Dental Phobia: Breaking The Fear Cycle

What do dentists, doctors, and IRS auditors have in common? That may sound like a riddle, but it’s a serious question. The answer is that a lot of people are afraid of all three. We can’t speak for doctors or auditors, but at The Center for Dental Anesthesia in Alexandria we help people coping with fear of the dentist get the treatment they deserve, so they can maintain good dental health.[1]

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Dentistry has never been more comfortable for patients than it is now. The very phrase “comfort dentistry” is heard at practices all over the country. Yet fear of the dentist, in particular the phenomenon of dental anxiety and phobia, remains.

“We all strive to make [dentistry] as calm and comforting to patients as possible,” said the CDA’s Dr. Zeyad Mady. “Patients with dental phobias and/or special care needs, typically still find these settings threatening.”[2]

The terms “dental anxiety” and “dental phobia” are often used interchangeably, but as we described in an earlier blog post, they are not the same thing. They are related, but dental phobia is at the extreme end of a continuum of fear. For the limited purposes of this article, the term “dental fear and anxiety,” or DFA, will be used.[3]

Cause and Effect

Patients with the highest levels of DFA often attribute their fear to a traumatic dental experience in their past. “It has been suggested that when the traumatic dental episode occurs in childhood it has a lasting effect,” researchers Laura Beaton, Ruth Freeman, and Gerry Humphris report. “Half of those suffering from DFA developed their fear or anxiety in childhood.” It’s an example, they said, of “conditioning via aversive treatment experience.”[4]

DFA may also result from an indirect experience, which these same researchers call “indirect vicarious experiences.” In this case, parents or other role models describe their own traumatic dental experiences to a child, with the regrettable effect of transferring fear.[5]

The Cycle of Fear

DFA can be so crippling in some people that they avoid going to the dentist altogether. This puts their dental health at risk and can have serious, long-term consequences.

The term “dental anxiety” was first used in the 1940s as a catch-all phrase: “an excessive dread of anything done to the teeth” to the extent that “any dental [work], no matter how minor … may be so postponed or procrastinated,” resulting in compromised dental health.[6]

In the 1980s another researcher described a self-perpetuating “vicious cycle of dental fear” that was a frequent consequence of DFA. Ulf Berggren’s cycle is sometimes represented as a circular graphic, but it’s just as clear when presented as a list:

  1. Fear and anxiety, leading to
  2. Avoiding dentist appointments, leading to
  3. Deteriorating dental health, leading to
  4. Feelings of guilt and shame, leading to
  5. Renewed anxiety and avoidance.[7]

Breaking the Cycle

If this sounds like you or someone close to you, it’s important to have hope. Experts say it is a cycle that can be broken. Recognizing the patterns and wanting to do something about them are very big first steps.

The following strategy has met with success:

  1. Make an appointment with your dentist, and be sure to mention your dental anxiety.
  2. On appointment day remind everyone: the hygienist, the dentist, and anyone else who will be treating you.
  3. Remember that all dental professionals see patients with teeth and gums in varying states, good and bad.

Your teeth won’t surprise anyone. Dentists know that one of their most important functions is restoring dental health. They are not there to judge you and the guilt and shame outlined in that “vicious cycle” really is groundless.

Many dentists can, in fact, be a partner in the battle against DFA. When seeing the dentist evokes anxiety or fear, sedation dentistry is an option.

At The Center for Dental Anesthesia, sedation is customized for each patient. “We always hope to ‘graduate’ patients from the complete sedation experience at all visits and work very hard to accomplish [that],” Dr. Zeyad Mady says. “Those attempts to reverse years of dental phobia, and totally rehabilitate patients from a dental and psychological aspect, can be challenging. But it is a core value of our practice to attempt it.”[8]

At the Center for Dental Anesthesia in Alexandria, treating patients with anxiety or fear is central to our practice. Dr. Mady and Dr. James Geren are both committed to providing outstanding care and bring comprehensive backgrounds and training to their work.

CDA is also committed to special needs dentistry, including patients with physical and mental disabilities. Our doors are also open to the general public.

At the Center for Dental Anesthesia in Alexandria, we are committed to providing quality dental care. Please call our office to schedule an appointment.


End Notes

[1]      Comparison adapted from “Why the Fear of Dentists Is so Common,” by Lisa Fritscher. Article referred to hereafter as Fritscher.

[2]      Interview, July 2019.

[3]      “DFA” is borrowed from “Why Are People Afraid of the Dentist? Observations and Explanations,” by Laura Beaton, Ruth Freeman, and Gerry Humphris. Referred to hereafter as Beaton. . Refer also to Fritscher.

[4]      Beaton.

[5]      Beaton.

[6]      Beaton, citing Coriat IH: Dental anxiety: fear of going to the dentist. Psychoanal Rev 1946; 33: 365–367.

[7]      See, for example, “The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear,” by Jason M. Armfield, Judy F. Stewart, and A. John Spencer.

[8]      Interview, July 2019.


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