- Anxiety vs. Phobia
- #1: Communicate
- #2: Sensory-adapted office
- #3: CBD
- #4: Behavior modification & relaxation
- #5: Therapy dogs
- #6: Cognitive-behavioral therapy
- #7: Nitrous oxide
- #8: Anxiety medication
- #9: Sedation dentistry
- #10: General anesthesia
- in Children
- Special Needs
Fear of the dentist, otherwise known as dental fear, dental anxiety, or dental phobia, is a common problem for many people. I’ve seen it over and over in my practice, and unfortunately, it can be hard to find thorough advice on how to deal with it.
The worst part about dental anxiety is that it often turns an irrational fear into a truly problematic experience. Many dental practices take the time to consider an anxious patient’s needs when given the chance.
But avoiding dental situations can lead to a multitude of oral and overall health problems. As an added problem, fixing out-of-control dental problems is far more expensive than preventative care in the long-term.
Here, I discuss evidence-based strategies for beating dental anxiety as well as specific advice for children and people with special needs in the dental chair.
Try the strategies below to take control of your dental health again without fear.
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Why are people afraid of the dentist?
Most people who experience dental anxiety have had bad experiences at a dental appointment. However, that’s not the only cause of this fear.
- Past Experiences: A painful, embarrassing, and/or frightening deal visit is likely to lead to a future fear of the dentist. In one survey report, 71% of patients had experienced pain, 23% experienced fear, and 9% experienced embarrassment with their dentist. All three experiences in the same percent equated to a 22.4 times higher risk of dental anxiety, regardless of the age when they had a negative experience. Some research calls this “conditioned” fear, where one traumatic experience defines the perception of how all future visits will go.
- Media Influences: Sometimes called the “informative pathway,” it’s possible for both children and adults to become afraid of the dentist because they see negative portrayals of dental procedures in movies or other media. The root canal procedure is one that’s often talked about and even shown as extremely painful and invasive in many movies and TV shows.
- Modeling Parental Behavior: It’s possible to learn behavior through modeling, or “vicarious conditioning.” This means if you’re afraid of the dentist and your child sees it, they’re much more likely to experience fear in the dentist’s chair, too.
- Direct Verbal Threats: It might seem like a good idea at the time, but threatening dental work as a consequence of not brushing teeth, for instance, can create a lot of anxiety. That’s why I encourage parents to teach good oral hygiene habits through fun and joyful habit practices and never use the dentist as a threat or punishment.
- Fear of Pain: No one likes to be in pain, and it’s true that many kinds of dental work can cause some form of pain. Unfortunately, this one is a vicious cycle — not going to the dentist because you’re afraid of pain will very likely lead to more pain down the road.
- Fear of Needles/Injections: It can truly be hard to accept the idea of some sort of injection for dental work. For many types of work, a local anesthetic is necessary to make the patient comfortable, which obviously presents an issue. To make it worse, many people experience a fear that anesthesia options “won’t work,” adding to their anxiety.
- Loss of Control: Perceived helplessness is a big part of the level of dental anxiety many people experience. It’s easy to feel like you have no control when your mouth is wide open and you’re “stuck” in the chair.
- Embarrassment: Particularly if a person has major issues with their teeth, bad breath, or problems sharing their personal space, feeling embarrassed or even a lack of self-esteem can result.
- Fear of Financial Loss: There’s no way around it: dental care can get expensive. If you’re already facing money problems, the idea of getting a huge bill from the dentist can be a reason to avoid a visit at all.
- Female Gender: In one Detroit-area study, women were more likely to be afraid of the dentist than men.
- Perceived Controlling Dental Providers: A 2018 study found that up to 38% of students see their dentist as “controlling.” This goes to the loss of control mentioned earlier — if you feel your dentist doesn’t work with you on treatment options, it can lead to fear in the future.
Dental Anxiety vs. Dental Phobia
It’s important to differentiate that dental anxiety and dental phobia are somewhat different. There’s not a perfectly clear line where these two diverge, but it’s generally clear that “normal” dental anxiety is less drastic than a dental phobia.
If you have a phobia, it’s possible to experience major issues sleeping, panic attacks, feelings of illness, crying at the thought of a dental office, or problems breathing normally at the thought of a dentist touching your mouth.
Dental phobia is also known as odontophobia or dentophobia and is characterized by an intense fear of the dentist. Because of the long-term issues with skipping dental visits, it’s important to talk to a therapist to resolve these fears. It’s unlikely that people with a full-blown phobia will overcome their dental fears using home remedies.
Drawbacks of Dental Fear
As I’ve mentioned, the major issue with ignoring a fear of the dentist is that your dental health is going to suffer. Even with a near-perfect diet and incredible dental hygiene routines, most people will still develop hardened tartar and calculus that need to be removed to avoid developing cavities, gum disease, and other problems.
Keep in mind that prevention is always the most inexpensive and least painful way to address dental treatment. A simple cleaning may cause brief tooth sensitivity, but it goes a long way in preventing painful recovery from major dental work.
Sadly, dental anxiety drives people to visit the dentist only when problems become symptomatic. This almost always means that a restoration or more invasive treatment of some kind is required. For instance, cavities can be reversed — but you typically have to catch the decay early, before it’s caused pain.
We’re not just talking about oral health here — gum disease, which begins with gingivitis, can eventually turn into a very painful condition. Not only will the disease and treatments all cause pain, but periodontitis/gum disease is also connected to many systemic health concerns, such as diabetes, heart disease, and Alzheimer’s.
In summary: Avoiding the dentist will only make it worse in the long run. That isn’t meant to scare you more, but to encourage you to address your anxiety sooner rather than later.
How common are dental anxiety and dental phobia?
Being afraid of the dentist is fairly common. Here are some quick statistics:
- Rates of dental anxiety that causes avoiding the dentist range from 7.8%-18.8%, depending on the study.
- Around 60% (some reports say up to 75%) of people have some kind of fear about visiting the dentist.
- Dental fear is the 5th most common cause of anxiety.
- Most people report less anxiety after a procedure is done than the anticipation of dental work.
- About 1-5% of people experience full-blown dental phobia, suffering from irrational fear so strong that they may actively avoid the dentist even when in extreme pain.
So… what can you do about it?
#1: Communicate openly with your dentist.
It may sound overly simple, but the first step must be to talk to your dentist about your anxiety. Ideally, the entire dental team in an office (hygienists, dental staff, etc.) is trained to help calm anxiety and be encouraging and sympathetic.
Specifically, I ask new dental patients what exactly makes them nervous. (It’s generally easy to tell when someone is anxious, so I try to be as empathetic from the start as possible.)
- Does the needle scare you?
- Is it the sound of the drill?
- Are you afraid I’ll think poorly of you because of your breath or dental issues?
- Are you concerned the anesthesia will wear off too soon and leave you in more pain than expected?
- Do you struggle with generalized anxiety disorder (GAD) or other mental health concerns?
These answers help me direct how each visit goes and plan out future visits to consider my patients’ individual needs.
Remember: Unless you speak up, your dentist and hygienist won’t know what’s going on or how they can help.
One very effective way communication helps is that you can develop a “stop signal” that you can use during any point in your procedures. Whatever hand gesture or other motion you decide on with your dentist, that signal can be used to request your dentist or hygienist stop if you begin to feel more anxious.
If you find a good dentist, s/he should be able to help calm you throughout your visit. They may do this by a reassuring touch on the shoulder, good eye contact, a smile, and a gentle voice. First and foremost, your dentist should listen and respond to any concerns that arise.
#2: Try a sensory-adapted environment.
A recent development in preventing dental fear at the office is called a sensory-adapted dental environment (SDE), also known as “The Snoezelen environment.”
In this technique, a dental office makes sure their waiting room and treatment areas utilize decor and structure that considers all five senses and how to keep them from being too aroused or causing a higher level of anxiety.
SDE is characterized by three specific features:
- Partially dimmed lights with lighting effects
- Vibroacoustic stimuli
- Deep pressure massage
It’s generally useful specifically for pediatric dental patients, but a general consideration of how to avoid stimulating the senses during a visit can go a long way in easing fear.
#3: Use CBD oil before dental work.
In order to get away from pharmaceuticals, I started implementing the use of CBD oil in my practice several years ago.
There’s no research that shows exactly how CBD might work within a dental practice, but it does seem to help soothe nervousness in general. I often recommend my patients who are apprehensive about their visit take CBD (this is the brand I use) the night before and the morning of their dental appointment.
Some reports state that CBD is safe and effective in children, but it’s limited. Talk to your healthcare provider before trying CBD with your kids.
There are contraindications for CBD, particularly for how it reacts with heart medications or other prescription drugs. My article on CBD covers many of these contraindications, but it’s a good idea to talk to your general healthcare provider before trying CBD, especially if you take any prescription medication.
The dosage is yet unclear, but I recommend starting taking around 90 milligrams to see how it may help with your anxiety.
Note: While THC (where it’s legal) has some potential to calm the nerves, CBD actually works most effectively for many people. THC can increase anxious feelings, so I suggest understanding how you interact with these different substances before trying them out.
#4: Practice behavior modification and relaxation techniques.
There are several behavior modifications that have shown promise in reducing dental anxiety. Some of these are great home remedies, while others should be practiced with an experienced provider.
The most useful behavioral modification techniques are:
- Guided imagery
- Hypnotherapy (this may even lead to a reduction in pain in up to 75% of people)
- Distraction (diverting the patient’s attention to something other than the anxiety trigger)
- Tell-show-do (back to communication, this is a structured way to discuss and perform procedures that involves the patient in the process from start to finish, giving them back control)
- Exposure therapy
- Positive reinforcement
Relaxation techniques may include:
- Jacobsen’s progressive muscular relaxation
- Functional relaxation therapy
- Autogenic relaxation
- Ost’s applied relaxation technique
- Deep relaxation or diaphragmatic breathing
- Relaxation response
#5: Find a dentist who uses therapy dogs in their practice.
As it turns out, therapy dogs at the dentist can be quite the balm to an anxious patient.
My sweet pup, Remy, has been a therapy dog in my office from time to time. He was even featured on a local news website in 2014 for his hard work!
Featured below is Remy with my wife, Roseann, as she preps for dental work.
A 2018 study found that a therapy dog in the waiting room of a pediatric dental office helped reduce anxiety after just 15 minutes.
Another clinical trial in 2019 — this time with adult patients — found that both the patients’ personal experience and blood pressure during the appointment decreased when holding a therapy dog.
Not a big fan of dogs? That’s okay! Just make sure the office staff is aware you don’t want to interact with a therapy dog on site.
#6: Try cognitive-behavioral therapy (CBT).
Technically, CBT fits within the category of behavior modification techniques. But this one is somewhat unique, as it’s a long-term solution that helps with not only dental anxiety but general mental health concerns.
If you find that you still have strong, panicked reactions during or before any dental visit, consider talking to a therapist about ways you can reframe the experience in a more positive way. Your therapist can help evaluate what further habits might help reduce your anxiety levels.
#7: Request nitrous oxide.
Nitrous oxide (which is not the same thing as nitric oxide) is commonly known as “laughing gas” by dental patients. This gas is used to drive down anxiety and helps keep a patient’s mind off their fears of a particular procedure and has an amnesiac effect.
Not all functional dentists recommend nitrous, but I find that if a patient has exhausted other anti-anxiety remedies, this one can be effective.
Fortunately, nitrous oxide is very inert (has a short half-life) and doesn’t stick around in the bloodstream for very long. Once you’ve taken 3-5 breaths of pure oxygen (O2), the chemical no longer remains in your bloodstream.
Laughing gas may be just as effective as a course of cognitive-behavioral therapy and relaxation techniques for calming the nerves at the dentist. It’s not cheap, so if you don’t need it, it’s less expensive to skip it.
In children, the use of too much laughing gas can cause nausea or vomiting. It’s also not recommended for repeated use in people who are clinically deficient in vitamin B12, as it can interfere with B12 absorption (although this is very rare.)
Fun fact: nitrous oxide has been around since the late 1700s.
#8: Take anxiety-relief medication before dental visits.
Anti-anxiety medications are rarely a great long-term strategy for treating anxiety because of the major side effects they cause (particularly over time).
However, when other strategies have failed and nitrous oxide doesn’t work well, I prescribe diazepam (Valium). A patient in that situation will get one dose of Valium for the night leading up to their visit as well as one pill about an hour before their procedure. Halcion, a similar medication, is also sometimes used.
Benzodiazepines come with many drug interactions and contraindications, so your dentist should only prescribe them after taking a full family and medical history.
#9: Try IV sedation dentistry.
The term “sedation dentistry” applies to nitrous oxide through general anesthesia. In IV sedation dentistry, you’re not fully under general anesthesia but are sedated to the point that you aren’t awake or alert in any way during the procedure.
The safest and most effective way to use this kind of sedation is with the assistance of a trained anesthesiologist.
#10: Undergo general anesthesia.
Only patients with extreme dental phobia are typically prescribed general anesthesia because it has several more risks than other therapies. Because the patient is fully unaware of the entire procedure, it can help reduce anxiety.
An anesthesiologist is required in these situations.
Dental Anxiety in Children
When it comes to the dentist, it can be a nightmare for both parent and child if there’s a high level of fear involved.
I outline some details in an article on pediatric dental anxiety. Here are the basics:
- Children tend to be less anxious after their first visit is out of the way. Your efforts to make visit #1 as peaceful as possible will be worth it!
- In addition to many of the reasons adult patients are scared of the dentist, young patients may also feel a fear of obstructed breathing and a general fear of the unknown.
- It’s best to start dental visits the first time your baby/toddler cuts a tooth. Developing a positive view of dentists upfront goes a long way towards developing good dental habits.
- If you’re afraid of the dentist, your child will pick up on it. In situations with very anxious parents, I recommend considering another family member come with the child to avoid the child vicariously learning the same fear.
- Communication is key for pediatric dental patients. Talk through each step with your child before it happens. Make sure s/he knows how to ask the dentist to stop if s/he experiences discomfort. Reinforce the fact that they aren’t totally powerless in the situation.
- For very anxious children, consider talking them through the process the week leading up to their visit. My granddaughter loves to read a book about visiting the dentist before her appointments (and sometimes, just for fun!).
- Pay attention to your child’s reaction to his/her dentist. If the dentist makes him/her uncomfortable, think about finding a different pediatric dentist in your area.
- Above all, aim to reinforce good habits with fun and positivity, rather than forcing habits with demands and threats.
A note on general anesthesia for pediatric patients: While it may help in the short-term, anesthesia doesn’t restore a sense of lost control. It seems that using it once may result in the same or higher level of anxiety at subsequent visits because the child didn’t consciously face their irrational fear.
A recent development in childhood dental anxiety suggests that music intervention therapies may help reduce anxiety.
Dental Anxiety in Special Needs Patients
Special needs patients may experience a high level of anxiety during dental work due to a large number of factors.
Whether it’s an issue of sensory overstimulation or just a lack of understanding of what’s going on, I tell patients it’s important to find a dentist who specializes in special needs care. This will often be a pediatric dentist.
Most general and family dentists can be sensitive to these issues. However, it can be difficult to give individual patients with special needs the unique, specialized care they need.
Your dentist will also need to consider contraindications for any of the strategies listed above, some of which aren’t appropriate or possible with certain types of special needs.
Therapy dogs may also be an important intervention for special needs patients who are concerned about their dental checkups. A 30-subject study of adult patients with “intellectual disorders,” like autism or Down’s syndrome, found great results with a certified therapy dog within the dental practice.
Q: Is nitrous oxide safe for everyone?
The only two rare side effects that can occur are nausea and vomiting in children if too much gas is administered, and in very rare cases, vitamin B12 inactivation. This potentially fatal condition can technically occur in patients with clinical or subclinical vitamin B12 deficiency.
Patients with known B12 deficiency or in any of the below categories should talk to their dentist about the potential risks before using nitrous oxide:
- MTHFR deficiency
- Pernicious anemia
- Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
- History of partial or total gastrectomy or ileal resection
- Gastric subacidity
- Use of metformin (a medication used to manage blood sugar)
- Vegans or children breastfed by vegan mothers, who are often B12-deficient
- Repeated occupational or recreational exposure to N2O
Q: What foods or drinks make anxiety worse or better before I go to the dentist?
Q: Will using a weighted blanket help me feel calmer?
Q: Can I use essential oils before or during my visit?
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