentist’s office for my implant procedure, I was already sweating and on the verge of tears.

After several shots of Novocaine, I felt no pain whatsoever. But that didn’t matter. I squirmed as I sensed incisions in my gums and heard drill collide with bone. I panicked about how intrinsically wrong it felt for someone to put titanium in my body. I worried: Would I be able to eat? To talk? Would I get an infection?

After an hour and a half, I returned to the receptionist swollen and tear-streaked. The periodontist joked, “She was shaking like a leaf, it was like a moving target!”

Not long afterward, I checked out my score on the Dental Anxiety Scale. My whole body tensed up when I read the first question: “If you went to your dentist for TREATMENT TOMORROW, how would you feel?” I scored a 21, which qualifies me as a “highly dentally anxious patient, possible dentally phobic.”

I have a lot of company. In fact, the Diagnostic and Statistical Manual of Mental Disorders estimates that almost 4 percent of people are “dental phobics.” According to the DSM, the prevalence rates for dental fears are similar to the rates of people who fear snakes or heights.

But we’re not quaking alone in the chair. Of late, researchers have been seeking to understand dental fear better, from its prevalence to the disparate elements that add up to phobia. For example, one recent brain scan study found that the buzz of the dental drill is a particular source of distress. And they’ve been exploring and testing potential remedies, from therapy to sedation.

Dr. Matthew Messina, a Cleveland dentist and consumer adviser for the American Dental Association, estimates that the rate of dental phobics is even higher than 4 percent. Around 10 percent of the adult population in the United States, Dr. Messina says, have a dental phobia so paralyzing it prevents regular dentist visits.

Dr. Lisa Heaton, a licensed clinical psychologist who treats patients at the University of Washington’s Dental Fears Research Clinic, says that up to 75 percent of adults have at least some anxiety about going to the dentist.

I have always been squeamish about dental visits, but I entered a new chapter of anxiety when I was 16 and saw an oral surgeon who told me I would eventually need dental implants in my lower jaw, where I’m missing two adult teeth.

We dental phobics don’t just have to open wide and bear it. We can seek to understand our fear — and counteract it.

He explained, to my horror, that would mean a bone graft — likely scraped from my own chin — followed by titanium posts drilled into the spots where my teeth would have been. A couple months later, a fake tooth would be placed atop each post.

I was fitted for what dentists call a “partial” and what I would call dentures. A plastic set of teeth I removed and brushed every night of high school and college to “give my gums some air,” as the dentist called it. The grating pressure of plastic on gum every day for six years wasn’t great for my oral health, and dentist appointments turned into battles. The hygienist would move the sharp “probe” closer to my exposed gums and I would move my head farther away.

This summer, a long-overdue visit to the dentist (I make a habit of canceling appointments last-minute) confirmed that if I didn’t receive implants over the next couple of months, I would soon face permanent nerve damage.

My avoidance stemmed from what was, in my view, a perfectly rational aversion to pain, but the logic behind dental phobia varies. (And yes, there is some logic to it.)

Close Encounters

  • Sitting in the dental chair is, undeniably, a claustrophobic experience. “If I’m your cardiologist, for the most part, I can treat you from four, five feet away. But with dental care, I have to really very much get into someone’s personal space,” says Dr. Messina. The sound of dentistry is also an issue – the scraping and the drilling.

Cost

  • Another source of anxiety, says Dr. Messina, is the high cost of dental work. In 2007, my periodontal consult told me the implants would cost $16,000, which was a major factor in my procrastination. That price tag was reduced by $9,000 over six years, even though my trusty insurer, Cigna, made it clear they would not, no matter the circumstances, cover any portion of the implant. When the receptionist requested the $5,000 I owed after a truly unpleasant surgery, it felt like a kick in the gut, and added another layer to my resentment toward the dentistry field.

Ill Tidings

  • “Some people are concerned to come into the dentist because they’re afraid of bad news,” says Dr. Messina — and that’s especially true for the 10 percent of people who put off dental visits. The consequences can certainly get in the way of patient health. Dr. Messina says that advanced dental decay, infected teeth and periodontal problems can lead to life-threatening medical emergencies. “Then we’ve gone out of the boundary of dentistry,” he says, “because the problem has exceeded the mouth and it’s a health risk.”

But we dental phobics don’t just have to open wide and bear it. We can seek to understand our fear — and counteract it. Dr. Heaton at the University of Washington recently conducted an evidence-based review of psychological treatments for dental phobia. It found that behavioral and cognitive-behavioral treatments were effective at reducing the fear, even months or years after the intervention, she said.

Cognitive behavioral therapy is a kind of exposure therapy, Dr Heaton explained. In one method, if a patient is afraid of dental injections, a clinical psychologist encourages their patient to breath deeply, relax their muscles and think positive thoughts. “I can do this, I can handle this.”

Then the psychologist, alongside a dentist, talks to the patient about the dental injection. What its purpose is, why the needle looks the way it does. The dentist then inserts a capped needle (one that can’t actually poke the patient) into the patient’s mouth, so the patient has an opportunity to cope and manage their anxiety.

That action, which is initially frightening, is repeated until it becomes boring. At that point, the psychologist and dentist begin a cap-off rehearsal, where they go through the same steps with an uncapped needle. The anxiety is initially high again, but it goes down as the action is repeated.

“At a certain point,” Dr. Heaton says, “they just say, ‘You know what? I’ve gone through all the steps and I know that I can stay calm during this, and so we can just go ahead and do the injection.’”

Dr. Heaton says she and her team have had significant success with this approach in their clinic. Might this approach apply to other elements of dental procedures like cleanings, fillings and implants?

“Very often what we find is that, just the trust that’s built up during that process — just people getting used to being in the dental setting and having things in their mouth — that does tend to generalize to other aspects of the dental procedure,” says Dr. Heaton.

Researchers have also looked into treatments involving eye-movement therapy, but those strategies depend on a patient who is afraid due to one, specific traumatic event with a dentist.

‘You might have $1,000 in sedation for a $100 cleaning.’

Another option for dental phobics is sedation dentistry, which includes a range of patient choices. The lowest level of sedation is nitrous oxide, or laughing gas. On the other end of the spectrum, a patient can be completely knocked out, as they would be to get their appendix out.

The week before my implant surgery, I called the dentist’s office to ensure I would be knocked out. “Nope,” said the cheery receptionist. “It’s a minor procedure, you won’t be sedated.” I was shocked, but too timid to ask for an exception to be made.

I asked Dr. Messina if I could have demanded sedation. Better yet — could I be sedated for a simple cleaning? He said, with reservations, that I could. “The question is, why do you feel you need that? We need to explore the reasons.”

And there are issues with sedation dentistry. “Obviously, when we start sedating people, we’ve added another level of medical risk,” says Dr. Messina. And, there’s an added cost. “A routine dental cleaning might cost $100. You throw the sedation in, you might have $1,000 in sedation for a $100 cleaning.”

Dr. Heaton sees sedation dentistry as a great short-term solution for the 10 percent of people who are dental phobic, but she doesn’t see it working in the long-term.

“They wake up with the same fear that they went to sleep with, they just have better teeth in the moment,” she said.

Patients who undergo sedation tend not to follow up with their dentist on a regular basis, Dr. Heaton added. Instead, she advocates for the lasting change that comes with cognitive behavioral therapy.

And there’s some added incentive to conquer dental anxiety — fear is likely to translate into more pain. Martin Tickle, a professor of dental public health at Manchester University, surveyed dental patients to ask whether they’d felt pain.

“The strongest predictor of pain during dental procedures was dental anxiety,” Tickle told The Guardian. “Anxious patients were four times more likely to experience pain than non-anxious patients after controlling for other factors.”

As for me, cognitive behavioral therapy sounds effective, but scary and time-consuming — and my budget doesn’t allow for sedation. After going through a nauseating surgery I spent six years dreading, I was actually able to eat and talk normally after just a couple days, and the pain was extraordinarily minimal.

I’d like to think that my quick recovery lessened my anxiety — that I will confidently walk to my next appointment and speak to my dentist with a steady voice because I know that I’ll be fine when it’s over.

But, as I look at my calendar and realize I’ll be starting the next phase of the implant process on Jan. 9, I can’t help but reach for my phone. I just might be busy that day….

Tips to get you through your next dental procedure:

  • Check out your score on the Dental Anxiety Scale. Then, show it to your dentist so they know what they’re dealing with, Dr. Messina suggests.
  • “The time to develop a relationship with a dentist is before something hurts,” says Dr. Messina. Talk to your dentist about past dental experiences that you found scary or frustrating.
  • Try finding a dentist who has an office with a calming effect. This Parisian dentist redecorated entirely to sooth her patients.
  • Interview dentists before you settle on one. Call up a couple different offices and ask to meet with the dentist for 15 minutes, without any kind of dental treatment scheduled. If they’re not willing to do that, they’re not the dentist for you, says Dr. Heaton.
  • Talk to a doctor about sedation options if that’s what you need to get back in the dentist’s chair — but keep in mind the long-term goal of sedation-free dentistry.
  • Figure out the best time of day for you to see a dentist. If you don’t want to worry about it all day, schedule it for the early morning. If a gag reflex issue is part of your dental anxiety, try for the afternoon.
  • Before the procedure begins, try controlled breathing. Take a big breath, hold it in, and then slowly let it out. This will slow your heartbeat and relax your muscles.
  • If that recent study about sound as a source of dental fear rings true to you, use headphones to listen to a podcast, a comedy routine, or a playlist that’s sufficiently distracting. Here’s the playlist I used for my surgery.
  • Ask if you can hold the suction – it’s a way to have control over some element of the dental procedure.
  • Have someone you trust in the waiting room for when you’re done with your procedure.

Readers, if you’ve grappled with dental fear, any other tips or suggestions? What works for you?

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  • toxygen

    The playlist link near the end of article does not work. Otherwise, nice article.

  • klhayes

    Does anyone know about the use of lasers instead of drills? Is that only for minor cavities or was it just a fad? You hear about drill-”less” dentistry but I don’t know anyone who has had it. That would alleviate my fears big time.

  • ElaineMarie34

    Dental fear is also often an expression of developmental or other trauma. The intimacy of someone in your mouth who might cause you pain, with you in a vulnerable position, can trigger a trauma response. I have never found a dentist who understood this and was sensitive to it.
    I also agree with those who say it’s gotten harder to know whether you’re being manipulated or marketed to by dentists who see you as a profit center. I’d cite the push for adult braces, which might result in years of follow-up repairs for problems from the braces, as an example. TMJ is another. I’ve had more luck reducing tooth, neck, and jaw pain with self-administered trigger-point massage than with a ton of random treatments from dentists who say this or that “might” improve things.

  • Bobby Glennon

    There are many new technologies available that can take the anxiety out of going to the dentist. One of these new technologies is the DentalVibe (www.dentalvibe.com), an easy to use, low cost, injection comfort technology that makes any injection pain-free. Most patients will not tell their dentists that they hurt them, they simply wince and take the pain and then never return. 1,000′s of dentists worldwide are having great results using the DentalVibe, especially with children. More patients than ever before are returning for additional dental work instead of waiting until it gets necessary, or worse, critical. Dentists MUST embrace new technology and be open to new techniques and procedures that are more patient-centric. It is not the dentistry that hurts, it is the pain of the injection. check this out: http://www.youtube.com/watch?v=kwp-CpfNkG0&list=PLZo_CPr1_Oa43no9jPLWjHAwy2YkTigWk

  • DakotaNM57

    If we placed as much emphasis on advancements in the dental field as we do in the medical field we wouldn’t be reading articles such as this one. I’ve been though major surgeries, having broken bones set, spinal taps.. the list goes on. But nothing frightens me as much as going to the dentist. I’ve seen numerous dentists in my lifetime and only recently found one which doesn’t seem immune to the discomfort the person in the chair is feeling.
    I had one dentist try to continue drilling after I’d told him I could feel it. Phobias about dental work definitely has an earned foundation.

  • http://www.ManifestPositivity.com/ Dave Berman, C.Ht.

    Not to take anything away from cognitive behavioral therapy, but hypnosis has a much longer track record of success for dental issues.

    http://www.humboldthypnosis.com/hypnosis-dentistry-long-history-new-insights/

  • Jamie Boots

    They could quit ripping people off. That would help. The prices are all massively inflated. The dental industry act like its a luxury not a necessity. It Should not cost hundreds or thousands for some plastic and wire. It does so everyone can walk away with a fortune on the mouths of every patient. Its a scam but one they getaway with because you can die if you let it go. .

  • Steve

    I’ve never heard of nerve damage due to having open spots. That sounds really fishy to me. Exactly how does a missing tooth, properly extracted and healed, cause nerve damage?

  • CRDDDS

    Novacaine has not been used in Dentistry in probably over 50 years. What is commonly used today is Lidocaine with Epinephrine or Carbocaine. They are chemically different structure than Novacaine. Most people react to the epinephrine in the Lidocaine and when doing so report a sense of speeding of the heart rate or trembling. Often times they equate this trembling to fear. Epineprine is used in the Lidocaine to constrict blood vessels and increase the duration of the anesthetic. If your Dentist did not explain this to you find another Dentist. Also, the potential for nerve damage resulting from “not” having the implants done is highly suspect. Your Periodontist needs to seriously be questioned.

    I really dislike articles like this released to the public with much misleading material. It makes the job of the Dentist more difficult. The best way, in my opinion, to choose a Dentist is to find one that is first and foremost in his style an Educator and by that I mean an Educator that provides “factual” information not nerve damage poppy-cock to promote treatment acceptance. . .

  • Ari Vinograd

    We actually specialize in treating patients with dental anxiety / phobia, and published our methods: http://drvinograd.com/holistic-dentist/dental-phobia-being-scared-of-the-dentist/

  • MichaelNewJersey

    I am a periodontist and have never heard or read about nerve damage occurring because a patient did not get an implant to replace a missing tooth. This is total horse***t! I’ve been in this profession for 31 years and can tell you that this is totally untrue and nothing but a manipulative tactic to frighten you into having the procedure done..

  • http://www.ugottafriend.com/ Kelli B

    My stepbrother was a phobic. He had a severe abscess, and refused to go to the dentist no matter how much the family begged him to. He died a horrible death as a result. He was only 29 years old and a single dad. His five year old boy was orphaned, and cried every day for years.

    For God’s sake, folks, educate yourselves and seek professional help when necessary. I hate going to the dentist too, to the point of tears, but I go because it’s a part of life. It just has to be done.

    • http://www.ugottafriend.com/ Kelli B

      Just saw that part of the article is still online. Looks like the “archived” portion is gone, but here it is. It was the front page headline that day.

      http://www.al.com/press-register/stories/index.ssf?/base/news/1226830695202950.xml&coll=3

      • http://www.ManifestPositivity.com/ Dave Berman, C.Ht.

        I’m sorry for your loss Kelli. This is sad in the extreme. Even the more common cases of anxiety and dental phobias are unnecessary suffering (see my comment down thread).

        BTW, for the skeptical periodontist in NJ, I put the title of the article Kelli linked in Google and was surprised to see over a million hits to similar stories about deaths related to untreated dental problems. This link mentions two more cases.

        http://abcnews.go.com/Health/insurance-24-year-dies-toothache/story?id=14438171

        • http://www.ugottafriend.com/ Kelli B

          Thanks for your input, Dave.

  • ZEUS

    watching Marathon Man was the worst dental experience i’ve had.

  • Christina

    This article hits really close to home. I am massively, massively afraid of the dentist. I haven’t been in over 10 years, but even reading this article makes me anxious, breathing shallow and getting teary eyed. I’m not a nervous person at all (in fact, my job is quite dangerous and even life threatening and that doesn’t bother me too much), but even the thought of the dentist is about as much as I can bear. I know I need to go, but I honestly can’t even handle the thought. :(

    • Emma-Jean Weinstein

      Writing it made me very anxious too!

    • klhayes

      When I was a kid, I threw up AFTER the dental appt!!! I hate it so much and this article stress me out too.

    • http://www.ManifestPositivity.com/ Dave Berman, C.Ht.

      Christina and klhayes, you are both acknowledging something very important. It doesn’t take a visit to the dentist to make you uncomfortable, it only takes your thoughts about it to do that. Our thoughts always influence our feelings about everything in life. When we change our thoughts we feel different. Hypnosis is often used to help people with dental issues – not just fear/anxiety, but also teeth grinding/clenching, relaxing the gag reflex, staying disciplined with recommended treatment (including flossing, brushing, etc.), and changing habits that affect oral health, such as smoking or nail biting. Give it some thought…

  • chaotik_lord

    I don’t have any anxiety about the idea of any procedures, but I have extreme sensory issues that make the feel of a simple pick or the pitchy sound of the drill two cubicles away pain-inducing. I am constitutionally incapable of suffering a simple cleaning without earplugs and extreme sedation. I’m not at all phobic, however. I’ll gladly sign on to any procedure without sensory stimulation; my molar extraction took place in a private room with a relatively low-pitched and quiet device, and I was all right.

    I do better with earplugs and if they let me keep on the vest that they use for x-rays; unfortunately, the noise still travels through the jaw to the inner ear, so I avoid the dentist.

    • Kathy Richmond

      I remember my family was on an extended trip and I had to see a dentist across the country whom I had never met before when I was about 8. I remember they struggled to put a mask over my mouth and nose (nitrous oxide). I found the experience rather terrifying. I continue to need regular dental work and even braces during my childhood and adolenscence.
      Luckily I didn’t develop a full dental phobia, but I really didn’t like going to the dentist. As it turned out one of my first job out of college was as a dental receptionist. The continued exposure took away all my fear.
      I learned to relax in the dentist chair and deep breath. Focus on the ceiling. My current dentist has pictures on the ceiling.
      In my forties I started needing to replace old fillings. Since there was little tooth that needed to be drilled away one time the dentist suggested that I probably didn’t need any novacaine. After that my perference is not to have any shots. The intense cold/discomfort I experience during the drilling isn’t worth the hours of feelings numb. Novacaine or the eqivalent they use today seeems to last for hours on me. I find the numbness more bothersome than those few minutes of drilling. Plus if the drilling bothers me too much, the dentist can always give me a shot. But I’ve never done that.
      I do accept the shot for bridgwork or for a filling right at the gum line where the gums might be irritated or disturbed. Some dentists insist on it.
      It is a sense of accomplishment when something that formally used to be so anxiety provoking no longer ellicits that fear response any more.

  • crankycoffey

    I used to have major dental anxiety (and I’ve needed a ton of dental work over the years). After I got the Novocaine shot, I would experience unreasonable fears about what was going on in my mouth – that the dentist was filling my mouth with blood, cutting my tongue, etc.

    When I got a new dentist a few years ago, I told her about this (I’d never told a dentist about it before) and she said “OK, you probably just don’t like this kind of novocaine.” She said it was sort of a speedy drug, and that some people didn’t respond well to it. She told the hygienist to give me the other kind.

    It worked! Now when I have to get work done, I get this alternate type of numbing drug (whatever it is) and I don’t freak out. In fact, I can practically fall asleep.

    Talk to your dentist if you’re having problems – it can’t be worse than keeping silent, and if it is, get a new dentist.

    • http://www.ugottafriend.com/ Kelli B

      Thank you for sharing this. People don’t realize that certain drugs, including anesthetics, can result in these kind of side effects. Yours was not a mental issue. It’s physiological. In your case, it sounds like the quick adrenaline release caused by the novocaine triggered your anxiety. It happens more often than people realize. I’m glad you found an alternative. I can’t use novocaine either, I have to have a slow-reacting, non-adrenaline-based anesthetic. Education and communication are vital parts of having a successful experience.

  • Heather127

    On what planet will simple sedation such as nitrous oxide add $1000 to a bill?

    My dentist works with a lot of dental-phobes, and prescribes a benzodiazepine and uses nitrous if needed. IV sedation — the kind that adds a lot of money to the bill — is used for more difficult procedures such as implants, or when a patient needs a lot of work done at once.

    What helps is to find a dentist who works with those who are dental-phobic, and not to put up with anyone who discounts your fears. You, the patient, are the consumer. You have the power to say no and to go elsewhere.