A dental phobia is described by The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a “marked and persistent fear that is excessive or unreasonable”. Unfortunately, it assumes that the person who suffers the phobia recognises that their fear is excessive or unreasonable. Importantly however, that person’s fear or phobia is being categorised as a condition that implies ‘failure’ on behalf of the person who suffers it, by the very implication of the terms ‘excessive or unreasonable’.
For many people with a dental phobia, they may believe or feel that their fear is completely normal, or they may be unsure what to do about it. Even more importantly, they may not believe they have the will power to change their phobia, or that there is a dental practice that would be able to assist them to overcome their fears and anxieties.
Traditionally, a phobia can lead to avoidance behaviour of the situation, object, or activity such as having dental treatment. It can often lead to an inability to make an appointment to see a dentist. Exposure to this feared stimulus such as even thinking about needing dental treatment may provoke an immediate anxiety response, or even a panic attack. This phobia causes considerable distress, and impacts on other aspects of the person’s life, not just their dental and oral health.
“When you explore your fears then you set yourself free.”
― Stephen Richards
Laughing, smiling, talking, and even eating can become extremely problematic as the person’s dentition (teeth) begin to fail and degrade over time. Embarrassment, avoiding contact with friends and family, avoiding jobs that involve dealing with the public, loss of self esteem, and feelings of guilt for not having properly looked after one’s teeth are very common amongst people with dental phobias.
For approximately 20% of the population, dental phobia tends to be more common in people who suffer from other mental health disorders, notably General Anxiety Disorder, Panic Disorder / Agoraphobia, and Depression. A problem with defining dental phobia however, is that there are many types rather than just one, and they may be rational due to a past bad or negative experience or experiences, and some forms of a dental phobia that may seem more “irrational” to others, yet are very rational to the person who suffers with it.
You are the person who suffers a dental phobia and you begin to experience minor discomfort in a tooth and realise that you ‘may need a filling’. After all, it has been ‘years since you saw a dentist’. The mere thought of picking up the telephone to make an appointment causes your heart to start racing and your hands to shake. You break out in a cold sweat, and you feel sick in the stomach, so you don’t pick up the telephone but instead repeat to yourself “my tooth will be okay for now. I’ll make an appointment ‘next week’.”
Some time later, the tooth begins to throb and ache. Now you know you need to go to the dentist. Another panic attack, and instead you head off to the GP and are typically provided with pain relief and antibiotics. This decreases the pain for another few weeks so again you avoid making that phone call to the dentist. A repeat script(s) for antibiotics keeps the pain at bay when it flares up. Months later, you are eating dinner and suddenly the tooth falls apart with considerable pain and the following day your face swells up. Now it’s a trip to hospital where you are given more antibiotics.
Despite repeated time off work, an aching tooth, a swollen face, many sleepless nights, and repeat panic attacks you still don’t get to the dentist. What was a small amount of decay requiring a relatively quick filling, is now an expensive and dreaded root canal, complex crown reconstruction, or an extraction.
Unable to bear the pain any longer as you cannot eat, smile, talk, or even breathe without the tooth hurting, you finally make it to a dentist. You have no idea what to expect or who you are seeing, because after all, you ‘never go to the dentist’ so it’s literally pot luck choosing from local advertising or on the recommendation of a ‘friend’s friend whose cousin works there’. But….. it’s 4.30pm on a Friday afternoon and the tooth requires surgical extraction because it is so broken down that it is now ‘unrestorable’. If you aren’t needing to be referred to a specialist, an hour or so later the tooth is out, your face is completely numb, you are emotionally drained and physically exhausted, and unfortunately you vow ‘never again will I visit a dentist’. Until the next time.
At the Hobart Orofacial Pain and Special Needs Clinic, we aim to make all visits to the practice as relaxing and calming as possible.
The most difficult skill for clinicians to develop is the “how to” of talking to patients who suffer phobias to dental treatment in a developmentally appropriate, non-judgmental, facilitative, and empathetic manner. As discussed previously, there are many reasons and causes of dental phobia, and our primary goal is to work with people to help them overcome that fear and be able to access regular, pain-free, relaxing dental treatment.
The initial visit begins with a consultation that occurs in a non-threatening, non-clinical, office based environment. During this consultation we will discuss medical and dental histories, and assess all the required information including any xrays. A detailed treatment plan, be it simple and straight forward, or relatively complex depending on the needs of the patient, along with all of the various possible treatment options will then be provided. This may include the treatment being conducted under relative analgesia (laughing gas), oral sedation, conscious IV sedation, a combination thereof, or a general anaesthetic option.*
Our practice is the only one of its kind in Hobart able to provide combinations of oral and intravenous sedation in a fully endorsed environment as per the standards set by the Australian and New Zealand College of Anaesthetists for conscious sedation. (please see “What Is Sedation” for further information)
The ultimate aim of our clinic is to take those patients as described in the above case example, or those that would only ever consider having ‘general or emergency treatment under a general anaesthetic in hospital’, through the entire journey of being able to make an appointment, to the end point of being able to sit comfortably in a dental chair without inducing fear or a panic attack. And importantly, for the patient to eventually be able to be referred to a suitable and caring general dental practitioner who will expertly manage the long-term oral health goals of the patient through a regular continuing care program.
* General anaesthetic options are typically reserved for those people who are initially intolerant or unsuitable for treatment under conscious IV Sedation, or for treatment that preferably requires a general anaesthetic (e.g. surgical wisdom tooth removal). This is to assist in reducing the reliance on and the associated costs for hospital based treatment.