Sedation and the Trio of Dental Distress: Anxiety, Phobia & Fear

By Genni Burkhart

Let’s face it, as dentists, you're more likely to encounter patients who are anxious rather than enthusiastic about sitting in your chair. Uneasy patients' level of dread can vary from worry and stress to panic, physical manifestations, and complete avoidance. While dental phobia is considered the most extreme, all three emotions (anxiety, fear, and phobia) can lead a person to avoid the dentist for decades, even a lifetime.

As sedation dentists, understanding the differences can help your patients (and potential patients) overcome harmful psychological barriers, schedule regular checkups, and realize better oral health through dread-free visits.

Skipped Dental Care

In the United States, people avoid going to the dentist for a whole host of reasons. In fact, 19% of American adults skipped dental care in 2023¹, making it the most avoided type of medical care. While this wasn't merely due to dental distress, fear-based avoidance did contribute to the lack of care.

Recent estimates also suggest that 15.3% of adults globally experience dental anxiety, with 12.4% reporting higher levels of fear and the most severe type of distress, dental phobia, at 3.3%. For children, dental fear was reported at 21.7%, citing "choking" as being the most feared aspect of treatment².

Not All Dental Distress Is Equal

While the terms distress, anxiety, and fear are often seen as interchangeable, they aren't. These terms represent distinct psychological and emotional responses to dental experiences. The latest research, however, explains how to distinguish the differences.

• Dental Anxiety: This is seen as a fear of the unknown and comes from generalized anxiety around dentists. According to Dental Fear Central, most people have some degree of dental anxiety, especially for more involved procedures that are new to the patient. However, dental anxiety isn’t necessarily responsible for complete avoidance.
• Dental Fear: Dental fear is specific and often arises from a past traumatic experience. If a patient can tell you exactly what they're scared of (gagging, suction, drills, or needles), this is considered dental fear. It's also common to have more than one dental fear, and these fears can keep patients from regularly visiting the dentist.
• Dental Phobia: The most intense of dental distress, dental phobia can be so powerful that those suffering from it can avoid the dentist indefinitely, only to seek emergency care when the physical pain becomes too overwhelming. Some people with dental phobia might still visit a dentist but do so with intense dread.

Which is Worse?

Among the trio of distress, dental phobia is by far the most harmful. It leads to complete avoidance of dental care, and the result can lead to severe oral health problems, including untreated cavities, gum disease, and tooth loss. The result is often a need for emergency treatments, which exacerbates the phobia by reinforcing negative dental experiences³.

Sedation and Non-Sedation Treatment Tools

Sedation dentistry offers a powerful way to connect with patients experiencing dental distress by addressing their specific fears and concerns. By tailoring messaging to highlight how sedation alleviates different types of dental anxiety, from fear of pain and sensory sensitivities to past traumatic experiences, practices can create a personalized reach. Here are a few specific benefits of sedation that apply to each type of dental distress.

1. Dental Anxiety

• Reduces the Stress of Anticipation: Sedation helps calm patients before and during procedures, alleviating the generalized worry accompanying dental visits.
• Encourages Routine Visits: Easing anxiety through sedation encourages patients to keep up their dental visits and improve their outcomes. Better outcomes equal less anxiety.
• Provides a Pain-free Experience: Patients with lower pain tolerances benefit from sedation, which reduces discomfort during procedures.

2. Dental Fear

• Eases Specific Triggers: Sedation can address the fear of needles, drills, and other dental tools by dulling sensory perception and allowing the patient to relax.
• Suppresses Memory: Oral and IV sedation causes short-term, partial amnesia, helping patients avoid recalling distressing aspects of the procedure.
• Improved Cooperation: A relaxed patient is more cooperative, allowing you to perform procedures efficiently without interruptions caused by patient fear.

3. Dental Phobia

• Overcomes Severe Avoidance: Sedation enables people with the most extreme phobias to undergo delayed, necessary treatments they'd otherwise avoid entirely.
• Comprehensive Care with Minimal Visits: Sedation allows phobic patients who avoid frequent visits to complete multiple, even complex, procedures in one or two sessions, reducing the need to make multiple appointments.
• Breaks the Cycle of Fear: Positive experiences under sedation can help to reduce the overall phobia over time, encouraging continued dental care by realizing there's nothing to fear.

As sedation dentists, it’s also important to remember that a wide variety of techniques and tools are available to treat dental fear disorders, including sedation. Dental Fear Central is an excellent resource for dentists and dental professionals seeking to treat the trifecta of dental fear. They provide patient insight, stories, tips, and resources for the dental professional.

No matter the type of dental distress, these methods offer additional support beyond just using sedation.

• Relinquish Control. Some patients' fears center around the loss of control. Remember that patients will look for a dentist who fits their needs. Have a conversation with the patient to discuss their unique situation and give them the power to signal that they need a break from the treatment. Agree to a sign, such as a hand raise, during treatment so you'll know when to stop, giving the patient some comfort in control.
• Show empathy and understanding. Be genuine and sincere when communicating with patients. Don't pass judgment or chastise them for a lack of dental care. Instead, seek to understand and listen.
• Take it Slow. Let the patient know their first checkup won't involve complicated or painful procedures. After that, they make appointments at their own pace. Some might benefit from longer appointments, others from shorter and more frequent ones.
• Be on Time. The worst way to start an appointment with an anxious patient is by making them sit in the waiting room or the operatory alone with all the dental equipment, contemplating the worst-case scenario.
• Distractions are up to the patient. Many dental practices now use televisions, iPads, or music to distract patients. However, for some, this can actually instigate their anxieties and fears. Let them decide what type of media and the sound level used to distract them.
• See the experience through your patients’ eyes. Sit in the waiting room, walk back to the operating room, and notice the details. Is there clutter? Loud talk about patients in front of other patients? How are the aesthetics of your office? When was the last time you walked in their shoes?

In Conclusion

Understanding the differences between dental anxiety, fear, and phobia allows you to take a more thoughtful and tailored approach to patient care. For sedation dentists, these levels of distress aren’t just abstract concepts; they likely represent a significant portion of your patient base. By recognizing what drives each patient's hesitation, you can better position sedation as a solution that meets their unique needs, helping patients feel safe, comfortable, and confident in your care.

Author: With over 15 years as an award-winning journalist, editor, and writer, Genni Burkhart has covered everything from news, politics, and healthcare to finance, corporate leadership, and technology. As the Editor-in-chief of The Incisor newsletter and blog and features writer at DOCS Education, she brings a refreshing insight and a passion for storytelling to the world of sedation dentistry.

References:

1. USAFacts. (2023). How many people skip medical treatment due to healthcare costs? Retrieved from https://usafacts.org/articles/how-many-people-skip-medical-treatment-du…
2. Peric R, Tadin A. Associations between Dental Anxiety Levels, Self-Reported Oral Health, Previous Unpleasant Dental Experiences, and Behavioral Reactions in Dental Settings: An Adult E-Survey. Medicina (Kaunas). 2024 Aug 12;60(8):1303. doi: 10.3390/medicina60081303. PMID: 39202584; PMCID: PMC11356593.
3. Beaton L, Freeman R, Humphris G. Why are people afraid of the dentist? Observations and explanations. Med Princ Pract. 2014;23(4):295-301. doi: 10.1159/000357223. Epub 2013 Dec 20. PMID: 24356305; PMCID: PMC5586885.