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Harvard Commentaries
35320
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Minding Your Mind Minding Your Mind
 

Getting Over Dental Fears


June 25, 2012

By Michael Craig Miller M.D.

Harvard Medical School


People may talk openly about their fear of heights or spiders. Those who are afraid of dogs may delight in telling you about the bite they got from the neighbor's pooch while walking home in third grade.

One phobia that may have a significant negative impact on a person's health is fear of going to the dentist.

In fact, a large Dutch study found that dental phobia was the most common phobia. (After that comes a phobia of heights and spiders.) While it may be possible to avoid high places and spiders, it really is best not to avoid the dentist, especially when you have a toothache.

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Dental Phobia Is Common

Some surveys report that almost one in four people are afraid of getting a dental exam. In most cases, dental anxiety is unpleasant, but does not interfere with health.

People whose dental fear is severe, however, may so dread the thought of going to the dentist that they cancel appointments, delay seeking care, and sometimes wind up needing more invasive and painful procedures as a result.

Women are more likely than men to report experiencing dental fear and phobia. (The same is true with other types of anxiety disorders.) About half of adults who suffer from dental phobia can trace their fears back to unpleasant childhood experiences. Just the sight of a dentist's chair, the sound of a dental drill or the smell of certain chemicals can trigger memories.

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Ways To Ease Your Fears

There are drugs that may help reduce anxiety. They work best when used with various mental, educational and behavioral strategies — especially those that help you gain a sense of control in a situation where you may feel helpless.

Try some of the following techniques during your next dental visit. They're easy to learn, get better with practice and can be used together.

    • Breathing techniques. Physical tension and emotional stress can actually make us more sensitive to pain. People who are anxious tend to hold their breath or breathe rapidly. This sort of breathing pattern only heightens anxiety and muscle tension. Deep breathing can reduce physical and mental tension. Breathe in slowly and count to five before exhaling to another count of five. Or place one hand beneath the belly button and breathe so that the abdomen rises and falls with each breath.
    • Muscle relaxation. Progressive muscle relaxation (tensing and then releasing one group of muscles at a time in order to promote whole-body relaxation) can help to slow heart rate and promote calmness. Just a few minutes of progressive muscle relaxation, focused on two or three major muscle groups, may help during an appointment.
    • Desensitization. This approach combines deep breathing and relaxation with gradual exposure (through audiotapes, videotapes or the patient's own imagination) to the cue that most triggers dental phobia. A patient who is afraid of needles, for example, may look at pictures of a dentist's needle in a safe environment, such as at home or in a therapist's office, while practicing relaxation and breathing techniques. The goal is to help you learn to relax while confronting whatever triggers your dental fear.
    • Distraction. Focusing your mind elsewhere is another way to feel less anxiety and pain during dental visits. It may help to listen to music through headphones. But sometimes soothing music is not enough. Some people need a more complicated task to distract them. Stories or riddles may help distract children. Adults can try counting (such as tiles on the ceiling, or slats on a window blind) as a way of turning attention away from the procedure itself.
    • Hypnosis. Hypnosis involves reaching a state of deep relaxation through a combination of deep breathing, muscle relaxation and attention modification. People who can't tolerate anesthesia and those who are afraid of needles may want to try hypnosis. It may be difficult to find a dentist trained in this technique, however. Because children tend to have more vivid imaginations than adults and are more open to suggestion, hypnosis may be a particularly good technique for child patients. Some patients may also be able to hypnotize themselves by combining relaxation techniques with positive imagery or focus words.

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Dentistry Is Often Truly Painless

Dentists have gotten very good at making you comfortable before they start working on your teeth. Even procedures like root canal are not actually so bad. It no longer holds up as a metaphor for torment! What used to take several visits often now takes one — the tools are more refined and the treatments are more efficient.

There is no shame in being very afraid, however. Come armed with a few techniques that you can use. If one doesn't work, have a backup to try next.

Also, find a dentist who is patient with your fear. He or she can help you bear the few moments of discomfort before the anesthetic takes hold. Your teeth will thank you with every bite.


Dionne RA, et al., eds. Management of Pain and Anxiety in the Dental Office. (W.B. Saunders Company, 2002).

Loggia ML, et al. "Effects of psychological state on pain perception in the dental environment." Journal of the Canadian Dental Association. 2008; 74(7): 651–56.

Oosterink FM, et al. "Prevalence of dental fear and phobia relative to other fear and phobia subtypes. European Journal of Oral Science. 2009; 117(2): 135–43.

Peltier B. "Psychological Treatment of Fearful and Phobic Special Needs Patients." Special Care Dentist. 2009; 29(1): 51–57.

Simpson R, et al., eds. Hypnosis in Dentistry: A Handbook for Clinical Use (Charles C. Thomas, 1985).

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Michael Craig Miller, M.D. is editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 25 years.

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