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!
What is a phobia?
In a medical sense, phobias are defined as unreasonable, excessive fears 1 that lead to avoidance of the feared situation, object or activity (even though the Greek word “phobia” simply means fear). Exposure to the feared stimulus provokes an immediate anxiety response, which may take the form of a panic attack. Dental phobia causes a lot of distress, and impacts on other aspects of your life. People who suffer with dental phobia will spend an awful lot of time thinking about their teeth or dentists or dental situations, or else spend a lot of time trying NOT to think of teeth or dentists or dental situations. Which is pretty hard in today’s society, which is saturated with ugly reminders such as toothpaste commercials.
What is dental phobia?
Dental phobia is poorly defined. It is not actually listed as a separate entity in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders.
Perhaps this is because dental phobia is simply too messy to pin down. For coding a specific phobia, DSM-5 only lists 5 stimuli:
- Animal (e.g. spiders, insects, dogs)
- Natural environment (e.g. heights, storms, water)
- Blood-injection-injury (e.g. needles, injections, blood, invasive medical procedures, injury)
- Situational (e.g airplanes, elevators, enclosed places) and
- Other (e.g. situations that may lead to choking or vomiting)
From this list, dental phobia may involve a “blood-injection-injury” stimulus (such as needles or surgery or injury), a “situational” stimulus (the dental surgery or waiting room), or “other” (e.g. situations that may lead to choking or vomiting). Interestingly, there is no option for a “person” phobic stimulus in DSM-5, only an “animal”, so a phobia of the dentist (as a person) can’t be coded.
Is dental phobia an irrational fear?
In many ways, dental phobia is very different from other specific phobias.
- Firstly, the fear is often directly linked to another person (the dentist) and their behaviour.
- Secondly, many common dental fears are 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, to name but a few, really can happen (especially with the wrong dentist).
- There is another peculiarity about dental phobia: the large number and variety of fears which people may experience. There are over 20 common fears discussed on this website alone, and this list is by no means exhaustive!
What can cause dental phobias?
It comes as no surprise that most (though by no means all) dental phobias are caused by previous bad experiences with dentists or dental treatment. 85% of people with dental fears report having had negative, traumatic or painful experiences.
One large study from Singapore found that individuals who reported having experienced painful dental treatments and perceived a 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 2.
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.
A history of abuse:
Dental phobia is also common in people who have been sexually abused. A history of bullying or having been physically or emotionally abused by a person in authority may also contribute to developing dental phobia, especially in combination with bad experiences with dentists.
It is often thought that it is the fear of pain that keeps people from seeing a dentist. But even where pain is the person’s major concern, it is not pain per se that is necessarily 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.3
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 4.
Other causes of dental phobia include insensitive, humiliating remarks by a dentist or hygienist. In fact, insensitive remarks and the intense feelings of humiliation they provoke 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.
Another cause of dental anxiety is observational learning. This appears to be of only minor importance, judging by our forum and by the available research 5. 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 cause people to develop dental fears. Examples include “Horton Hears a Who” and “Nick at Night”.
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 sterilized 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.
It has been suggested 6 that dental phobia is a misnomer and in many cases could be more accurately described as a type of post-traumatic stress disorder (PTSD). Most people who have developed dental phobia as a result of past bad experiences don’t feel that their fear is “excessive and unreasonable”. PTSD would be a much more accurate description than calling this a “phobia” (and, by implication, irrational):
“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.”
On this website, we use “dental phobia” as useful short-hand for “terror at the thought of dentists and/or dentistry and/or anything dental-related”. Some people feel that their fear is justified and rational, while others feel they’re being silly for getting so upset over something which “everyone else” seems to have no problem with. Dental Phobia is really an umbrella term which covers a wide range of different fears. There are some fairly distinct subtypes of dental phobia, such as needle phobia or terror at the thought of gagging and being sick.
Other mental health issues and dental phobia
Dental phobia and anxiety can co-occur with other mental health issues, especially
- Generalised Anxiety Disorder (the things you worry intensely about may include dental stuff),
- panic disorder/agoraphobia (the fear of what will happen if you panic while visiting the dentist and/or the fear of having to leave your safe space),
- depression (lack of motivation resulting in lack of self-care, including caring for your dental health, which will exacerbate avoidance because of fear of lectures or dental treatment; embarrassment over the state of your teeth which makes it even harder to feel good about yourself or to socialise), and
- emetophobia (fear that you may gag or choke on something and throw up, or fear of drugs used in dentistry causing nausea and vomiting).
The difference between anxiety, fear and phobia
Another way of conceptualising levels of dread is by distinguishing between anxiety, fear and phobia:
- DENTAL ANXIETY is a reaction to an UNKNOWN danger. Anxiety is extremely common, and most people experience some degree of dental anxiety especially if they’re about to have something done which they’ve never experienced before. Basically, it’s a fear of the unknown.
- DENTAL FEAR is a reaction to a known danger (“I know what the dentist is going to do, been there, done that – I’m scared!!”), which involves a fight-or-flight response when confronted with the threatening stimulus.
- DENTAL PHOBIA is much stronger (“I know what happens when I go to the dentist – there’s no way I’m going back if I can help it. I’m so terrified I feel sick”). Someone with a dental phobia will avoid dental care at all costs until either a physical problem or the psychological burden of the phobia becomes overwhelming. The fear is so strong that it interferes with your quality of life and/ or your ability to function.
The intriguing thing about this conceptualisation is that it suggests a mild-moderate-severe progression. But in reality, dental anxiety (a reaction to an unknown danger) can be just as debilitating, or in some cases even more debilitating, than a full-blown phobia. In a way, dental anxiety can be more difficult to tackle than dental phobia, because if you’re not sure what exactly is causing your anxiety, it can make it harder to come up with solutions.
How is dental phobia measured?
There are various instruments for researchers which attempt to measure the degree of the fear, such as Corah’s Dental Anxiety Scale (DAS) and a shorter version, the Modified Dental Anxiety Scale (MDAS). Click here for a PDF download. However, if you suffer with dental phobia, you won’t find it too hard to beat the high score, never mind being scared enough to qualify!
Alternatively, ask yourself the following question: “Am I terrified of dentists and avoid them at all costs?” If the answer is yes, this is a good indicator of dental phobia! Even seemingly innocuous reminders of anything dental-related may produce a panic-attack if you suffer with dental phobia, such as people talking about dentists or teeth, toothpaste commercials, or “dental words” (such as words starting with de-, or words like accidental).
Who is affected with dental phobia?
Anyone can be affected with dental phobia! It doesn’t matter if you are young or old, a woman or a man, a cleaner or a nuclear scientist, rich or poor.
You may have come across news stories which imply that dental phobia is more common among women. For example, the 2009 Adult Dental Health Survey in the U.K. reported that women are twice as likely as men to experience extreme dental anxiety. But… all this means is that women are more likely to admit to their fears!
In reality, it is likely that there is no significant difference between men and women when it comes to dental anxiety. There are lots of men who avoid dentists but generally speaking, they find it much harder to admit to it (even in a survey – and it should be pointed out that the survey mentioned above involved visiting people in their homes, so it wasn’t exactly anonymous). Also, women who work in more “macho” professions such as the police force or the military often find it harder to articulate 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.”
“Help… I really feel like a wimp as a guy. I know I shouldn’t be this way, but I can’t help it. :'(”
“I know it is not by chance that so many active duty, reserve soldiers or veterans have major issues around going to the dentist. Not that it’s announced out loud (I know I would be mortified) that you’re afraid of something so little as a dental appointment if you’ve been shot at or actually shot.”
“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 male can make it more difficult for you to overcome your fears, because even if you did manage to see a dentist, you might find it much harder to be open about your fears, and you may try to “tough it out”. But this strategy rarely, if ever, works. A lot of men also mention their fear of a young, pretty dental assistant seeing them frightened and seeing their teeth, and this can be as big a deterrent as seeing the actual dentist for some.
The good news is that once you do manage to seek help and open up about your fears, you may find a huge weight lifted off your shoulders. Dentists (and their assistants) are well used to guys being anxious or phobic – it is not at all unusual. A study done on our dental phobia support forum concluded that:
Our findings did not suggest any discernible differences [between males and females] in either the reasons given for accessing this online group nor its advantages in terms of coping with the challenges of dental anxiety. (Buchanan & Coulson, 2007)
Here is what one of the men on our forum said:
“I too thought the only way I could have dental work done again was if I had a GA, I had a mouthful of holes and broken teeth too…
In the past, I did everything I thought I needed to, 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’m at the dentist because I want my teeth to be healthy, it’s for me and I have a say in it.
I now have a totally different outlook on the dentists, 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 consequences on a person’s life. Not only does their dental health suffer, but dental phobia may lead to anxiety and depression. Laughing out loud is 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 avoid 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. Dental phobia sufferers may 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 might not go amiss.
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 7.
However, most people actually don’t mind going to the dentist. There is a reason for this – nowadays, dentistry can be pain-free and there are many personable, kind and compassionate dental professionals around. Many if not most people who’ve suffered with dental fears and phobias reckon that having found the right dentist for them has made all the difference. This is especially true when fears were caused by previous bad experiences.
- Diagnostic and Statistical Manual, 5th Ed., 2013
- Milgrom P, Vignehsa H, Weinstein P. Adolescent dental fear and control: prevalence and theoretical implications. Behav Res There. 1992 Jul; 30(4): 367-73.
- 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. The contribution of embarrassment to phobic dental anxiety: a qualitative research study. BMC Psychiatry, 2004; 4:10.
- Townend E, Dimigen G, Fung D. A clinical study of child dental anxiety. Behaviour Research and Therapy, Vol. 38, Issue 1, January 2000, pp 31-46.
- Bracha HS, Vega EM. Posttraumatic dental-care anxiety (PTDA): Is “dental phobia” a misnomer? Hawaii Dent J. 2006 Sep-Oct;37(5):17-9.
- The Health and Social Care Information Centre. Adult dental health survey 2009. London: Department of Health, 2010.