Written by the Dental Fear Central Web Team
Last updated on August 20, 2020
What is dental phobia, and what causes it?
Ambling along an innocent-looking road, you pass a sign for a dental surgery. Immediately, your heart starts racing, you break out in a cold sweat, and you feel shaky and nauseous. Argggh, not yet another reminder of the dreaded D-word – better cross that road and face the other way!! Is that you? You may be one of the many people who suffer with dental phobia!
Dental phobia (an extreme fear of the dentist) is used as an umbrella term which can involve many different fears or one specific fear. Dental phobia causes a lot of distress and may impact on other areas of your life.
You may spend an awful lot of time thinking about your teeth or dentists or dental situations, or else spend a lot of time trying NOT to think about teeth or dentists or dental situations. Which is pretty hard in today’s society, which is saturated with ugly reminders such as toothpaste commercials.
The difference between dental anxiety, fear and phobia
The terms dental anxiety, fear and phobia are often used interchangeably.
One useful way of defining them is as follows:
- Dental anxiety is a reaction to a potential, anticipated danger 1. Most people experience some degree of dental anxiety, especially if they’re about to have something done which they’ve never experienced before. Often, it’s a fear of the unknown – the “uncertainty factor”.
- Dental fear tends to be far more specific. If somebody has a fear, they’re usually able to pinpoint what they have a fear of2, for example needles or pain or gagging or being humiliated. If you have a lot of different dental fears, pinpointing them can become a little overwhelming, but you should be able to identify them with some prompting.
- Dental phobia is even more intense. The terror you feel is so strong that you avoid the dentist altogether until either the physical pain or the psychological burden of the phobia becomes overwhelming. Some people with dental phobia, for various reasons, may still attend a dentist. But they will endure these encounters with intense fear or anxiety.3
When you’re in the depth of a dental phobia, this cute teddy may strike you as pretty frightening (a dentist in teddy’s clothing) – yet another reminder of your worst nightmare…
Phobias have sometimes been labelled irrational or exaggerated fears. But once you start digging a little deeper, this usually isn’t the case with dental phobia.
How is dental phobia different from other phobias?
At the moment, dental phobia is treated as a sub-classification of Blood-Injection-Injury (BII) specific phobia3. This type of phobia also includes needles and invasive medical procedures.
This classification is highly problematic. Some dental phobics do have a very specific fear of needles and may faint when having an injection, and see this as their main problem. But this is the exception rather than the rule.
Here are some key differences which set dental phobia apart from other specific phobias:
1. The fear involves another person
With dental phobia, the fear is often directly linked to another person (usually the dentist) and their behaviour.
2. The large variety of fears
There are over 20 common dental fears discussed on this website alone, and this list is by no means exhaustive! Most people with dental phobia have more than just one dental fear.
3. The fear is not necessarily exaggerated or unrealistic
You may perceive your fears as excessive or irrational. Then again, you may not. Dental fears are often entirely realistic. Many of the things people are afraid of, for example being lectured or told off, not getting numb, mutilation in the form of unnecessary treatment, the dentist not stopping despite you being in distress, to name but a few, really can happen (especially with the wrong dentist).
On Bondi Beach
Is dental phobia really out of proportion to the actual danger? This will depend on your point of view and your previous experiences.
Mike Gow, a dentist from Glasgow and founder of the International Society for Dental Anxiety Management, uses the following analogy:
If you were standing on Bondi Beach and you look out into the water and you see a dark shape moving around in the water, do you have a shark phobia if you never want to go into the water? Is that a shark phobia? No. Because you’re on Bondi Beach and it’s a suspicious dark shape that could be a shark. If you’re at your local swimming pool and you see a dark shape in the water and you decide not to get in, that’s a phobia. That’s excessive.
Now, somebody who has only had difficult and bad experiences at the dentist, their only reality has been on Bondi Beach. And actually, their phobic response is legitimate. If their recollection of what happened during this horrible appointment is true, then wanting to stay away from that situation for me is entirely rational, that is not a phobic response. Now the difference, and the crucial part, is making sure that when they go to a dentist they see a dentist who is as safe as the swimming pool. So it’s the environment that becomes important rather than the phobia. The phobia has protected them from all dentists when actually it’s just the dentists that are not nice to them that they need to avoid.
Phobia vs. Trauma
Some researchers have suggested that dental phobia may be a misnomer. In many cases, dental phobia more closely resembles post-traumatic stress disorder (PTSD)4:
We propose that the term “Posttraumatic Dental-care Anxiety (PTDA) is more accurate since it specifies that the mode of acquisition is typically not innate (as with blood phobia), but rather acquired, most frequently through direct conditioning akin to PTSD.
Of course, not everyone fears the dentist because of previous bad experiences with a dentist. As we’ll see, there are many reasons why people develop dental anxiety and fear.
What can cause dental fear and phobia?
Bad experiences with dentistry
In one large study from Singapore, people who reported painful dental treatments and a perceived lack of control were 13.7 times more likely to report higher dental fear, and 15.9 times more likely to report being less willing to return to dental treatment 7.
Sometimes, people cannot recall a bad experience, for example because they were very young when it happened. They may only learn about the experience from their parents or other people who were around at the time. But the anxiety is still there even though they have no conscious memory of the event.
Other traumatic experiences
Dental phobia is more common in people who have been sexually abused than in the general population.8 For survivors of trauma, feeling vulnerable and at the mercy of an authority figure is a trigger for memories to flood black. And the dental environment is full of triggers for memories because of the parallels it has with particular kinds of trauma and especially with power imbalance.9
So it’s not at all surprising that sexual assault victims are more likely to have high dental anxiety and experience fear related to lying flat in the dental chair, and are more likely to have a more pronounced gagging reflex.10 11
A history of bullying or having been physically or emotionally abused by a person in authority can also contribute to developing dental phobia.
Finally, traumatic experiences in medical settings often spill over into the dental realm. It’s common to have a phobia of dentists if you have a phobia of medical settings more generally.
Feelings of powerlessness
Many people with extreme dental anxiety or phobia feel powerless in dental social situations. You may have felt in the past that you had to obey the dentist, or you may have had a dentist who would not stop even though you were in distress.
Preparedness and Genetics
People may be inherently “prepared” to learn certain phobias, such as needle phobia. For millions of years, people who quickly learned to avoid snakes, heights, and lightning (and sharp objects, such as needles, which would not have been sterilised in those days, apart from giving you a nasty sting!) probably had a good chance to survive and to transmit their genes. So it may not take a particularly painful encounter with a needle to develop a phobia. 12
Another cause of dental anxiety is observational learning.13 If a parent or other caregiver is afraid of dentists, children may pick up on this and learn to be afraid as well, even in the absence of bad experiences. Hearing other people’s horror stories about visits to the psychodentist can have a similar effect. Also, the depiction of “the dentist” in the media (especially children’s films/cartoons and comedies, and of course horror movies) can contribute to developing dental fears.
People often assume that it’s the fear of pain that keeps you from seeing a dentist. But even where pain is the person’s major concern, it is not necessarily the pain as such that is the problem. Otherwise, dental phobics would not avoid the dentist even when in pain from toothache. Rather, it is pain inflicted by a dentist who is perceived as cold or controlling that has a huge psychological impact. Pain caused by a dentist who is perceived as caring is far less likely to result in psychological trauma.14
Especially after years of avoidance, you may feel shame and intense embarrassment in social situations and try and hide your mouth. The thought of a dentist seeing your teeth may be impossible to even contemplate. 15
Another cause of dental phobia is insensitive, humiliating remarks by a dentist or hygienist. In fact, insensitive remarks are one of the main factors which can cause or contribute to a dental phobia. Human beings are social animals, and negative social evaluation will upset most people, apart from the most thick-skinned individuals. If you’re the sensitive type, negative evaluation can be shattering.
Other mental health issues and dental phobia
Dental phobia and anxiety can occur together with other mental health issues. Here are some of the more common combinations:
Generalised Anxiety Disorder and Health Anxiety
The things you worry about intensely may include or focus on dental stuff.
Panic and Agoraphobia
You are scared of what will happen if you panic while visiting the dentist. Also, you may not feel confident to leave your safe space to visit a dental practice.
A lack of motivation is common with depression. It often leads to a lack of self-care – including caring for your dental health. Add to this the feelings of guilt and shame that often go hand-in-hand with depression, and it’s easy to see why you may want to avoid the dentist. The fear of getting lectured or needing lots of dental treatment can be overwhelming.
Eventually, the state of your teeth may make it even harder to feel good about yourself or to socialise. Sometimes, dental phobia can cause depression, or make it worse. It’s a vicious circle.
If you have a fear of throwing up, dental treatment can be daunting. You may fear that you may gag or choke on something and throw up. Or you may worry about drugs used in dentistry or pain control causing nausea and vomiting.
Even a mild degree of social anxiety can make you more prone to feeling easily embarrassed. You may be worried about crying, shaking, or making a fool of yourself. And, of course, you may be worried about what the dentist or their assistant thinks or says about your teeth or oral hygiene.
When you experience another mental health issue, it can make overcoming dental fears more challenging. Additional psychological support can be invaluable.
How common is dental phobia?
While there are no reliable statistics (after all, few dental phobics will freely admit to never visiting a dentist… that’s if they hang around to complete the questionnaire!), the most conservative estimates reckon that 5% of people in Western countries avoid dentists altogether due to fear. In the UK’s Adult Dental Health Survey (2009), 12% of adults had extreme dental anxiety, while over a third (36%) had moderate dental anxiety. 16
In this video, dentist Niall Neeson answers the question: “Is dental phobia still common?”:
Is dental phobia more common among women than men?
The 2009 Adult Dental Health Survey in the U.K. reported that women are twice as likely as men to experience extreme dental anxiety.16 But the odds are that women are simply more willing to admit to their fears.
Here are some comments from our forum:
I’m a 37-year-old VERY heavily tattooed construction worker and I’d like to think I can handle everything, except my teeth.
I’m a grown man and a full-time firefighter. I can run into a burning building without blinking an eye but the thought of sitting in a dentist chair scares the hell out of me… even typing this puts a knot in my stomach.
Being a man can make things more difficult, because you may find it harder to be open about your fears. Many men also mention their fear of a young, pretty dental assistant seeing them frightened and seeing their teeth. This can be as big a deterrent as seeing the actual dentist.
The good news is that once you do manage to seek help and open up about your fears, you may find a huge weight has been lifted off your shoulders:
In the past, I did everything to please the dentist, being brave and putting up with anything… When I thought about that, I realised that was the wrong thing to do. I now have a totally different outlook, I’m still very nervous, but my dentist is willing to work with me and goes at the speed that I can cope with. My dentist talks to me and I feel so in control, it’s a totally different experience from what I had before.
You can find a dentist like this too, but you must be honest with them, don’t try and hide the fear you feel.
The impact of dental phobia on daily life
Dental phobia can have wide-ranging effects on your life. Not only can your dental health suffer, but dental phobia may lead to anxiety and depression. Laughing out loud may be out of the question – too hard to hide one’s teeth… Depending on how obvious the damage is, you may avoid meeting people, even close friends, due to embarrassment over your teeth, or turn down jobs which involve contact with the public.
Loss of self-esteem over not being able to do something as “simple” as going to a dentist and intense feelings of guilt over not having looked after one’s teeth properly are also very common. Some people also avoid doctors for fear that they might want to have a look at their tongue or throat and suggest that a visit to a dentist would not go amiss.
There is a light at the end of the tunnel…
It is possible to overcome dental phobia or at least make progress that would have seemed utterly impossible previously. The path to success will be different for different people, but there are many options to help. If you do your research, find the right person and the right practice for you, then it is possible.
There are many people out there who used to have a debilitating dental phobia, but they actually managed to build trust and confidence and overcome this burden. At this time, that may seem very difficult to imagine. But remember, if others can do it – you can do it too!
If you or someone close to you is affected by dental phobia, fear, or anxiety, visit our Dental Phobia Support Forum!
You may also like:
Dental Phobia Success Stories – feel free to add yours!
Footnotes and References
- Coriat IH (1946). Dental anxiety: fear of going to the dentist. Psychoanal Rev 33:365-367.
- Horwitz, AV (2013). Anxiety: a short history. Baltimore, Maryland: The Johns Hopkins University Press
- Diagnostic and Statistical Manual (2013), 5th Ed. (DSM-5®).
- Bracha HS, Vega EM (2006). Posttraumatic dental-care anxiety (PTDA): Is “dental phobia” a misnomer? Hawaii Dent J. Sep-Oct;37(5):17-9.
- Humphris G, King K (2011). The prevalence of dental anxiety across previous distressing experiences. Journal of Anxiety Disorders 25(2):232-6.
- Ost LG, Hugdahl K (1985). Acquisition of blood and dental phobia and anxiety response patterns in clinical patients. Behav Res Ther. 23(1):27-34.
- Milgrom P, Vignehsa H, Weinstein P (1992). Adolescent dental fear and control: prevalence and theoretical implications. Behav Res There. Jul; 30(4): 367-73.
- Humphris G, King K (2011). The prevalence of dental anxiety across previous distressing experiences. Journal of Anxiety Disorders 25(2):232-6.
- Fredriksen TV, Søftestad S, Kranstad V, Willumsen T (2020). Preparing for attack and recovering from battle: Understanding child sexual abuse survivors’ experiences of dental treatment. Community Dentistry and Oral Epidemiology 48(4): 317-327.
- Leeners B, Stiller R, Block E, Görres G, Imthurn B, Rath W (2007). Consequences of childhood sexual abuse experiences on dental care. Journal of Psychosomatic Research 62(5):581-8.
- Uziel N, Bronner G, Elran E, Eli I (2012). Sexual correlates of gagging and dental anxiety. Community Dental Health 29(3):243-7.
- Randall, CL, Shaffer, JR, McNeil, DW et al (2017). Toward a genetic understanding of dental fear: evidence of heritability. Community Dent Oral Epidemiol 45:66-73.
- Townend E, Dimigen G, Fung D (2000). A clinical study of child dental anxiety. Behaviour Research and Therapy, Vol. 38, Issue 1, pp 31-46.
- Bernstein DA, Kleinknecht RA, Alexander LD (1979). Antecedents of dental fear. Journal of Public Health Dentistry, 39, 113-124.
- Moore R, Brodsgaard I, Rosenberg N (2004). The contribution of embarrassment to phobic dental anxiety: a qualitative research study. BMC Psychiatry, 4:10.
- The Health and Social Care Information Centre (2010). Adult dental health survey 2009. London: Department of Health.