Dentophobia: An Insight Into the Aetiology and Coping Mechanisms Surrounding Dental Fear and Anxiety

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More than 10 million adults in the UK have dental anxiety, with an estimated 6 million suffering from dental phobia.1

This statement, echoed from the eminent site of the Oral Health Foundation, powerfully highlights the complex enigma of dental fear and anxiety that is omnipresent within our current society.

Dental anxiety commonly extends from being fearful of the dental setting to eventually avoiding dental treatments by all means. Although universally shared, it is evident that this issue is not heavily discussed amongst peers, attributing to the perpetuating neglect of dental care- such effects will be discussed more thoroughly later on.

With this being said, undoubtedly, to many people, the sound of the dental drill or even the thought of an extraction constructs images of unforgiving pain, anxiety, and a squeamish sense of fear. With most types of phobias, we can align its causes back to a specific stimulus. Subsequently, throughout this article, I will holistically discuss the root causes of dental fear, with an attempt to portray its further management opportunities.

Firstly, let us start by divulging into the aetiology of dental anxiety. Before we fulfil a more thorough investigation, we must understand that the causes can be separated into exogenous and endogenous sources, allowing us to deepen our comprehension and awareness of the dentally anxious patient.

Exogenous Sources (external sources):

. Direct previous traumatic experiences

It has been suggested that traumatic past childhood experiences -such as receiving invasive treatments at the dentist- contribute to increasing levels of dental anxiety later in adulthood, particularly because children can form accurate memories of these evocative experiences. This perhaps provides an explanation as to why it is so common for children to be afraid of the dentist, and thus the relation to the staggering proportion of dental anxiety amongst adults within the UK (as mentioned in the introduction).

. Indirect vicarious experiences

These types of experiences concern the development of anxiety by learning behaviours from family members or external sources such as the media. Themessl-Huber et al. found that parental dental fear is a significant predictor of a child’s anxiety in similar situations.

Endogenous Causes (internal sources):

. Personality traits

Like most situations, introverted people are more likely to experience anxiety when exposed to unfamiliar or vulnerable situations. This notion can easily be extended to the concept of dental anxiety; where neuroticism and extraversion play two identifiable roles. Unlike extraverts, neurotic people tend to exhibit self-consciousness and timidness. A study carried out by Halonen et al. reported that dental anxiety is positively correlated to neuroticism, yet negatively correlated to extraversion, suggesting that individuals who are highly neurotic or introverted are more likely to experience dental anxiety.

. Cognitive ability

Toledano et al. also carried out an experiment to examine how cognitive abilities affect dental anxiety in children. He found that children with high intelligence showed less anxiety at their first visit to the dentist.2

From this, it is clear that dental anxiety has its foundation early on in childhood, spanning towards one’s later life. Although complex and intercalated, it is evident that psychological concepts originate from our brains and our psyche. Therefore, to get a further understanding, let us direct our attention to the neurology of dental fear, through the study of a paediatric dentist, Hiroyuki Karibe.

Karibe split 34 volunteers into high and low dental fear groups. He then scanned the participants in an fMRI, while playing them a series of sounds, including screeching dental drills and suction tool noises.

When people in the low fear group heard the sounds, parts of the brain called the left and right superior temporal gyri (responsible for auditory recognition) responded more than when they heard neutral sounds, implicating that dental sounds triggered more activity in the primary auditory areas of the brain.

Anxious people responded differently. Instead, Karibe saw a more intense response in the left caudate nucleus (responsible for movement, learning, and memory), thus indicating its role in learning and storing tangible memories of the sounds of the dental instruments.3

Fortunately, these findings can be applied to assess the effectiveness of cognitive therapy for dentally anxious patients. For example, it is evident that the onset of dental anxiety has many further repercussions such as the culmination of complete avoidance of dental visits, which for most individuals can result in the depletion of dental health and hygiene. This ideology is visually displayed in the diagram below.

The vicious cycle of dental fear: exploring the interplay between oral  health, service utilization and dental fear | BMC Oral Health | Full Text
[Model of the vicious cycle of dental fear]4

As well as noting the cyclical repercussions of dental fear, it is important to be aware of the multitude of coping mechanisms available to help reduce dental anxiety. Apart from sparking a conversation with friends and family or internally documenting one’s own anxious thoughts, coping mechanisms are essentially designed to be distinct for everyone. As a result, we must acknowledge that ultimately these fears stem from our minds, and in order to individually diminish these anxieties, we must learn about its origins to consequently prevent the extent at which dental anxiety displays amongst the upcoming youthful generation.

By communicating with your dentist and understanding their role to support and care for patients, future experiences will hopefully be made to be a more contented experience for dentally anxious patients, and the stigma that surrounds the dental environment as an intimidating and fearful place will subsequently be lessened.


References

  1. “Income, education and social isolation linked to dental anxiety in new report” (2018) [online]https://www.dentalhealth.org/news/income-education-and-social-isolation-linked-to-dental-anxiety-in-new-report[Accessed 31 August 2020]
  2. “Why Are People Afraid of the Dentist? Observations and Explanations” (2013) [online]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586885/#B49 [Accessed 31 August 2020]
  3. Ian Sample “Scared of the dentist? This is why, say neuroscientists” (2013) [online]https://www.theguardian.com/society/2013/nov/10/dentists-drills-brain-neuroscientists [Accessed 31 August 2020]
  4. Armfield, J.M., Stewart, J.F. & Spencer, A.J. “The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear” (2007) [online] https://bmcoralhealth.biomedcentral.com/articles/10.1186/1472-6831-7-1 [Accessed 31 August 2020]

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