If you feel dread in the pit of your stomach at the thought of a dental appointment, you’re not overreacting. Dental anxiety is extremely common, and it runs the gamut from a fluttery feeling in your stomach to keep-your-mouth-shut-for-years phobia. We spoke to psychologists to find out what’s behind that fear and collected some coping mechanisms to help you make it through your next trip to the dentist (or even your lifelong check-ups) without the meltdown.
Just How Common is This, Really?
The problem isn’t just how common dental anxiety is, but what it prevents us from doing. Avoiding the dentist means small problems become crises, crises become more expensive to solve, and we risk damaging the very thing, our teeth, that we’re trying to protect. Fixing a seriously damaged tooth requires more time in the dentist’s office and more dental work than if the problem was caught early. Fixing 10 small cavities is less expensive (and less painful!) than filling just one root canal, but if you have full-on dental phobia, odds are you already know all this.
What’s Actually Driving the Fear
Most people don’t come up with a fear of the dentist out of nowhere. There are often specific triggers that make those visits frightening, and once you put a name to yours, you can start working through them.
The biggest one? Needle phobia. I mean, even people who don’t technically have a phobia of needles are allowed to get nervous about a big long needle being plunged into the dense, sensitive flesh close to their jawbone.
The sound of the drill and the physical sensation of its vibration are common triggers too. Loss of control, of your body, of your ability to communicate, of what’s happening right over your head, is another. And if you’re one of those who chokes at home even thinking too hard about your tongue, the aches and pains in your jaw, and the light, there’s a mental trigger piled on top of the very reasonable physical ones.
And honestly, sometimes it’s just that simple. Your brain skipped fear-mediating and went straight for “yep, being afraid of dentists now, we’re good.” It’s not that you had one of the above experiences. It’s just that you had a bad dentist. A painful cleaning, maybe, or someone who seemed rushed or uninterested or careless or all three. And your brain slapped a stapler on that and said “right then, we’re classifying this under ‘dentists’ forever and never reconsidering it.”
The Avoidance Cycle, and Why it Makes Things Worse
Here’s the thing about avoidance: avoidance begets avoidance. The more you dodge, the easier and more justified it is to dodge the next time, and the next, and the time after that. If you cancel your cleaning because you have a cold, your next six-month appointment will likely be delayed an additional four to six weeks, if not more, because there were already no slots available for the next several weeks. The later you schedule, the more likely it is that something will come up to interfere with the appointment, because it will be so far in advance that you could not foresee it. The longer you go between visits, the more you’ll feel like the damage has been done and it’s best not to bother, which, as mentioned, guarantees still more damage, and so on ad nauseam.
Choosing a Practice That Takes This Seriously
Not all dental practices are the same when it comes to anxiety, and it’s worth taking some time to seek out the right one for you. Things to look for include practices that advertise their services for nervous patients prominently on their website, rather than treating it as an afterthought. Practices that block-book extra time for anxious patients are likely to be patient and understanding, whilst practices which describe in detail the structured consent process they use, including clear ‘stop’ signals, are unlikely to push you further than you feel comfortable.
Patient reviews are a goldmine here too. If several mention that they appreciated being able to take things slowly, try focusing on the practices that promote this and actually check their reviews. If you’re looking for a dentist in Coventry, finding someone who actually delivers on what they claim on their website is key, practices that have invested in staff training in sedation and anxiety management are also likely to be the ones that genuinely understand how to put nervous patients at ease.
Techniques You Can Use Before You Even Leave the House
A significant amount of dental anxiety is most intense in the lead-up to the appointment, with much of it eroding away once you’re actually there. Managing that anticipatory dread specifically is time well spent. Breathing through it is unlikely to be news to you, but doing it properly is probably a novelty. Slowing your respiration is proven to be the single most effective way to reduce anxiety, but most people don’t do it because they don’t do it correctly. Holding a tissue under your nose won’t hit the magic 9 breaths per minute. Ten seconds to breathe in, ten seconds to breathe out is closer to the mark. The pause in between stops you hyperventilating. Wash, rinse, repeat. You can knock down on this one with a few minutes of pre-appointment practice, and then again in the waiting room.
What to do Once You’re in the Chair
During your consultation, which you should always book in if you feel anxious, your dentist can also go through strategies including using a small amount of local anaesthetic to numb the area before the proper injection goes in, using more subtle filling materials so that less drilling is needed, or suggesting sedation. They should also be laying out all your options and walking you through each of them, so at no point do you feel surprised by a new treatment.
What Good Anxiety-Aware Dentistry Looks Like From the Other Side
Dentists experienced with anxious patients usually employ a method called tell-show-do. They explain what they’re going to do, show you the instrument or give a taster somewhere less sensitive, and only then proceed with the step. No surprises. That’s often all it takes to keep a tolerable procedure from becoming a panic trigger.
Another is gradual desensitisation. Some practices might start treatment with nothing more than acclimatising to the chair over a couple of visits, gradually building up to a full check-up, then treatment. Few offer it, because it’s slow work, but it’s often the only route to treatment for someone who hasn’t been able to open their mouth in a dentist’s chair for years.
And this is facilitated by good chairside manner. Unhurried, jargon-free explanation; a dentist that stops rather than a dentist that keeps working through the tooth or scale; these things can usually make someone dread seeing their dentist a little less. This isn’t the soft skill some suppose: for anxious patients, it’s part of the clinical competence.
Understanding Sedation Options
If you’ve tried all the tricks and tips, conscious sedation is the next option. That should scare you less than the thought of judging yourself for being too terrified. It’s a tool, not a consolation prize, and a good practice will treat it as such.
Nitrous oxide, or laughing gas, is the lightest form of sedation. You simply breathe it in through a mask, start to feel floaty and happy within a couple of minutes, and remain alert and responsive the whole time. It wears off almost immediately once the mask is removed, so you’re usually able to drive yourself home.
Oral sedatives, which are taken sometime before your appointment to create an increased sense of relaxation and, sometimes, sleepiness, are the next step up. You may find you need someone to drive you home, and the effects will take more time to wear off than with nitrous oxide.
IV sedation is the strongest, and it’s also administered directly into your bloodstream. In general, it’s used only for patients with strong phobias or in conjunction with more extensive procedures. You won’t remember your treatment at all.
No one is going to skimp on your sedation and insist you just get used to what you’re doing. If it feels like you need a little help, ask for it.
When Self-Help Isn’t Enough
For some people, fear of the dentist is not just a punchline, the dread is so deep that even breathing exercises and a patient dentist don’t provide enough relief. In that situation, it’s worth being upfront about what’s proven to help most. Cognitive Behavioural Therapy is the most effective evidence-based tool from the psychological arsenal against phobias; it teaches patients to confront and defuse the catastrophic thoughts that connect themselves to the idea of dentistry in general. The hope is that once these are uncovered and disarmed, they will no longer kick in automatically. Structured hypnotherapy is a possible alternative treatment: although research is limited by small sample sizes, some patients have found it really helpful, and it’s especially worth considering if the phobia is specifically triggered by needles, or if you have a problematically sensitive gag reflex.
