Dental anxiety is rarely out of the spotlight, and a topic that I have certainly spoken about in the past. As an endodontist, I am accustomed to treating patients who are very afraid of sitting in the chair and have a root canal done and I know how difficult this can be from the professional’s perspective. As such, I like to keep up to date with any new research that is released around this topic, to ensure that I am able to understand why my patients might be afraid and, in response, do what I can to try and assuage their concerns in the surgery.
The Oral Health Foundation recently highlighted some new research,[i] which has discovered that being afraid of the dentists will not only affect a patient’s oral health, but may have serious implications to their overall quality of life.
The study revealed that dental anxiety can heavily impact people both psychologically and socially, leading to feelings such as shame, poor self-confidence and social isolation. Other key elements of social wellbeing – income and education, for example – could also be negatively affected by dental anxiety. Indeed, from the cohort questioned, it was revealed that those who were afraid of going to the dentist were twice as likely to be on a lower income than those who felt comfortable in the chair. Naturally, it also showed that they would have significantly poorer oral health as well.
With issues like this, one cannot help but consider them in the ‘chicken or the egg’ perspective. Were these patients already in a disadvantaged environment, which led to a lack of education or poor experience with overworked, under-resourced dentists and, consecutively, fear of the dentist – or was it the other way round, that their fear led them on an ultimately downward spiral? The research doesn’t answer this question, but I believe the solution is quite clear. We need to work with patients to remove the reputation of fear from the dental profession.
But, of course, that’s easier said than done.
As we know, there are many adults in the UK who suffer from dental anxiety, with the majority stating they are actually phobic. The causes for this are too eclectic to list fully, but we know for certain that pain is a leading factor, as is the feeling of vulnerability and lack of control.
These two issues, however, are, if not simple but widespread enough, to address effectively. Painful treatment is, in my opinion, a thing of the past. Treatment removes the pain, it should never inflict it. We have the means to provide our patients with painless treatment in practically all scenarios, so we should ensure we do so. Often it’s the pain of, and often just the thought of, the anaesthetic needle. But even this can be combated with technique and technology. Now, it’s just a case of ensuring our patients know this. Similarly, we can effectively work with patients who feel vulnerable in the chair, by using distraction techniques such as video headsets, or sedation, or even giving them control by discussing the treatment and telling them they can tell us to stop at any time. A stop button will work wonders in this regard.
Dental anxiety is itself a bit like toothache and, if you can excuse the tangential analogy, we know that toothache can be treated in a number of ways: the symptoms can be treated short-term with painkillers, it can be treated properly with proper care, or it can be avoided by education and preventative measures. Dental anxiety is the same; it can be dealt with haphazardly, on a case by case basis – but it’s unlikely to really go away; we can explore the roots of the fear and address these with patients to eliminate them, or we can prevent dental anxiety altogether by working closely with patients from a young age, educating parents, doing outreach work and raising awareness. Only this way can we begin to treat dental anxiety properly.
With this new research, and knowing that dental anxiety can affect our patients in such fundamental ways, beyond just their oral health, but in almost every aspect of their lives, we should work harder than ever before to address our patients’ fears. Only this way will be fulfilling our true remit as healthcare professionals.
[i] The Oral Health Foundation: https://www.dentalhealth.org/news/details/1000