Between 6-14% of the population avoid attending the dentist because of anxiety about treatment. Between 45-55% of patients who attended the dentist are anxious in the dental environment.
The reasons people fear attending the dentist are varied and include pain, cost of treatment, lack of control while in the dental chair, embarrassment and fear of the unknown. The cause of dental anxiety is usually a previous bad experience, but can be caused indirectly through horror stories about dental treatment from family, friends and even the media.
The fear of treatment may appear to the patient to be irrational, uncontrollable and without obvious cause. Such patients will only attend for treatment when in extreme discomfort or never at all. As a result their dental condition deteriorates to the point where their appearance is affected. This can cause embarrassment and loss of self-confidence which in turn can cause problems socially and at work.
For other patients, the fear is not so deep seated. They can explain the cause of their anxiety and can usually control it to some extent. However, they are still anxious about dental treatment and will try and avoid it where possible.
Fear of dental treatment can be overcome by a variety of treatment methods which are described on this website.
When you make the appointment to see the dentist, tell the receptionist you are nervous about treatment. This first appointment will usually be to discuss your fears about treatment and to do an initial examination of your teeth. From this appointment a provisional treatment plan can be made. Depending on what you and the dentist decide, this plan can include one or more of the the treatment methods outlined below. Initially, you may wish to have treatment using one or more of these described methods. However, the ultimate aim should be to reduce your anxiety to a level that it is possible to have treatment without any assistance. This is not possible in all cases, but where it can be achieved it is very satisfying for both patient and dentist.
There are several methods available to help you overcome your fears while dental treatment is being done. These are:
This is the simplest method of treatment for nervous patients. It involves a careful and sympathetic approach from the dentist, with explanations of what is being done and allowing the patient control over the procedure.
Some patients may want to bring a friend along for support. It may also be possible to play relaxing music or to watch a video while having treatment.
This involves the use of oral sedative drugs e.g. diazepam, midazolam, which are taken before treatment. They can also be taken the night before treatment to help you sleep.
The sedative effect of these drugs is unpredictable and can vary between individuals. Because the drugs are taken by mouth it is impossible to quickly increase or decrease the amount sedation.
They are best used for sedation the night before treatment to ensure restful sleep or to produce light sedation during treatment where anxiety levels are low.
While under the effects of the drug, the patient must be accompanied by a responsible adult and refrain from driving and operating machinery.
This involves administering a sedative drug in order to produce a very relaxed state so that treatment can be carried out. The drug also causes short term memory loss so that very little of the treatment can be remembered.
The drug is administered through one of the veins in the arm or hand. The amount of drug given varies between individuals but enough is injected to produce relaxed state within five minutes. Because the drug acts very quickly, more can be given if necessary to increase the feeling of relaxation.
The effects of the drug can last up eight hours after and the patient must be accompanied by a responsible adult and refrain from driving, operating machinery or other responsible activities during this time.
It can be used on most healthy adults but must be avoided in patients with severe lung disease, some heart problems, obesity or in pregnancy. It is also not suitable for children or the elderly.
This type of sedation is very safe as the patient is not unconscious as in general anesthesia. It works for the vast majority of patients and it is a very effective way of providing dental treatment. It is also very effective in treating patients who gag easily.
This involves giving a mixture of nitrous oxide (‘laughing gas’) and oxygen which are inhaled through a rubber face mask. The nitrous oxide reduces anxiety and improves co-operation, without causing unconsciousness.
The effects of the nitrous oxide wears off very quickly and the patient can leave the surgery without the need for an accompanying adult.
This technique can used for most patients but must be avoided in those with colds and other respiratory problems, psychiatric treatment, vitamin B12 deficiency and in pregnancy. This form of sedation is particularly useful for treating anxious children.
General anesthesia. (GA) involves being ‘put to sleep’ in order to provide dental treatment. It is only available in hospitals and specialist centers, and must be administered by a qualified anesthetist. Because of the slight risks involved with GA, it is only used where there is no other option. The procedure is usually limited to adults who are undergoing complex treatments (e.g. extraction of wisdom teeth) or are not suitable for the other methods of treatment described. It is also used to treat anxious children. Treatment provided under GA is usually limited to extractions and simple fillings.
This involves the use of hypnotherapy to reduce anxiety.
It is very effective in people who are respond well to hypnosis. It may involve one or more preliminary sessions before treatment is attempted. The hypnosis may be done by a hypnotist working with a dentist or by the dentist if he is qualified in hypnotherapy.
This type of treatment is not widely available and can be time consuming and expensive.
This form of treatment is used to treat a whole range of phobias and anxiety disorders. The psychotherapist will initially try and locate the origin of your fears. They will then follow a program of therapy designed to overcome or control your anxiety sufficiently for you to undergo dental treatment.
Acupuncture is a medical treatment which can be used to relieve the symptoms of a variety of physical and psychological conditions including dental anxiety. Each patient’s case is assessed by the practitioner and treatment will be tailored to the individual.
Community Dental Service?
A Community Dental Service (CDS) provides treatment for people who may not otherwise seek or receive dental care, such as people with learning disabilities, elderly housebound people, people with mental or physical health problems or other disabling conditions which prevent them from visiting a family dentist / General Dental Practitioner.
A Community Dental Service often manages oral health promotion and oral screening for schools. The CDS may provide treatment for children identified at screening, who do not have a family dentist. Some CDSs only accept patients on referral from GPs or from General Dental Practitioners. Your local CDS will be able to give you information about the exact services it provides.