It is estimated that dental anxiety affects between 4 and 30% of the population around the world (Humphris & Kign 2011): being anxious about going to the dentist is a common fear.

For some people the anxiety connected with dental procedures can reach a very distressing level, and can lead to postpone or avoid dental appointments, with the result of a poor oral health and increased possibility of invasive and potentially painful treatment (Milgrom, Newton et al, 2010; Ng & Leung 2008; Armfield, Stewart et al. 2007).

While many people can react with fear (a natural emotion that arises when we are confronted with something that threatens us) when they are going to have a dental procedure done, some people experience anxiety. Anxiety is a response to the environment that is characterized by anticipation and worries about a situation.

So, what is a phobia? A phobia can be diagnosed when the experiences of fear and anxiety are so distressing that the normal daily life of a person is disrupted by behaviours aimed to avoid the feared situation or object. Specifically, a phobia is an intense fear of an animal, object, place, situation or activity that most of the people would not be afraid of (DSM IV-S).

Dental phobia is an example of a specific phobia. A common reaction to a phobia, is the creation of “safety behaviours” or the avoidance of the feared situation. In this specific case, the avoidance of the dentist’s appointments. These natural behaviours can worsen the phobia with the passing of time (Palmer & O’broin, 2008).

Left untreated, a severe dentist anxiety or dentist phobia, can lead to the perpetration of a maladaptive cycle: the avoidance or delay of the appointments with the dentist, cause the dental problems to worsen and this lead to more invasive treatment. The experience of more invasive treatment makes the anxiety related with the dentist to be maintained or increased (Armfield, Stewart et al. 2007).

Different levels of anxiety require a different approach to the management of the symptoms.

People with low or moderate level of dental anxiety, may benefit from environment changes in the dentist’s studio (as a welcoming and familiar environment) or/and the provision of information about procedures. To build a good rapport with the dentist and distractions during the procedure, are other ways to lower the level of anxiety.

On the other hand, people who deal with high level of anxiety or dental phobia might need a specific treatment (Newton, Asimakopopulu et al. 2012).

The treatment that is demonstrated to be the most efficient in reducing dental anxiety (and to treat phobias in general (NICE 2004)) is the Cognitive Behavioural Therapy (CBT).

A CBT treatment for phobias typically lasts six to ten sessions. It integrates both behavioural aspects and cognitive restructuring techniques.  Some behavioural techniques include relaxation, mini-experiments and systematic desensitization.

On the other hand, the cognitive restructuring is achieved analysing the thoughts that people have in regards the feared situations. The aim is to create new connections between thoughts, emotion and behaviours, where the feared object is not related anymore with distressing emotions.

The use of drugs against anxiety is sometimes prescribed, but it is usually recommended in short term period, and often combined with other talking therapies (Palmer & O’Broin, 2008).

Other interventions for dental anxiety like hypnotherapy, acupuncture and eye movement desensitization have been studied, but further research is needed to prove their efficacy (Gordon, Heimberg et al. 2013).

 

Marta Bezzone

 

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REFERENCES

Armfield, J. S., Stewart, J. F., & Spencer, A. J. (2007) ‘The vicious cycle of dental fear:exploring the interplay between oral health, service utilization and dental fear ‘ BMC Oral Health, 7(1).

Gordon, D., Heimberg, R.G., Tellez, M., Ismail, A.I. (2013) ‘A critical review of approaches to the treatment of dental anxiety in adults’ Journal of Anxiety Disorders, 27, pp. 365-378.

Humphris, G. & King, K. (2011) ‘The prevalence of dental anxiety across pre-vious distressing experiences’ Journal of Anxiety Disorders, 25, pp.232–236.

Milgrom P, Newton J T, Boyle C, Heaton L J,Donaldson N. (2010) ‘The effects of dental anxiety and irregular attendance on referral for dental treatment under sedation within the National Health Service in London’ Community Dent Oral Epidemiology,  38, pp. 453–459.

National Institute for Clinical Excellence (2004) Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. London: NICE.

Newton,T., Asimakopoulou, K., Daly,B., Scambler, S., Scott, S. (2012) ‘The management of dentalanxiety: time for a sense of proportion?’ British Dental Journal 213(6), pp.271-274.

Ng, S. K. S., & Leung, W. K. (2008) ‘A community study on the relation-ship of dental anxiety with oral health status and oral health-relatedquality of life’ Community Dentistry and Oral Epidemiology, 36, pp.347–356.

Palmer, S., O’Broin, A. (2008) ‘Phobias – what, who, why and how to help’ The British Psychologial Society. London.