What is Dentophobia?

Dentophobia, an overwhelming fear of dentists, is considered to be one of the most common specific phobias. Although many phobias go undiagnosed and accurate statistics are not available, it is thought that an estimated 8 million people in the UK experience a phobia of dentists.

Today, we are going to look at dentophobia in more detail, including the common causes, triggers, symptoms and treatments.

What is dentophobia?

Sometimes known as odontophobia, dentophobia is an extreme and irrational fear of dentists, dental treatments and dental clinics.

Although many people dislike dentists and may feel fear or anxiety when they go to the dentist, dentophobia is severe and out of proportion with the situation and potential risks. Dentophobia can be so severe that a person may avoid visiting the dentist even if they are in pain, have poor dental health or are in need of dental treatment.

Failure to seek dental treatment when you need it can have a significant impact on your oral health and your overall wellbeing. Minor infections or small cavities that could be easily fixed can lead to significant tooth decay and damage if left untreated. Bad oral health can also result in your teeth becoming unsightly or can result in bad breath.

This can affect your self-confidence and your social relationships. Even if you know that your phobia of dentists is irrational and not in proportion to the potential risks, you may be unable to control your psychological and physiological response to your triggers.

Determining whether you are experiencing a fear of dentists or dentophobia can be difficult.

However, there are some key differences. To be classified as a phobia, your dentophobia must:

• Include feelings of intense fear, panic or anxiety that are irrational and difficult to control or manage.
• Include fear that is out of proportion to the potential danger.
• Last longer than six months.
• Negatively impact your day-to-day life.

Dentophobia is a type of specific phobia. A specific phobia is a lasting, overwhelming and unreasonable fear of a specific object, situation, activity or person, in this case, an overwhelming fear of dentists.

Dentophobia has several different elements that make up the condition.

 A person’s phobia may be connected to one or more of these elements.

• A fear of pain
  Some people associate dental treatments with pain. Dental procedures often involve some pain, either at the time of the procedure or in the hours and days that follow, especially procedures such as tooth extraction. Someone who is particularly sensitive to pain, has had a previously painful experience at the dentist or negatively associates the dentist with pain may experience a fear of pain connected to the dentist that develops into a phobia.
• A fear of the dentist
  This involves a fear of the dental practitioner and/or dental nurses. Similarly to iatrophobia (a phobia of doctors), a phobia of dentists can be connected to the person themselves. The type of treatments they do, their clothing, the instruments they use, and the typical characteristics of the dentist can all be connected to your phobia.
• A fear of anaesthetic
  Anaesthetics are a group of medications that are used to numb the sensation in certain areas of the body. The majority of dental procedures will use local anaesthesia, where just a small area of the body is numbed, in this case, the gums and mouth. Some procedures may require general anaesthesia, a type of anaesthesia that causes you to become unconscious. Some people are fearful of anaesthesia because of the loss of control they feel and the potential risks that are involved.
• A fear of blood
  A person who has haemophobia, an extreme fear of blood, (link to haemophobia article once published) often experiences a fear of situations that they associate with blood or where there is a risk of bleeding. Because many dental procedures, and sometimes even dental check-ups, can result in some amount of bleeding, this can result in fear and anxiety connected to dentists, which can develop into dentophobia.
• A fear of choking
  Some people dislike having foreign objects in their mouths because of the fear of choking. This fear may be more common in people with a sensitive gag reflex. If something touches the roof of your mouth or the back of your tongue, this can cause a reflexive contraction in your throat. This can result in coughing, gagging, and even vomiting and can cause a fear of choking. People who have previously experienced choking or difficulty breathing may also have a fear of choking.
• A fear of needles
  People who are scared of needles or have trypanophobia, an extreme fear of needles in a medical setting, (link to trypanophobia article once published) often also develop a fear of places and situations where they may encounter needles, including the dentist.
• A fear of noises associated with the dentist
  This could include the noise of dental drills and other dental equipment. Hearing or thinking about these noises can trigger fear and anxiety.
• A fear of the smells associated with the dentist
  A dentist clinic has very specific smells that are often not found anywhere else. These smells can trigger negative memories or thoughts and can result in negative emotions and adverse reactions.

How common is dentophobia?

Approximately half of all people report experiencing fear and anxiety about visiting the dentist. However, it can be difficult to determine how many of these people are experiencing a true phobia.

Negative thoughts and emotions about dentists can occur on a spectrum, ranging from low levels of fear and anxiety to severe fear, panic and anxiety that can impact your ability to function in your day-to-day life and can impact your decision-making, result in avoidance behaviours and affect your oral health and overall wellbeing.

Because avoidance behaviours are common, with many people with dentophobia avoiding going to the dentist, this phobia often goes undiagnosed. However, it is estimated that 12% of people experience dentophobia, which equates to more than 8 million people in the UK.

Who is at risk of dentophobia?

Although anyone can develop dentophobia, certain risk factors can increase your likelihood of developing the condition, including:

• Having another relevant phobia, such as iatrophobia or haemophobia.
• Having a close family member, such as a parent or sibling, with dentophobia.
• Having a close family member, such as a parent or sibling, with another phobia.
• Being exposed to the fear of dentists during childhood or adolescence.
• Having a history of anxiety, depression, panic attacks or extreme fears.
• Being a naturally more anxious person.
• Having a negative or traumatic experience relating to dentists.
• Having a substance use disorder, including misusing drugs or alcohol.
• Experiencing high levels of stress.

It is important to keep in mind that even if you have some of the above risk factors, this does not mean you are going to develop dentophobia. A person who has an anxiety disorder and has a parent with dentophobia may never develop the phobia themselves. On the other hand, a person with none of the above risk factors may develop dentophobia.

A fear of dentists is almost twice as common in women compared to men. However, it is unclear whether statistics represent a true gender difference in the development of phobias, or whether women are more likely to seek a diagnosis than men.

How to deal with dentophobia

Many people with dentophobia implement avoidance behaviours as a way of dealing with their phobia. However, although avoiding dentists is possible the majority of the time, there will be times when you must visit the dentist. The NHS recommends that those with good oral health should have a dental check-up at least every 12–24 months. People with poor oral health need more regular check-ups. Check-ups help to keep your mouth, gums and teeth healthy and allow your dentist to detect any problems early.

Additionally, avoiding the dentist may not be an effective long-term solution. Failure to address your phobia could result in your symptoms becoming more severe in the future. If you haven’t learnt any coping strategies, this could result in a more severe phobic reaction, which could be particularly problematic if a situation arises in the future where you need to visit a dentist, for example, if you develop tooth decay, a cavity or an infection.

If you don’t address your phobia and deal with your symptoms and triggers, you may find yourself avoiding essential treatment or you may experience more severe symptoms when faced with dental treatment in the future.

Coping strategies can help you to reduce and alleviate the symptoms of your phobia and reduce the impact it has on your day-to-day life and overall wellbeing. It can also help you to reduce avoidance behaviours and help you to manage your phobia more successfully.

Some long-term and short-term coping strategies you can implement include:

• Educate yourself
  Learning about dentists and different dental treatments can help to alleviate your fear and anxiety. It can help you to understand the importance of dental care, the high level of training dentists go through before they are able to practise, and the low risks associated with visiting the dentist. This information can help you to rationalise your fears and anxiety.
• Learn about your phobia
  Thinking about what initially caused your phobia and what your triggers are can help you to understand your phobia and rationalise your thoughts and emotions. This can help you to manage your symptoms more effectively.
• Create a fear ladder
  A fear ladder allows you to analyse your phobia and determine which situations cause you the most anxiety.
  For example, your fear ladder could look like this:
  – 1 = Having dental treatment.
  – 2 = Going for a dental check-up.
  – 3 = Lying in a dental chair.
  – 4 = Seeing dental equipment.
  – 5 = Someone you love visiting the dentist.
  – 6 = Watching a video of someone at the dentist.
  Once you have created your fear ladder, you can then tackle your triggers one at a time, starting at the bottom of the ladder (the situation that results in the lowest phobic response). This can help you to build up your tolerance of your triggers gradually.
• Speak to your dentist
  If you require a check-up or dental treatment, informing your dentist of your phobia and your triggers is recommended. Your dentist can take your fears into consideration and implement measures such as booking your appointment when other patients won’t be present, removing any particularly triggering items from the room, keeping the environment calm and stress-free and working at a pace that you are comfortable with.
• Challenge negative thoughts
  Negative thoughts can exacerbate your symptoms and worsen your phobia. Remind yourself that the risks are minimal and that you are not in danger. If you begin to experience symptoms of dentophobia, remind yourself that the feelings will soon pass and that your fear is irrational.
• Implement distraction techniques
  If you are in a triggering situation or you need to visit the dentist, implementing distraction techniques can help to reduce your physiological and psychological responses to your triggers. Distraction techniques could include listening to music, engaging in conversation, reading, playing a game or watching a video. Focusing on something external, such as counting the number of objects in a room or the number of passing cars, can also help to keep you calm.
• Implement visualisation techniques
  Visualisation has been found to be an effective coping strategy for reducing the symptoms of phobias. When faced with your trigger, visualising a place or memory that keeps you calm or elicits positive emotions can help to alleviate your symptoms.
• Practise yoga, meditation or mindfulness
  Yoga, meditation and mindfulness teach you how to control your breathing and your body’s response to your triggers and can help you to feel more in control and calm. This can help to reduce the physiological and psychological responses you may have when faced with a dentist.
• Practise deep breathing techniques
  Deep breathing is an effective way of lowering stress and relieving tension in your body. This is because it sends a message to your brain to relax and calm down. Breathing exercises help to reduce anxiety and can help you to control your nervous system, which is central to your phobic responses. Practise deep breathing before and during your dental appointment.
• Implement lifestyle changes
  Phobias and other mental health conditions can be made worse by factors such as lack of sleep and excessive stress. Take steps to reduce stress in your everyday life, eat a healthy balanced diet, exercise regularly and ensure you have a good sleep routine. These lifestyle changes can help to reduce the symptoms of your phobia long term. This is because these lifestyle factors can impact your anxiety levels, your stress levels and your feelings of depression. You should also avoid caffeine, sugar and other stimulants in the lead-up to a dental appointment, as these can increase your heart rate and blood pressure and worsen your physiological symptoms.

What triggers dentophobia?

Dentophobia can have different triggers for different people. Your triggers can depend on what initially caused your phobia, the severity of your symptoms and your current mental health.

Some of the most common triggers for dentophobia are:

• Going to the dentist or having any kind of dental treatment.
• Being told you need dental treatment.
• Experiencing toothache or another symptom related to issues with your teeth, gums or mouth.
• Lying in a dental chair.
• Being in close proximity to a dental surgery or dental clinic.
• Having another medical procedure or visiting the doctor (as this could remind you of the dentist).
• Seeing a video or picture of a dentist or dental treatment.
• Seeing something you associate with the dentist, such as tools and implements.
• Smelling something that you associate with the dentist.

What are the symptoms of dentophobia?

The symptoms of dentophobia can vary from person to person and situation to situation, depending on the severity of your phobia, your triggers, your current mental health and wellbeing and your coping strategies.

Some people experience mild symptoms, whereas others experience more severe symptoms. One person can experience symptoms that are mild or more severe at different times. You may experience symptoms while at the dentist, in the lead-up to your appointment or when talking or thinking about dentists.

The symptoms of dentophobia are often similar to the symptoms of anxiety or panic attacks.

The symptoms can be both physiological and psychological and can include:

Physical Symptoms:

• Heart palpitations or feeling like your heart is racing.
• Elevated blood pressure.
• Rapid breathing, difficulty breathing, shallow breathing or hyperventilating.
• A choking sensation, difficulty swallowing or feeling like something is stuck in your throat.
• Chest pain, tightening in your chest or feeling like something is stuck in your chest.
• A dry mouth.
• Inability to sleep in the lead-up to your appointment.
• Shaking or tremors.
• Feeling like you cannot breathe or are suffocating.
• Nausea or feeling like you are going to vomit.
• Feeling dizzy or light-headed.
• Confusion or disorientation.
• Sweating, chills or hot flushes.
• Loss of appetite.
• Headaches.
• Freezing and being unable to move.
• Crying, screaming, running away or hiding (common in children with dentophobia).

Psychological Symptoms:

• Avoiding dentists, dental treatments and places or situations you associate with dentists.
• Inability to function normally when faced with your triggers.
• Immediate and overwhelming fear or panic when faced with dentists.
• Overwhelming anxiety.
• Anticipatory anxiety in the lead-up to encountering dentists.
• An inability to control your fear, panic or anxiety, even if you are aware that they are out of proportion to the threat.
• Feeling like you want to run away or hide (fight or flight).
• Feeling detached from yourself.
• Feeling like you are losing control.
• Feeling trapped or unable to escape.
• A sense of impending doom.
• Feeling like you are going to die or a fear of death.

What causes dentophobia?

The exact cause of dentophobia is unknown. There are several reasons why someone might develop a phobia of dentists. It could be that your phobia has one single cause, or that multiple factors contributed to you developing dentophobia. It could also be that your phobia has no clear cause.

Some of the most common causes of dentophobia are:

• A negative or traumatic experience
  Someone who has had a previous negative or traumatic experience involving dentists may develop dentophobia, particularly if the experience happened during childhood or adolescence. A traumatic or painful experience involving your mouth or teeth, even if no dentist was involved, could also result in dentophobia.
• A negative perception of dentists
  Dentists are often portrayed negatively in movies and TV shows, with evil or crazy dentists being popular villainous characters. Being exposed to this negative perception of dentists at an early age can cause children to develop an extreme fear.
• Hypersensitivity to pain
  People who are hypersensitive to pain may have an extreme, negative response to pain or the possibility of pain. The increased pain they feel when having dental treatments can result in them developing a negative association between dentists and pain, which can then develop into a phobic response.
• Fear rumination
  This is when you engage in a repetitive negative thought process and persistently and repetitively recap a negative experience with dentists or dental treatments or think about them in a negative way. Over time, these memories can become increasingly distressing and intrusive and can make you remember your encounter with dentists as being more painful, traumatic or scary than it actually was. Fear rumination reinforces your fear responses and can result in you developing a phobia.
• A learned phobia
  Phobias can be learned in what is known as an observational learning experience. This is more likely to happen if you are exposed to dentophobia during childhood or adolescence. A family history of dentophobia increases the likelihood of you developing the same fear.
• A history of abuse or bullying
  An individual who has experienced physical, sexual or emotional abuse, violence or bullying may be more likely to develop a phobia, such as dentophobia. This may be related to the fear of feeling out of control, not having control of their own body or someone else touching them.
• An information learning experience
  In some cases, people develop phobias because they were exposed to facts or information that scared them. For example, learning facts about complications that can arise during dental treatments can result in you developing dentophobia.
• Significant stress
  Significant, long-term stress or a life stressor can result in disproportionate fear responses or an inability to manage intense situations. This could result in you developing a phobia, particularly if you are exposed to the phobia or a traumatic situation involving dentists while you were already experiencing stress.

What are the potential complications of dentophobia?

Dental treatments are a type of medical treatment and are often essential to your overall health and wellbeing. Failure to have regular dental check-ups or to visit your dentist if you begin to experience worrying symptoms or dental issues can have multiple negative consequences or potential complications.

Such as:

• Tooth decay.
• Gum disease.
• Dental cavities.
• Inflammation of blood vessels.
• High blood pressure.
• Diabetes (oral inflammation can reduce your body’s ability to process sugar and use insulin effectively).
• Cancer (multiple studies show a relationship between gum disease and cancer).

Dental issues can also have a serious impact on your self-confidence, especially if you are experiencing symptoms such as bad breath, or decayed teeth. This could result in a person withdrawing and experiencing a negative impact on their social and professional relationships.

How is dentophobia diagnosed?

Because feelings of fear and anxiety surrounding dentists and dental treatments are relatively common, many people do not realise that their symptoms are unusual, and their fear is more severe and irrational compared to other people.

Dentophobia is a relatively unknown phobia. It does not have the same awareness as phobias such as claustrophobia, and many people are unaware of the characteristics and symptoms of dentophobia. If someone is unaware that they are experiencing a phobia, they are less likely to seek a diagnosis.

If you experience negative thoughts and feelings, such as fear or anxiety, when visiting the dentist, you may have dentophobia.

If you are unsure if your symptoms are severe enough to be classified as a phobia, consider whether they:

• Are out of proportion to the actual risks.
• Impede your ability to function in your everyday life.
• Have a negative impact on your quality of life.
• Occur whenever you visit the dentist or think about visiting the dentist.
• Cause you to avoid visiting the dentist, even if you are in pain or require treatment.
• Have a negative impact on your mental health or wellbeing.

Even if you are not completely sure whether your symptoms are consistent with dentophobia, your first step will be to make an appointment with your GP.

Your GP will look at your medical history, such as whether you have previously experienced an anxiety disorder, panic disorder or another phobia or extreme fear, any other medical conditions you are diagnosed with, and any medications or supplements you take. They will also likely ask about your family history (e.g. whether you have a close family member with dentophobia or another phobia).

If your GP thinks that it is possible you are experiencing dentophobia, they will refer you to a psychologist or another mental health professional.

The psychologist will use a phobia questionnaire and will ask about:

• Your triggers.
• The type of symptoms you experience.
• The frequency and severity of your symptoms.
• How much your phobia interferes with your everyday life.
• When your phobia began and what caused the onset of symptoms (if you know).

Your symptoms will then be compared to the diagnostic criteria for specific phobias.

To receive a formal diagnosis of dentophobia, your symptoms must fit the seven key criteria listed on the diagnostic criteria:

1. The fear must be persistent, excessive and unreasonable. It can occur when you visit the dentist, in the lead-up to visiting the dentist and at other times (such as when you think about dentists or see a video of dental treatments).

2. Exposure to dentists or dental treatments leads to an immediate anxiety response in the majority of situations.

3. The fear is excessive and disproportionate to the threat, and this is recognised by you.

4. You avoid places or situations where you could encounter dentists or avoid visiting the dentist, even if you require treatment or a check-up. If you encounter a dentist, you will experience extreme fear, anxiety or distress.

5. The anticipation of encountering dentists or requiring dental treatment and the avoidance behaviours you may implement can have a significant impact on your day-to-day life.

6. Your fear has lasted for a minimum of six months.

7. The phobia is not associated with another disorder or mental health condition.

How is dentophobia treated?

There are several different treatment options that may be recommended for someone with dentophobia. However, not all people with a phobia of dentists require treatment. If your symptoms are mild, you have implemented successful coping strategies or your phobia doesn’t significantly impact your day-to-day life and your wellbeing, you may not require treatment.

However, if your dentophobia stops you from seeking dental treatment, if your symptoms are severe or occur regularly, or if your phobia is affecting your wellbeing, treatment will likely be recommended. Your doctor will create a treatment plan that is personalised to you, your triggers and your symptoms.

When creating your treatment plan, they will consider:

• How severe your symptoms are and how frequently they occur.
• What the root cause of your phobia is.
• How significantly your phobia impacts your life.
• Your overall health and wellbeing, including your mental health.

The most common types of treatment for dentophobia are:

Exposure Therapy:

Also known as systematic desensitisation, exposure therapy is one of the most popular treatments for dentophobia. This type of therapy involves you being exposed to your triggers in a safe, controlled environment.

Your phobia will be assessed, and a fear ladder of different scenarios and situations will be created, to discover which are the most triggering and result in the most severe symptoms. The psychologist will then create a collection of dentist-related exposures for you to face.

Your exposure will be gradual, starting with the situation that results in the least phobic response, for example, looking at a picture of dental treatment or talking about visiting a dentist.

Once you are comfortable with this level of exposure, you will then progress to the next level. You will eventually lead up to visiting a dentist and eventually having a check-up or a dental treatment. Exposure therapy can also help you to address the negative thoughts and emotions you experience when faced with dentists and can help you to change your physiological and psychological responses. You will also learn relaxation and coping techniques.

Cognitive Behaviour Therapy (CBT):

Cognitive behaviour therapy may be offered as a stand-alone treatment or alongside exposure therapy. CBT is a type of talking therapy and sessions can be individual or as part of a group. Sessions are designed to help you identify and change your negative perceptions and harmful, flawed or negative thoughts surrounding dentists and can help you address the associated emotions and behaviours you experience.

CBT will also try to help you identify and address the root cause of your fear and overcome any negative patterns of thought.

During your CBT sessions, you will:

• Discuss your triggers and symptoms.
• Explore what caused your fear of dentists.
• Explore your fears in more detail.
• Learn how to recognise your negative thoughts and change the way you are thinking.
• Learn coping strategies and calming strategies, such as deep breathing exercises, distraction techniques and coping statements.

Clinical Hypnotherapy

Clinical hypnotherapy uses guided relaxation techniques and focused attention to help you to identify the root cause of your fear and help you change your thought patterns and any negative feelings you have about dentists. It can help you to change your perception of situations and reduce your phobic response.

Hypnotherapy usually involves entering a relaxed, hypnotic state. A combination of techniques will then be used to re-pattern your thoughts and memories related to dentists. Hypnotherapy can also teach you calming strategies, such as deep breathing and relaxation techniques which can help you to reduce your symptoms in the future.

Medication

Medication is not a common treatment option for people with dentophobia. However, you may be prescribed medication if other treatment options fail, or if your phobia is particularly severe. You may also be prescribed medication if you experience anxiety or depression alongside your phobia.

If you are offered medication, it will likely be in conjunction with other treatments, such as CBT.

Some possible medications that you may be offered include:

• Anti-anxiety medication.
• Beta-blockers.
• Selective serotonin reuptake inhibitors (SSRIs).