You’ve had discomfort in your mouth for a long time, your gums are bleeding, you’ve been postponing your annual mouth cleaning for more than three years and your tartar is building up, you think you may be starting to develop periodontitis, and you know there’s only one way to solve all this, there’s no other way… but just imagining it makes you panic, you’re scared out of your wits, you try to convince yourself that it’s really not necessary to go and you’re willing to put up with this situation rather than go into a dentist’s office.
In this article we are going to talk about a phobia much more common than is believed: odontophobia, the irrational fear of going to the dentist , a problem that can trigger several serious health complications.
What is odontophobia? Differentiating between anxiety and phobia
As we have mentioned before, odontophobia is the irrational and persistent fear of going to the dentist. To be considered a phobia, this fear must last for at least six months.
We must qualify that it is not the same to talk about the anxiety we can all feel before going to the dentist (something very common in society, not only in children) and another thing is to talk about a phobia of the dentist (odontophobia). Whether we want to or not, sometimes going to the dentist is uncomfortable because of the invasive intervention they usually do, since the mouth is a very sensitive area. It is normal and adaptive that somehow our body detects that there is a “danger”, and that as a consequence anxiety is activated to “run away” or to “fight”. However, odontophobia is something much more serious for the person who suffers it, since affects his quality of life very negatively .
A differentiating element from having a simple state of anxiety and having odontophobia will be the extent to which the person actively avoids going to the dentist even though it is really necessary for him/her to go. A very appropriate analogy to understand this is to compare it with the phobia of airplanes. Many people feel anxiety before flying, but don’t go any further and get on the plane without any alternative measures. People with a flight phobia will avoid getting on a plane as much as possible, and whenever possible they will take alternative transport, even if it is objectively harmful (financially, time wise, etc.).
In the case of the person with odontophobia, he or she will avoid going to the dentist at all costs as much as possible , while the person with anxiety will deal with it without giving it any importance, despite the discomfort or pain he or she may feel.
Symptoms of extreme fear of the dentist
People with dental phobia are generally afraid of invasive procedures (being poked, surgery, tooth extraction, anaesthesia, drilling…). They experience great anxiety , which can lead to increased sensitivity to pain. Some authors relate odontophobia or dental phobia to SID (Blood-Inject-Damage) phobia.
They are afraid of pain, and in some cases they are afraid of having a panic attack at the time of the intervention. As a consequence of the fear, patients often tense the muscles , even those of the face. Sometimes there can be a hypersensitivity to the choking reflex, especially in the case of men. Choking occurs when trying to introduce objects into the person’s mouth or when pressing on the throat, making medical intervention difficult or impossible.
In the most serious cases of odontophobia with hypersensitivity to the choking reflex the stimuli that generate the choking are amplified: thinking about the dentist, the smell of the dentist’s own utensils, brushing one’s teeth, wearing high collars, etc.
In general, the causes of any specific phobia, such as odontophobia, are explained by three important factors (Barlow, 2002): biological vulnerability, generalized psychological vulnerability and specific psychological vulnerability. We are going to focus especially on specific psychological vulnerability, since it is usually the one that plays the greatest role in odontophobia.
This would be related to a direct negative learning experience, based on direct conditioning . More specifically, it would be the typical scene of a child who goes through a negative experience at the dentist and from then on conditions the dentist with pain or phobic stimuli, and which is generalized to other stimuli (e.g., white coat, the smell of the dentist, seeing the materials…).
Logically, the severity and frequency of these negative experiences (feeling that every time you go to the dentist you have a very unpleasant or moderately negative experience) and infrequent exposure to the situation after the negative experience (increasingly increasing the frequency with which we go to the dentist because of the aversion and fear it generates: avoidance) are the most important variables for the development of this specific phobia.
Fortunately, today’s interventions by dentists are less invasive and painful than a few years ago, as a result of technological innovation and the use of finer and more painless tools.
How do you overcome it? Treatment
Live Exposure is one of the most effective treatments for dental phobia or odontophobia. If the person has an uncontrollable fear it can be useful to start with imaginative exposure exercises or watching videos about dentists, to continue with live exposure when the patient feels more prepared.
During the live exposure it is important that the patient feels that he has the possibility to control the feared stimulus through signals previously agreed with the dentist (e.g. deciding when he wants to be poked, stopping the drill). It is important that there is a high degree of predictability, i.e. that the patient is in control of the situation and knows what is going to happen at all times.
Obviously, it is better for the client to choose a trusted dentist and to have special empathy for the difficult situation the person is going through, as their intervention will surely require patience and special care. The dentist must explain the procedures to be followed, what the next step will be, and apply the appropriate anaesthetic in each case.
In cases of odontophobia it is also useful to train the patient in controlled breathing or in applied relaxation , especially when the somatic reactions of intense fear produce muscular tension or tension in the throat).