As COVID-19 restrictions ease, some dental services are restarting around Australia. That means another excuse for pushing back that check-up bites the dust.
None of us run into the arms of our dentists expecting to have a great time, but for hundreds of thousands of Australians, this prospect is a crippling fear that can lead to health problems.
Do you have a dental phobia? And can it be overcome?
What is dental phobia?
Dental phobia and dental anxiety are on a spectrum, says Sharonne Zaks, a dentist with more than 20 years’ experience and a special focus on anxious and phobic patients.
“Although dental anxiety and phobia are defined differently, in daily dental practice they are a continuum,” she says.
“Phobia often looks like doing anything to avoid coming, and often only being forced to come in when the pain is worse than the fear.”
Some people are driven to desperate measures to avoid a visit to the dentist.
About 15 years ago, a patient walked into Dr Zaks’ surgery with string hanging out of his mouth.
“He was sweating and shaking, and very ashamed,” she says.
“He’d had a broken tooth for years, but he was too scared to come in. So, he’d [eventually] superglued it back together — but it was upside down and back to front and he’d used a tampon to absorb moisture, which had now become stuck.”
Dental phobia can manifest in different ways.
“It can range from outright avoidance to panic attacks in the dental chair,” Dr Zaks says.
“I see people who haven’t been to the dentist for 40-odd years and people that struggle to just get to their appointments — or not turn up at all.
“Within appointments, people can find it difficult to lie back in the chair, there can be crying, patients get sweaty and shaky and often need breaks. Sometimes they will just get up and walk out in the middle of it.”
If that sounds like you, you’re not alone. Around 1.3 million of us have dental phobia.
“Millions more Australians are affected by dental anxiety,” Dr Zaks says.
“This is widely known to be one of the most common forms of anxiety and phobia in the world.”
A cycle of shame
Dental phobia can kickstart a troubling pattern where oral health worsens, leading to more avoidance and compounding dental issues, according to Dr Zaks.
“With avoidance altogether, the health of the mouth deteriorates, people feel ashamed and guilty and become embarrassed, leading to more avoidance and oral health issues.
“I call it the shame cycle.”
Sydney resident Shane Carr dodged going to the dentist for many years, despite having cracked teeth, bleeding gums, cavities and bad breath.
But turning 40 was more than a milestone for Shane, it was an impetus to face his fear.
He came across the callout to Catalyst’s pop-up teeth clinic and decided to reach out.
“It came up on Facebook and I thought I need to get over this, I have to look after myself a bit better; and try and overcome my fear of brushing my teeth, and looking at going to a dentist, and the dentist chair, and that drilling noise,” he says.
Shane committed to his first real check-up in 20 years — aside from an emergency tooth extraction that he was forced to act on due to the pain.
When he drove up to the clinic, his first instinct was to run.
“I was scared and anxious, especially when I got in car park, I wanted to reverse and take off.
“I started deep breathing to calm down, I thought, ‘I can’t let them down, they are expecting me’.”
Where does dental phobia come from?
Like a lot of phobias, Shane’s began with a traumatic event when he was younger.
“I went to the dentist and had to get two fillings, and I didn’t like needles,” he says.
“They started doing the procedure without the needle and the pain from that scarred me for life basically.
“That’s why I’ve never really been back to have my teeth looked at properly.”
Dr Zaks says some common reasons for dental phobias can be bad experiences as a child or teenager, absorbing other people’s fears such as your parents’, or a history of trauma.
“This can include sexual assault, domestic violence, head and neck injuries, or multiple forms of trauma together, which I often see in refugees,” she says.
“All trauma involves a loss of control, a loss of personal agency and power to change a situation. We can see it now with COVID-19.
“When we lose power, that stays with us; our bodies have their own memory of traumatic experiences. If a trauma survivor feels powerless or helpless, or is in a situation where they have no control again, memories of the initial events get triggered.
“Unfortunately, the dental environment is full of triggers, and there is a big power imbalance involved.”
But our oral health report card as a nation shows we shouldn’t let our fears get the better of us.
Gum disease affects one in five adults and tooth decay is the most common chronic disease in the country, so regular visits are important.
What causes dental anxiety?
According to Victorian Government’s Better Health Channel, dental anxiety can be caused by:
- A traumatic dental experience or other healthcare experiences
- Previous trauma to the head and neck
- Other traumatic experiences, including abuse
- Generalised anxiety, depression or post-traumatic stress disorder
- The view that the mouth is a personal area and accessing the mouth is an invasion of personal space
- Fear of loss of control
- Trust issues
- Anxiety associated with other conditions such as agoraphobia (fear of being in situations where you feel you cannot escape), claustrophobia (fear of closed spaces) or obsessive compulsive disorder, where there is an obsession around cleanliness that can make access to dental care more difficult
Can a trauma be overcome?
For Dr Zaks, the relationship with the patient is just as important as technical expertise.
“There wasn’t any consideration for creating an emotional connection with patients in the setup of dentistry at all,” she says of
The impact that we can have is incredible, we can transform people’s lives — particularly with how intimate it is and how vulnerable they are.”
Dr Zaks suggests that along with establishing a good relationship with your dentist, there are coping techniques that can be employed as needed.
- Practice deep breathing and other relaxation techniques before appointments
- Consider arranging a meet and greet visit without treatment
- Tell the staff you are nervous or scared when booking, and talk to the dentist openly about your fears and ways that things could be made easier
- Bring a trusted support person to the appointment, or a comforting object and your favourite music as distractions
- Arrange an enjoyable activity after the visit
- Ensure you stop the dentist any time you need a break, and develop a “stop” cue together
- Book the next visit straight away
- A towel or back cushion can help you breathe more easily, and a blanket over your body can be comforting
- Keep sedatives tablets, IV sedation and general anaesthetic as last resorts; they all involve side effects, extra cost and are often avoidable if a strong, trusting relationship is built
Referral to a psychologist can be helpful too. Short, targeted therapies including cognitive behavioural therapy can be very successful, Dr Zaks says.
“I have seen people get over their dental phobia. You can create counter-memories, even if people have had horrendous dental experiences or they are triggered. You don’t forget, but it changes.”
Coming to the clinic helped Shane change his perspective on his fear and dentists.
“All the dentists were there to support me. It was nothing compared to my previous experience,” he says.
“I felt before that dentists weren’t there to help me, that they are there to make money they didn’t care about my health at all.”
Watch Teeth Clinic: A Catalyst Special at 8:30pm April 28 on ABC 1 or iview.