Anxiety a barrier to dental treatment

If you were to survey 100 people you knew and ask them how much they enjoy going to the dentist, you could probably predict ahead of time what responses you would get.  In all likelihood, you would hear that a significant number do not enjoy going – some of whom push themselves and still go, and some who avoid the experience all together.  Some would respect their dentist and dental team, and would appreciate the care and compassion they receive, and yet they still would not ‘enjoy’ their visits.

Dental anxiety is very prevalent today, even though there has been a radical evolution in the way that dental care is provided.  Consider for a moment the style of dentistry that was provided only 60 years ago.  In the mid-1950s, most dental procedures were performed without administering local anesthetic.  There were no water-cooled high speed drills (they were introduced in 1959), so most of the ‘drilling’ was done with a belt-driven slow speed electric handpiece (some of you may remember those pulleys hanging from the ceiling at your childhood dentist).  And of course, the philosophy of dental care has also shifted dramatically.  Teeth were often considered to be “more trouble than they are worth,” and were often removed at the first indication of a problem, even if they were easily repairable.  One could understand then why someone who is 60 and older, and who grew up in this dental environment, would still have some dental anxiety dating back to their formative years.  So why then is dental anxiety still so prevalent in younger adults and children as well?

There is not only one answer to this question – rather, there are a number of factors which may contribute to dental anxiety.  First, the mouth is a highly-innervated, very personal and very sensitive part of the body.  Our mouths are integral to speaking, breathing, and swallowing, three very important functions that we are inherently uncomfortable with other people’s hands potentially interfering with.  Second, there may be a feeling of lack of control or vulnerability when reclined in a dental chair with one’s mouth open.  Those with a heightened gag reflex will certainly be able to attest to this.  Third, there are those darned injections.  Even though the availability of local anesthetics has been one of the greatest facilitators of comfortable dental care, there is still the physical and emotional aspect of receiving an injection, not to mention the various effects during and after the procedure.  Of course this is not a comprehensive or all-inclusive list – however, these issues come up time and again when consulting with anxious patients about the perceived causes of their apprehension.  Technology has brought us a long way, but there is only so much that technology can do to mitigate these issues.

In order to help patients with dental anxiety, dentists will offer the patient a variety of different techniques to enable the patient to undergo treatment in a painless and comfortable manner.  These techniques run the gamut – everything from music distraction and massaging dental chairs to medications which provide varying levels of drowsiness or sleep.  As you can imagine, dentists are thoroughly trained in the psychology of anxious and even phobic patients, and in the various techniques available to deal with them.  The key, however, to managing patients with dental anxiety is a dentist who acknowledges these feelings, is a good listener, is caring and understanding, and is willing to take the time to ensure that the visit is comfortable and positive for the patient.  It is always better to talk to your dentist about any concerns or apprehensions about dental treatment, rather than attempting to put up a ‘brave front’.

Dr. Allan Katchky is a dentist who practises in the East End.

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