Fear of Sights, Sounds and Smells

Sights, sounds and smells are powerful environmental triggers. If you suffer with dental phobia, merely evoking the images, sounds and smells you associate with dentistry is enough to generate intense feelings of anxiety or even panic. Just thinking of that smell may make you want to throw up.

Ughh… what’s that smell?

The typical clinging smell which impregnates some dental practices is caused by eugenol (a.k.a oil of cloves). You’d think that oil of cloves would smell a bit nicer, seeing how whisky with lemon and cloves smells rather nice… but no! Eugenol smells creepy. As we all know.

But here’s a mystery: when people without a fear of dental care smell eugenol, they rate the odour as pleasant :shock: (at least in one experiment conducted by a group of French researchers). They were comparing the reactions to eugenol of people with dental anxiety and people who were fearless of dental care. Here is what they found:

This odorant was rated as pleasant by non-fearful dental subjects but unpleasant by fearful dental subjects. The evoked autonomic responses were mainly associated with positive basic emotions (happiness and surprise) in non-fearful dental subjects and with negative basic emotions (fear, anger, disgust) in fearful dental subjects. These results suggest that eugenol can be responsible for different emotional states depending on the subjects’ dental experience, which seems to confirm the potential role of odors as elicitors of emotional memories.
(Robin, Alaoui-Ismaïli, Dittmar and Vernet-Maury, 1999)

Seems to confirm the potential role”?? That dental surgery smell gives us the creeps – big-time!

Smells are very powerful emotional triggers. This is because cells in the nose which process smell input send signals directly to the olfactory bulb, which is a part of the limbic system – an ancient part of the brain which is responsible for basic emotions like fear. Unlike other senses like seeing or hearing, the higher thinking structures are bypassed, and the sensory info is fed straight to the emotional center of our brain. No wonder then that we react so severely and immediately to smells that we associate with scary things.

Luckily, more and more dental practices are switching away from eugenol to non-smelly alternatives :D. You will find that in many places, “the smell” is no longer. Eugenol is becoming used less and less. Part of the reason is that it is incompatible with many modern dental materials, like white fillings and bonding agents. However, eugenol can be useful in some situations. For example, it is present in “alvogyl” – a brown substance used to treat the site where a tooth has been removed when it isn’t healing properly. Also, some temporary cements can have “the smell”:

“The smell is certainly less now, but there are certain materials used from time to time which have that distinctive ‘dentist’ smell. On occasions I come home from work and my wife will know if I have used a temporary cement for example because I ‘smell like the dentist’ apparently. I’m glad to say that it doesn’t happen too often!!” (Mike Gow, BDS)

But generally speaking, fewer and fewer dental practices feature “the smell”. And some practices are even using aromatherapy to put you into a good mood, for example by using the smell of oranges.

If “the smell” is a major turn-off for you, try and find a practice that has moved on to alternative materials!

The Sights

The decor

Some dental practice layouts, equipment and colour schemes are much more phobic-friendly than others. Does the place look clean (but not “sterile”)? Is there a happy atmosphere (or at least not a scary atmosphere)? What’s the overall “feel” of the place? Of course, the people who occupy the space (i. e. your dentist :D) can make a big difference in changing the overall atmosphere, but if the treatment room doesn’t look clean, this is a very bad sign. Avoid. And if the physical environment is important to you, do check out a few different practices first to have a look at their premises (often, they have piccies on the internet – so you can check them out from the comfort of your own home!). You’ll be amazed at the differences between practices – some are downright spooky, while others have a much more homely, living-room like atmosphere.

“The Chair” is another major turn-off, but again, there are so many different models on the market these days, and many of them don’t look all that spooky anymore.

The tools

Do you remember the days when all instruments were laid out in plain view on a tray? Nowadays, you’ll be hard pushed to find a place where instruments are laid out in plain view (in the UK at least). The main reason for this is that modern standards of infection control don’t allow it. At last – a Health & Safety regulation which actually benefits us!

Many people are scared of the sight of instruments being put into their mouths. The internet is full of stock photos of scary scenes where dentists come at their patients from the front with instruments held to their faces! Unfortunately, lots of websites choose to use these scary images, even though they are far removed from reality. The reality is that dentists work in such a way that you can’t really see the tools. Of course, you may wish to see them beforehand and have them demonstrated to you. For example, many people find that having a better look at “the drill” aka the handpiece, and having it demonstrated on their finger, takes a lot of the fear away. Or else, some people find that simply closing their eyes works for them while receiving dental care. On the other hand, there are people who like to see exactly what is going on, in which case you can ask your dentist to show you what they are doing with the help of mirrors.

The Sounds

Many people equate the sound of the drill with pain. The logic behind this is simple: if you’ve had a painful dentistry experience in the past which was accompanied by the sound of a dental tool, you’ve come to associate the sound with pain. Just hearing the sound may evoke a “perception” of pain. It can help to bear in mind that the sound actually has no correlation to pain once you are numbed up – it’s just air turbulence spinning the bur (unless it’s an electric handpiece – these are also quieter).

I doubt that anyone is all that keen on the sounds, but if you haven’t been to a dentist in a very long time, it might come as a relief to know that they’re not as noisy as you may remember them. Technology has moved on a lot. Also, bear in mind that when noise is “inserted” into your mouth, it sounds much louder than it actually is. Ask your dentist to demonstrate any instrument that makes a noise to you first (if you so wish), and sit up while being shown. Sitting up makes it much easier to feel in control. Many people find that their mind has been playing tricks on them (images of Black & Decker drills come to mind for some!) and the reality is nothing like they had imagined.

You can find lots more tips (and even an mp3 to blend out the sound of the handpiece) on our Fear of the Drill page!

Further reading

If you’d like to find out more about the importance of the environment, check out the excellent article Lloyd Jerome wrote for this site on the use of distraction in dentistry: The Art and Science of Distraction.