When I arrived at the dentist's office for my implant procedure, I was already sweating and on the verge of tears.
After several shots of Novocaine, I felt no pain whatsoever. But that didn't matter. I squirmed as I sensed incisions in my gums and heard drill collide with bone. I panicked about how intrinsically wrong it felt for someone to put titanium in my body. I worried: Would I be able to eat? To talk? Would I get an infection?
After an hour and a half, I returned to the receptionist swollen and tear-streaked. The periodontist joked, “She was shaking like a leaf, it was like a moving target!”
Not long afterward, I checked out my score on the Dental Anxiety Scale. My whole body tensed up when I read the first question: “If you went to your dentist for TREATMENT TOMORROW, how would you feel?” I scored a 21, which qualifies me as a “highly dentally anxious patient, possible dentally phobic.”
I have a lot of company. In fact, the Diagnostic and Statistical Manual of Mental Disorders estimates that almost 4 percent of people are “dental phobics.” According to the DSM, the prevalence rates for dental fears are similar to the rates of people who fear snakes or heights.
But we're not quaking alone in the chair. Of late, researchers have been seeking to understand dental fear better, from its prevalence to the disparate elements that add up to phobia. For example, one recent brain scan study found that the buzz of the dental drill is a particular source of distress. And they've been exploring and testing potential remedies, from therapy to sedation.
Dr. Matthew Messina, a Cleveland dentist and consumer adviser for the American Dental Association, estimates that the rate of dental phobics is even higher than 4 percent. Around 10 percent of the adult population in the United States, Dr. Messina says, have a dental phobia so paralyzing it prevents regular dentist visits.
Dr. Lisa Heaton, a licensed clinical psychologist who treats patients at the University of Washington's Dental Fears Research Clinic, says that up to 75 percent of adults have at least some anxiety about going to the dentist.
I have always been squeamish about dental visits, but I entered a new chapter of anxiety when I was 16 and saw an oral surgeon who told me I would eventually need dental implants in my lower jaw, where I'm missing two adult teeth.
We dental phobics don't just have to open wide and bear it. We can seek to understand our fear — and counteract it.
He explained, to my horror, that would mean a bone graft — likely scraped from my own chin — followed by titanium posts drilled into the spots where my teeth would have been. A couple months later, a fake tooth would be placed atop each post.
I was fitted for what dentists call a "partial" and what I would call dentures. A plastic set of teeth I removed and brushed every night of high school and college to "give my gums some air," as the dentist called it. The grating pressure of plastic on gum every day for six years wasn't great for my oral health, and dentist appointments turned into battles. The hygienist would move the sharp "probe" closer to my exposed gums and I would move my head farther away.
This summer, a long-overdue visit to the dentist (I make a habit of canceling appointments last-minute) confirmed that if I didn't receive implants over the next couple of months, I would soon face permanent nerve damage.
My avoidance stemmed from what was, in my view, a perfectly rational aversion to pain, but the logic behind dental phobia varies. (And yes, there is some logic to it.)
- Sitting in the dental chair is, undeniably, a claustrophobic experience. "If I'm your cardiologist, for the most part, I can treat you from four, five feet away. But with dental care, I have to really very much get into someone's personal space," says Dr. Messina. The sound of dentistry is also an issue -- the scraping and the drilling.
- Another source of anxiety, says Dr. Messina, is the high cost of dental work. In 2007, my periodontal consult told me the implants would cost $16,000, which was a major factor in my procrastination. That price tag was reduced by $9,000 over six years, even though my trusty insurer, Cigna, made it clear they would not, no matter the circumstances, cover any portion of the implant. When the receptionist requested the $5,000 I owed after a truly unpleasant surgery, it felt like a kick in the gut, and added another layer to my resentment toward the dentistry field.
- "Some people are concerned to come into the dentist because they're afraid of bad news," says Dr. Messina — and that's especially true for the 10 percent of people who put off dental visits. The consequences can certainly get in the way of patient health. Dr. Messina says that advanced dental decay, infected teeth and periodontal problems can lead to life-threatening medical emergencies. “Then we’ve gone out of the boundary of dentistry,” he says, “because the problem has exceeded the mouth and it’s a health risk.”
But we dental phobics don't just have to open wide and bear it. We can seek to understand our fear — and counteract it. Dr. Heaton at the University of Washington recently conducted an evidence-based review of psychological treatments for dental phobia. It found that behavioral and cognitive-behavioral treatments were effective at reducing the fear, even months or years after the intervention, she said.
Cognitive behavioral therapy is a kind of exposure therapy, Dr Heaton explained. In one method, if a patient is afraid of dental injections, a clinical psychologist encourages their patient to breath deeply, relax their muscles and think positive thoughts. "I can do this, I can handle this."
Then the psychologist, alongside a dentist, talks to the patient about the dental injection. What its purpose is, why the needle looks the way it does. The dentist then inserts a capped needle (one that can't actually poke the patient) into the patient's mouth, so the patient has an opportunity to cope and manage their anxiety.
That action, which is initially frightening, is repeated until it becomes boring. At that point, the psychologist and dentist begin a cap-off rehearsal, where they go through the same steps with an uncapped needle. The anxiety is initially high again, but it goes down as the action is repeated.
“At a certain point," Dr. Heaton says, "they just say, ‘You know what? I’ve gone through all the steps and I know that I can stay calm during this, and so we can just go ahead and do the injection.’”
Dr. Heaton says she and her team have had significant success with this approach in their clinic. Might this approach apply to other elements of dental procedures like cleanings, fillings and implants?
“Very often what we find is that, just the trust that’s built up during that process — just people getting used to being in the dental setting and having things in their mouth — that does tend to generalize to other aspects of the dental procedure,” says Dr. Heaton.
Researchers have also looked into treatments involving eye-movement therapy, but those strategies depend on a patient who is afraid due to one, specific traumatic event with a dentist.
'You might have $1,000 in sedation for a $100 cleaning.'
Another option for dental phobics is sedation dentistry, which includes a range of patient choices. The lowest level of sedation is nitrous oxide, or laughing gas. On the other end of the spectrum, a patient can be completely knocked out, as they would be to get their appendix out.
The week before my implant surgery, I called the dentist's office to ensure I would be knocked out. "Nope," said the cheery receptionist. "It's a minor procedure, you won't be sedated." I was shocked, but too timid to ask for an exception to be made.
I asked Dr. Messina if I could have demanded sedation. Better yet — could I be sedated for a simple cleaning? He said, with reservations, that I could. “The question is, why do you feel you need that? We need to explore the reasons.”
And there are issues with sedation dentistry. “Obviously, when we start sedating people, we’ve added another level of medical risk,” says Dr. Messina. And, there’s an added cost. “A routine dental cleaning might cost $100. You throw the sedation in, you might have $1,000 in sedation for a $100 cleaning.”
Dr. Heaton sees sedation dentistry as a great short-term solution for the 10 percent of people who are dental phobic, but she doesn't see it working in the long-term.
"They wake up with the same fear that they went to sleep with, they just have better teeth in the moment," she said.
Patients who undergo sedation tend not to follow up with their dentist on a regular basis, Dr. Heaton added. Instead, she advocates for the lasting change that comes with cognitive behavioral therapy.
And there's some added incentive to conquer dental anxiety — fear is likely to translate into more pain. Martin Tickle, a professor of dental public health at Manchester University, surveyed dental patients to ask whether they'd felt pain.
"The strongest predictor of pain during dental procedures was dental anxiety," Tickle told The Guardian. "Anxious patients were four times more likely to experience pain than non-anxious patients after controlling for other factors."
As for me, cognitive behavioral therapy sounds effective, but scary and time-consuming — and my budget doesn't allow for sedation. After going through a nauseating surgery I spent six years dreading, I was actually able to eat and talk normally after just a couple days, and the pain was extraordinarily minimal.
I'd like to think that my quick recovery lessened my anxiety — that I will confidently walk to my next appointment and speak to my dentist with a steady voice because I know that I'll be fine when it's over.
But, as I look at my calendar and realize I'll be starting the next phase of the implant process on Jan. 9, I can't help but reach for my phone. I just might be busy that day....
Tips to get you through your next dental procedure:
- Check out your score on the Dental Anxiety Scale. Then, show it to your dentist so they know what they're dealing with, Dr. Messina suggests.
- “The time to develop a relationship with a dentist is before something hurts,” says Dr. Messina. Talk to your dentist about past dental experiences that you found scary or frustrating.
- Try finding a dentist who has an office with a calming effect. This Parisian dentist redecorated entirely to sooth her patients.
- Interview dentists before you settle on one. Call up a couple different offices and ask to meet with the dentist for 15 minutes, without any kind of dental treatment scheduled. If they’re not willing to do that, they’re not the dentist for you, says Dr. Heaton.
- Talk to a doctor about sedation options if that’s what you need to get back in the dentist’s chair — but keep in mind the long-term goal of sedation-free dentistry.
- Figure out the best time of day for you to see a dentist. If you don't want to worry about it all day, schedule it for the early morning. If a gag reflex issue is part of your dental anxiety, try for the afternoon.
- Before the procedure begins, try controlled breathing. Take a big breath, hold it in, and then slowly let it out. This will slow your heartbeat and relax your muscles.
- If that recent study about sound as a source of dental fear rings true to you, use headphones to listen to a podcast, a comedy routine, or a playlist that’s sufficiently distracting. Here's the playlist I used for my surgery.
- Ask if you can hold the suction - it’s a way to have control over some element of the dental procedure.
- Have someone you trust in the waiting room for when you're done with your procedure.
Readers, if you've grappled with dental fear, any other tips or suggestions? What works for you?