DENTAL ANXIETY IN ADULTS

Some adults experience dental anxiety or fear of going to a dental clinic as they anticipate pain, gagging, or choking. Such patients are likely to cancel or delay dental appointments and ignore their oral health. Dental anxiety is usually associated with children, and its prevalence among adults is widely underestimated. In this article, we discuss the prevalence, causes, and management of dental anxiety.

Prevalence of dental anxiety in adults

Dental anxiety is a common problem, affecting 10%-20% of US adults and 4%-30% of adults globally. Females between 26 and 35 years of age are the most commonly-affected cohort.

Causes of dental anxiety in adults

Dental anxiety is a complex phenomenon that may result from several factors. These include:

• Fear of pain: Fear of pain or getting hurt during the dental treatment is the most common cause of dental anxiety. Anxious patients may overrate the pain that they may feel before the actual procedure.
• Past traumatic experience: A traumatic dental visit during childhood remains etched in the memory of people throughout their adult life. The fear of undergoing similar post-operative pain makes people avoid dental visits.
• Influence of family members: People easily come under the influence of family members or friends who had a bad experience during their dental visits. This instills a sense of fear in the mind of the person who intends to visit the dentist.
• Personality traits: Personality traits such as neuroticism are associated with extreme dental fear. Neuroticism is a tendency to remain negative or in an emotionally anxious state. Such people are more likely to have depressed moods, extreme feelings of envy, fear, and anger compared to others.
• Other phobias: Some people with dental anxiety may have several other phobias such as fear of blood injury, heights, closed spaces, and social phobia. The effect of these phobias combined can create a negative attitude toward dental visits.

Factors that can trigger dental anxiety in the dental office:

Research suggests that several factors can trigger dental anxiety in patients visiting the dental office. These factors include:

• The prolonged waiting period in the dental office gives ample time for the patient to overestimate the pain and discomfort that they may experience.
• The sight of needles, drills, and sharp instruments can trigger fear.
• Unpleasant sounds and vibrations created by drilling machines, compressors, and suction tubes can create discomfort and annoy patients undergoing treatment procedures.
• Smells from several dental materials (e.g., Eugenol, bonding agents, monomers) may induce nausea.
• Unwelcoming behavior of the dentist or staff can make patients more uncomfortable and apprehensive. The patient may lose confidence in the dentist which can aggravate their existing fears.

Consequences of dental anxiety:

People with dental anxiety experience negative thoughts, disturbance in sleep, and psychological distress. They are likely to have a greater number of decayed, missing teeth, and may require to undergo emergency dental treatment due to frequent teeth pain. The tendency to delay dental visits can negatively impact their quality of life. In addition to this, the dentist may also find it difficult to manage such patients in the dental office. If such patients are not managed well, they may continue to experience a vicious cycle of dental fear.                                                     

Diagnosis:

The dental treatment of anxious patients is time-consuming, increases the risk of mishaps during the procedure, and may cost more due to frequently-missed appointments. So, a thorough evaluation of the patient’s medical history, previous anxiety attacks and factors associated with dental anxiety are assessed before the treatment. Evaluation of heart rate or electrodermal activity (a measure of changes in the electrical activity of the skin) can help determine a patient’s state.

Management:

Below are some of the steps that dentists may take to reduce the anxiety in patients and eliminate their fear:

• Reduce the patient’s waiting period and invest sufficient time during the dental procedure.
• Keep the support staff well informed about the patient’s anxiety and instruct them to take extra care of the patient.
• Train the patient to raise hand or signal the dentist in case of discomfort during the procedure.
• Minimize factors that trigger anxiety in dental settings. For instance, keep sharp instruments and needles away from patient’s sight, use low-speed drills or minimally invasive restorative techniques to reduce the sounds and vibrations, spray scented fragrance in the dental setting to reduce the odor in the treatment room, and use dental lasers wherever possible to minimize bleeding during surgery.
• Use relaxation methods and distraction techniques (e.g., music via headphones) to make the patient feel more comfortable.
• In extreme cases, refer the patient to a psychiatrist or behavioral specialist to reduce anxiety levels.

Conclusion:

Dental anxiety is a common problem with limited awareness among people. Early diagnosis of such conditions and timely interventions can result in improvement in the patient’s oral health and their quality of life.

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References:

• Gordon, D., Heimberg, R. G., Tellez, M., & Ismail, A. I. (2013). A critical review of approaches to the treatment of dental anxiety in adults. Journal of Anxiety Disorders, 27(4), 365–378.
• Doerr PA, Lang WP, Nyquist LV, Ronis DL. Factors associated with dental anxiety. The Journal of the American Dental Association. 1998 Aug 1;129(8):1111-9.
• Armfield JM, Heaton LJ. Management of fear and anxiety in the dental clinic: a review. Aust Dent J. 2013 Dec;58(4):390-407; quiz 531.
• Bürklein S, Brodowski C, Fliegel E, Jöhren HP, Enkling N. Recognizing and differentiating dental anxiety from dental phobia in adults: a systematic review based on the German guideline "Dental anxiety in adults". Quintessence Int. 2021;0(0):360-373
• Hmud R, Walsh LJ. Dental anxiety: causes, complications and management approaches. J Minim Interv Dent. 2009 Jan 1;2(1):67-78.
• https://www.medicalnewstoday.com/articles/246608#what-is-neuroticism

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