How can I overcome my fear of the dentist?
A dentist’s technical competence is of course an important consideration, but that aside, above all else, it’s about this:
Personality, Personality, Personality
Something which can’t be taught, and yet makes all the difference: some dentists have a real knack for making people feel at ease.
If you don’t get that feeling from the first dentist you choose to meet, try another. Just because a dentist says on their website that they welcome anxious patients doesn’t necessarily mean they’ve got the natural ability and personality it takes. It’s also true that a dentist may be great for some people, but not a good match for others. Go with your gut instinct. You don’t need to settle for “good enough” or “better the devil you know”.
If at all possible, find someone you really like !
The assistant or dental nurse can also make an invaluable contribution to how looked after and protected you feel. If the nurse and dentist work well as a team, showing mutual respect and politeness to each other, this harmony rubs off and makes everyone feel more relaxed. For some people, the assistant is a major source of moral support, and they will only book in when they are sure that “their” nurse will be assisting.
What can help with overcoming dental phobias and fears?
1. psychological strategies – the way the dentist acts and communicates, specific techniques dentists can use to help, and tricks you can use yourself
2. technology and gadgets – new and not-so-new inventions which can make dental treatment more enjoyable
3. sedation – using drugs to make you feel relaxed.
There is a fourth aspect, and that is local anaesthesia technique (comfortable and effective numbing) – if dental treatment is painful, then all the psychology in the world is not going to help:
“CBT is good but CBT won’t work unless you have the right dentist. I mean really you can CBT for months but if you aren’t numb then forget it.”
The way you tackle your fears needs to be tailored to you as an individual. But generally speaking, we can look at tackling fears (or “dental anxiety management” in dentist-speak) as being a bit like a pyramid:
The dental environment, despite being of such huge importance, is often overlooked when it comes to dental anxiety. The environment sets the tone for the whole dental experience – first impressions do count! While we cannot do away with modern dental equipment, many people with dental fears find it really important that the rest of the room doesn’t have a clinical feel to it. This means, for example,
- instruments being hidden from sight as much as possible,
- artwork instead of photos of smile makeovers,
- friendly colour schemes,
- perhaps music playing in the background,
- dentists and staff not wearing white and not dressing in traditional medical outfits – the proverbial white coat can be a trigger for many older (and not so old) people, and
- doing away with the “typical” smells associated with dentistry as far as possible.
The foundation of the pyramid is communication. This means the way your dentist interacts with you (and the way you interact with your dentist). Your dentist should be someone who is supportive, caring, and easy to talk to.
You need to feel at ease with your dentist if you want to overcome your fears, and your dentist needs to know what you fear and how they may be able to help you.
Communication also means things like rapport, body language, and using non-threatening language that you can understand. Rapport (a harmonious connection) implies a relationship of equals, where you don’t perceive your dentist as a threatening or a condescending figure, but as a partner in your care.
It implies that you do things together with your dentist, rather than your dentist doing things to you.
You should only move on to the strategies below if you have a good rapport with the dentist you’ve chosen.
The least invasive approach should be considered and tried first, unless there is a good reason (such as your own preference) to move on to IV sedation straight away.
You may find it helpful to bring someone along to hold your hand for a bit of support. Most dentists are very happy for you to take a friend or family member to your appointment (just make sure they are not scared too!). If a dentist were to object to this, they’re not the right person to treat you.
Coping styles: Monitoring vs. Blunting
The choice of psychological strategies that you and your dentist use depends on your personal preferences. Coping strategies fall into two broad categories:
- monitoring: prefer being given detailed information and actively participating
- blunting: prefer less information/detail and may prefer being distracted or unaware.
Some people have a general preference for knowing exactly what is going to happen before and during a procedure, while others prefer only a brief explanation, and cope best by being distracted (or unaware of what is happening). However, things are rarely that straightforward. For example, you may prefer distraction or minimal information during certain situations or procedures but still like to be given detailed knowledge and the opportunity to participate in other situations. Or you may simultaneously seek information and distraction (or neither!).
Preferences can also change over time, for example because of changes in your general stress levels or mental health issues. The key is to remain flexible – there are plenty of options in the toolbox (both psychological strategies and sedation options).
Because we are all unique, the strategies used should be tailored to you as an individual.
Psychological strategies include techniques such as signalling, tell-show-do, structured time, distraction, desensitisation, relaxation (especially belly breathing), hypnosis and other options which you can read about on this site.
Generally speaking, people who have a monitoring coping style may respond well to strategies aimed at enhancing control, such as tell-show-do, structured time and signalling. People who have a blunting coping style may prefer distraction (though see the caveats above).
Some dentists with a special interest in helping people with dental anxiety systematically offer such psychological interventions. But more commonly, dentists tend to draw on these strategies without making them explicit. In other words, aspects of these techniques (or a variation thereof) may be integrated into the flow of your appointments. For example, your dentist may let you gradually get used to new, unfamiliar things, take things slowly, explain things to you, let you know what s/he is doing and what to expect, and so forth.
An integral part of psychological strategies is that any treatment is delivered comfortably and gently.
Of course, you can also choose to enlist the help of a therapist, such as a psychologist, psychotherapist, counsellor, or hypnotherapist. Cognitive-behavioural therapy tends to be the method of choice for tackling dental phobia and specific dental fears.
If psychological techniques on their own are not enough, there are various sedation options. Inhalation sedation (laughing gas) is great for making you feel more relaxed, and can be very much a “participation technique” also suited to people who like to feel in control of situations.
On the other hand, IV (intravenous) sedation may be better suited to those who are more willing to entrust control to another person. It can produce a level of sedation so deep that you may not remember much, or even nothing at all, of what happens during treatment.
IV sedation can also be a good option if you need lots of work doing and you are really worried about it. In this case, you might be better served getting things under control using IV sedation, and then experiment with other methods when you require just a bit of maintenance work.
Technology and Gadgets
There have been some exciting technological advances and innovations which can really help with specific fears. For example, the wand has been a real blessing for people with needle phobia. Handpieces (“drills”) have become quieter, and digital scanners for taking impressions are becoming more and more commonplace (and affordable).
You can find out more about some of these technologies, as well as about psychological and sedation approaches, by following the links in the What Can Help drop-down menu at the top of this page.