Dental anxiety

Published by Bupa's Health Information Team, June 2011.

This factsheet is for people who get anxious about visiting a dentist, or who would like information about overcoming dental anxiety.

Dental anxiety is feeling nervous about, or being fearful of, visiting a dentist. It can sometimes be a barrier to people getting dental treatment.

About dental anxiety

Dental anxiety is common and affects people of all ages. There are different levels of dental anxiety, ranging from slight nervousness to a severe phobia (an out-of-proportion fear that makes you steer clear of certain situations).

Dental anxiety affects people in different ways. You may be anxious about specific aspects of dental treatment, or being in close contact with someone you don't know very well. You may have had unpleasant experiences at the dentist as a child and are frightened that these will be repeated.

However nervous or fearful you are of having dental treatment, there are a number of things you can do to help you overcome your anxiety.

Getting support

The first step is to get in touch with your dentist and talk about your anxiety. It’s important to remember that he or she will understand if you are anxious about having treatment.

One way of finding a supportive dentist is by word of mouth. You may be able to get a recommendation from friends or family. Or you could make some phone calls to find out which dentists in your area specialise in treating people with anxiety. When you call, be open about your worries so that the staff can arrange the support you need.

To begin with, you may be able to book an appointment just to talk about your anxiety. This way you can meet with your dentist in person and discuss any worries you have. You may find it helps to take a friend or family member with you.

There are a number of things to bear in mind when you go to see your dentist for an appointment. The following may give you some ideas about the kind of support you can ask for.

• Timing. Ask your dentist to let you go at your own pace. For example, you might choose to just have an examination at your first appointment, or even just sit in the chair. Once the first stage doesn't frighten you any more, you can move on to the next. This way you may be able to overcome your anxiety gradually.
• Control. Talk to your dentist about having some control over the amount of treatment you're getting. It's important that you don't feel pushed further or faster than you can cope with. You may feel more in control if you have a signal (raising your hand, for example) that lets your dentist know that you would like him or her to stop.
• Specific concerns. If there are particular things that you're worried about, or if you have had a traumatic experience in the past, tell your dentist about them.
• Choice. There are a number of treatment options that may help you to relax. Ask your dentist to explain which options may be most suitable for you.

If your phobia is so severe that you can't even consider approaching a dentist for support, see your GP who may recommend you have cognitive behavioural therapy (CBT).

Sedation

You may find treatment easier if you have some form of sedation. This relieves anxiety and helps you to relax. You will still be awake but you probably won't be able to remember much about the procedure afterwards. There are three main types of sedation used in dentistry.

Oral sedation

Your dentist may prescribe you a medicine, such as temazepam or diazepam, to help reduce your anxiety. You will take this as a tablet, usually about an hour or two before your appointment. You must take these medicines exactly as directed by your dentist.

Inhalation sedation

This is also known as 'gas and air'. It's a mixture of nitrous oxide and oxygen. You breathe it in through a mask placed over your nose. You'll be able to understand what your dentist is saying throughout the treatment, but the sedation should reduce your anxiety.

When your treatment is finished, the sedation will wear off after a few deep breaths and the gases will soon leave your body. However, you may be asked to stay in the clinic for up to 30 minutes for the effects of the sedation to wear off fully. Your dentist may ask you to bring a friend or family member to accompany you home.

Intravenous sedation

If you have intravenous sedation, a medicine will be injected through a fine plastic tube (cannula) into a vein (usually on the back of your hand). The medicine will make you feel relaxed, but you will still be able talk and listen to your dentist (although you may not remember any of it afterwards).

You must have someone accompany you to and from your dental appointment. Sedation temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you’re in any doubt about driving, contact your motor insurer so that you’re aware of their recommendations, and always follow your dentist’s advice.

General anaesthesia

Occasionally, people who have severe dental phobia, young children and people with special needs may need general anaesthesia in a hospital to have dental treatment. However, all possible alternatives should be explored first.

If you have a general anaesthetic, it means you will be asleep during the treatment. You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your dental treatment.

Psychological techniques

If you think it may help, you can try a psychological technique to reduce your anxiety.

Distraction techniques

You may find that distracting your attention away from your dental treatment helps you to relax. For example, you may like to try:

• listening to music or audio books
• watching a video or DVD (this is an option in some dental surgeries)
• concentrating on relaxing each part of your body in turn
• thinking about something you’re looking forward to

Hypnotherapy

Hypnosis is a way to relax where you concentrate on suggestions of relaxation, which are given by your hypnotist. You will stay awake and be in total control.

Although hypnotherapy may help some people to relax, there is little evidence to show that it can reduce dental anxiety.

CBT

Behavioural psychotherapists can teach you ways to reduce your anxiety with CBT. Regular meetings and exercises can help you to change the way you feel about something you're scared of. Ask your GP if this is available to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.