If you start sweating at the thought of seeing the dentist, you—like 40 million other Americans—might have dental anxiety. But if you start skipping your dental appointments because you can’t stand the thought of being in that chair, you might have dental phobia.
A phobia is when your anxiety gets so high that it interferes with your life. Studies show that people with dental phobia, officially known as odontophobia, tend to forego dental treatment, often for years. That can have serious consequences, because oral health is connected to overall health, and a dentist can often catch problems you’ve missed.
A certain amount of dental fear is totally normal.
“There’s not a lot of experiences where you’re in a chair, you can’t really move, somebody’s hands are in your mouth and you can’t even communicate with them,” says Laura Seligman, a psychology professor at University of Texas Rio Grande Valley who researches how to treat dental phobias. “It’s pretty typical to have some anxiety about going to the dentist.”
But whether you have dental fear or a full-blown phobia depends on what you do when you get the reminder that you’re due for your regular checkup.
“First of all, are you going to the dentist?” Seligman says. “If you’re not going, or if you’re coming up with reasons why you don’t really need to go, that’s probably a sign that you are moving into dental phobia.”
Other signs include needing sedation during appointments or experiencing so much stress that you panic far in advance of the appointment. Knowing how to identify when dental anxiety has turned into a dental phobia can help you find the right care.
The roots of dental phobia
Watching Orin Scrivello inflict pain via drill in Little Shop of Horrors is terrifying, but evil dentists on film aren’t the cause of most dental phobias. Research shows that many phobias begin because of an experience in childhood.
“We find that having a really negative, painful dental experience early in your history seems to be important for development of dental fear and phobia,” says Andrew Geers, an experimental psychologist and professor at the University of Toledo who researches dental phobias. When children have bad experiences at the dentist’s office, they may later put off scheduling appointments, cancel their appointments and have more cavities.
People also tend to become phobic after experiences where they felt shame or a lack of control. You might feel embarrassed or uncomfortable about the state of your teeth or if you haven’t been to the dentist in a while. Experiencing pain can also lead to a phobia.
“There is going to be some pain at the dentist,” Geers says. “It is a vulnerable position and it’s a very sensitive area of the body.”
There is evidence that the way we experience and learn from mouth pain is different from the way we experience pain in the rest of the body. Researchers don’t know exactly why, but it seems anxiety is easier to learn when it stems from pain in the mouth.
Treating dental phobia
The gold standard for treating phobias is exposure therapy. When people are anxious about something, they tend to avoid it, which makes it harder to go back and face the fear.
“Exposure therapy helps the person start facing the things that they’re afraid of in a specific way so that they learn new information that is not consistent with their fears,” Seligman says.
Some studies show that exposure therapy for dental phobias can work in as little as one session where the patient is slowly exposed to their source of fear, whether that’s opening their mouth for the dentist or facing the dental drill.
Researchers have also investigated treating dental phobia with virtual reality exposure therapy or smartphone-based exposure treatment. Other recommended strategies for managing dental anxiety include hypnosis, acupuncture, distraction, positive reinforcement, putting on headphones, muscle relaxation and relaxation breathing.
But the best strategy might be a good old-fashioned conversation with your dentist; talking to your dentist about your fears can help alleviate them.
“They might be able to work with you to try to ease some of the anxiety,” Geers says.
Some people also like to meet a new dentist before the appointment to get familiar with the environment. You can also come up with a specific plan to address your worst fears. If you’re nervous that you’ll be in pain and won’t be able to communicate to the doctor, tell the dentist that when you raise your hand, that means they need to stop.
These types of plans may be most useful if you have dental anxiety. If you have dental phobia and basic coping strategies don’t help, consider seeking specialized treatment from an expert.
“It’s just like any other disorder,” Seligman says. “If you had diabetes I wouldn’t tell you to treat it at home.”
Ultimately, the consequences of untreated dental phobia can be severe.
“We see that when people recognize that they have dental phobia, they tend not to get treated,” Geers says. And when they do get treated, it is often later in life, after more severe issues have developed.