What is Dental Phobia
Ambling along an innocent-looking road, you pass a sign for a dental surgery. Immediately, your heart starts racing, you can feel the heat rising to your face, and you become shaky and nauseous. Argggh, not yet another reminder of the dreaded D-word - better cross that road and face the other way! Is that you? You may be one of the many people who suffer with dental phobia!
So what IS dental phobia?
A "phobia" is traditionally defined as "an irrational severe fear that leads to avoidance of the feared situation, object or activity" (even though the Greek word "phobia" simply means fear...). Exposure to the feared stimulus provokes an immediate anxiety response, which may take the form of a panic attack. The phobia causes a lot of distress, and impacts on other aspects of the individual's life, not just their oral health. Dental phobics will spend an awful lot of time thinking about their teeth or dentists or dental situations, or else spend a lot of time trying NOT to think of teeth or dentists or dental situations. Which is pretty hard in today's society, which is saturated with ugly reminders such as toothpaste commercials. The Diagnostic and Statistical Manual of Mental Disorders (you'd have to be pretty mental to think up such an unwieldy title, which is why it's usually referred to as DSM-IV) describes dental phobia as a "marked and persistent fear that is excessive or unreasonable". It also assumes that the person recognizes that the fear is excessive or unreasonable. Conclusion? It's highly unlikely that the American Psychiatric Association (who established the DSM-IV criteria) consists of dental phobics. You might be interested to learn that DSM-IV's predecessor, DSM-III, defined homosexuality as a mental disorder... I'd hazard a guess that most dental phobics would object to being labelled as suffering from a mental disorder. (This is not to say that dental phobia cannot co-occur with psychiatric disorder - of course it can. Dental phobia appears to be more common in people who suffer from another psychiatric disorder, notably Generalized Anxiety Disorder, agoraphobia, depression, and emetophobia. Research suggests that about 20% of dental phobics have a concurrent psychiatric disorder.) The main problem in defining "dental phobia" is that there isn't just ONE type of dental phobia, but many types - some rational, some "irrational". More about this below. To read more about specific phobias as defined by DSM-IV, click here!
Whether the fear is "unreasonable", "excessive", or "irrational" is debatable... not if you end up in the hands of the wrong dentist! Which, incidentally, is one of the reasons why people end up as dental phobics in the first place...
A distinction has been made between dental anxiety, dental fear, and dental phobia.
DENTAL ANXIETY is a reaction to an UNKNOWN danger, and the individual anticipates the worst even from relatively straightforward procedures. Anxiety is extremely common, and most people experience some degree of dental anxiety especially if they're about to have something done which they've never experienced before. Basically, it's a fear of the unknown.
DENTAL FEAR is a reaction to a known danger ("I know what the dentist is going to do, been there, done that - I'm scared"), which involves a fight-or-flight response when confronted with the threatening stimulus.
DENTAL PHOBIA is basically the same as fear, only much stronger ("I know what happens when I go to the dentist - there's no way I'm going back if I can help it. I'm so terrified I feel sick"). Also, the fight-or-flight response occurs when just thinking about or being reminded of the threatening situation. Someone with a dental phobia will avoid dental care at all costs until either a physical problem or the psychological burden of the phobia becomes overwhelming.
One problem with defining dental phobia is that "dental anxiety" (a reaction to an unknown danger) may feel just as frightening as a "phobia" to a person, and they may well be defined (or define themselves) as phobic. From what little research there is available, this may be more common in people who are generally anxious. Also, some people who've never had a bad experience with a dentist or a dental procedure can develop dental fear or phobia - this is usually the result of vicarious learning (that is, scare-stories or media portrayal).
I like to think that "dental phobia" is simply useful short-hand for "terror at the thought of dentists and/or dentistry and/or anything dental-related". Some people feel that their fear is justified and rational, while others feel they're being silly for getting so upset over something which "everyone else" seems to have no problem with. "Dental Phobia" is really an umbrella term which covers a wide range of different fears, as you'll see on the "What's Your Fear?" pages. It would also appear that there are some fairly distinct subtypes of dental phobia, such as needle phobia or terror at the thought of gagging and being sick. Dental phobia is most often caused by bad, or sometimes horrific, dental experiences (studies suggest that this is true for about 80 -85% of dental phobias, but there are difficulties with obtaining representative samples). Dental phobia is also quite common in people who have been sexually abused, particularly in childhood. A history of bullying or having been physically or emotionally abused by a person in authority may also contribute to developing dental phobia, especially in combination with bad experiences with dentists.
It has also been suggested that dental fear and phobia are more widespread among successful people who are in positions of power. Those who have a desire to control their environment may find it particularly hard to "relinquish" control to a dentist. My guess would be that this personality trait may predispose individuals to develop dental phobia, but that the actual cause of the phobia are bad dental experiences.
There can be other causes as well, such as insensitive remarks by a dentist, or overhearing other people's horror stories of visits to the psychodentist. In fact, insensitive remarks and the intense feelings of humiliation they provoke are one of the main factors which can cause or contribute to a dental phobia. Human beings are social animals, and negative social evaluation will upset most people, apart from the most thick-skinned individuals. If you're the sensitive type, negative evaluation can be shattering Some subtypes of dental phobia may indeed be defined as "irrational" in the traditional sense. People may be inherently "prepared" to learn certain phobias, such as needle phobia. For millions of years people who quickly learned to avoid snakes, heights, and lightning (and sharp objects, such as needles, which would not have been sterilized in those days, apart from giving you a nasty sting!) probably had a good chance to survive and to transmit their genes. So it may not take a particularly painful encounter with a needle to develop a phobia.
Some research suggests that people who've had horrific dental experiences (unsurprisingly) suffer from symptoms typically reported by people with post-traumatic stress disorder (PTSD). This is characterized by intrusive thoughts of the bad experience and nightmares about dentists or dental situations. For more information on PTSD, click here!
Dental phobia can have wide-ranging consequences on a person's life. Not only does their dental health suffer, but dental phobia may lead to anxiety and depression. Laughing out loud is out of the question - too hard to hide one's teeth... Depending on how obvious the damage is, the individual may avoid meeting people due to embarrassment over their teeth, or not be able to take on jobs which involve extensive contact with the public. Loss of self-esteem over not being able to do something as "simple" as going to a dentist and intense feelings of guilt over not having looked after one's teeth properly are also very common. Dental phobia sufferers may also avoid doctors for fear that they might want to have a look at their tongue or throat and suggest that a visit to a dentist might not go amiss... For personal accounts of dental phobia, you can have a look at various "success stories" which have been published on dental phobia websites. Go to Dental Fear Central's "Help! Links to Dental Fear and Phobia Sites" page for information on where to find them. We're also starting a new site with dental phobia stories, if you'd like to take a look.
If you suffer from dental phobia, you'll be inclined to think that nobody else feels the way you do - after all, who else would rather be dead or have open-heart surgery than meet up with a dentist?
Actually, quite a lot of people! While there are no reliable statistics (after all, few dental phobics will freely admit to never visiting a dentist... that's if they hang around to complete the questionnaire!), the most conservative estimates reckon that 5% of people in Western countries avoid dentists altogether due to fear. And many more are anxious or scared about dentistry.
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