Understanding the Trifecta of Dental Distress: Anxiety vs. Phobia vs. Fear

Finnish researchers claim that one out of every two adults has mild anxiety of the dentist, while one in 10 is extremely afraid. We’ll review the differences between these psychological emotions, and the best ways to help patients overcome them.

By Genni Burkhart

Let’s face it, as dentists you’re not always faced with enthusiastic and elated patients. For those uneasy patients, their level of dread can vary – rooted in past traumatic experiences, all the way to a generalized fear of the unknown. While dental phobia is considered the most extreme, all three emotions (anxiety, fear, and phobia) can lead a person to completely avoid the dentist for decades, even a lifetime.

As sedation dentists, understanding these differences can help patients (and potential patients) overcome these phycological barriers, become regular patients, and realize a better quality of life through dread-free oral health visits.

Finnish Researchers Take An Innovate Approach

According to researchers at the University of Oulu, Finland (1), fear of the dentist is highly prevalent. While most people can manage to go to the dentist, some are reluctant and experience varying levels of anxiety and fear. But for a limited few, their powerful fear of the dentist is considered odontophobia. This is defined as a terror so intense that there’s a complete avoidance of the dentists until either the physical pain or emotional distress becomes too overwhelming.

Making global headlines for their innovative, multifaceted approach to this issue, the Clinic for Fearful Dental Patients (CFDP) in the City of Oulu, Finland aims to put a stop to dental anxiety, fears, and even the most extreme phobias.

This study followed patients treated at the CFDP. At the clinic, patients received care in a multifaceted approach. Patients at CFDP are treated by three dentists "who are interested in treating fearful patients and have taken courses on the topic," explains study author Vuokko Anttonen. Two are clinical practitioners who lecture at the University of Oulu on the topic of dental fear, and the third is a hypnotist. From this, the long-term effects of the fear treatment period were studied. For example, whether or not patients visited their own dental clinics after their treatment at CFDP ended, if they stopped dental care altogether, and if/how often they required emergency dental treatment. This ten-year follow-up included a total of 152 patients from 2006-2016.

What Can Be Learned?

Younger patients, (2-10 years in age) had significantly more follow-up dental examinations than those treated over the age of 10. Preliminary success was associated with the number of examinations, but not with emergency visits and missed appointments. A link between fewer dental examinations and dental emergency care needs was associated with unsuccessful dental fear treatment. From this, researchers concluded that dental fear treatment at an early age is the most beneficial, and successful treatment has a positive impact on dental care and regular dental attendance. Meaning, without successfully treating the psychological factors, the initial positive results diminish over time. For those patients, dental distress is something that must be addressed throughout their lifetimes, perhaps with a focus on the multifaceted approach, the CFDP took – treating both the oral health and psyche of patients.

Not All Emotional Distress Is Equal

Unfortunately, the terms dental fear, dental phobia, and dental anxiety are often seen as interchangeable – but they aren’t. Here's how to distinguish the differences.

  • Dental Anxiety: This is seen as a fear of the unknown and comes from a 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.

Treating The Whole Patient

As sedation dentists, it’s important to remember there's a wide variety of techniques and tools available to treat dental fear disorders including, but not limited to sedation.

Dental Fear Central is a great 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. While it’s a United Kingdom-based website, they offer technology, courses, and highly relevant resources useful for dentists everywhere.

Here’s a few recommendations that apply to dental anxiety, fear, and phobias. The level and exact method for each patient is unique to their situation.

  1. Relinquish Control. For some patients, their fears center around the loss of control. Remember that patients will look for a dentist that 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.
  2. Show empathy/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.
  3. Take it Slow. Let the patient know their first checkup won’t involve complicated or painful procedures. After that, make appointments at their pace. Some might benefit from longer appointments, others from shorter and more frequent ones.
  4. Be on Time. Tick tock. Tick tock. The worst way to start an appointment with an anxious patient is by making them sit in the waiting room or in the operatory alone with all the dental equipment contemplating the worst-case scenario.
  5. Distractions are up to the patient. Many dental practices are now using televisions, iPads, or music to distract patients. However, for some, this can actually act as an instigator to their anxieties and fears. Let them decide what type of media, as well as the sound level used to distract them.
  6. See the experience through your patients’ eyes. Sit in the waiting room, walk back to the operatory and pay attention to the details. Is there clutter? Loud talk about patients in front of other patients? How’s the aesthetics of your office? When is the last time you walked in their shoes?

In Conclusion

It’s important to realize that working with fearful patients can be difficult and requires more time and effort on your part. But, like so many of life’s endeavors, facing challenges while helping others is often rewarded tenfold. For many dentists, caring for others is one of the driving factors in choosing this profession. As you help patients overcome their fears, anxieties, or phobias you’ll in turn discover a truly devoted patient and one that’s likely to spread the good news about your exceptional care to others.


  1. Kankaala, T., Laine, H., Laitala, ML. et al. 10-year follow-up study on attendance pattern after dental treatment in primary oral health care clinic for fearful patients. BMC Oral Health 21, 522 (2021). https://doi.org/10.1186/s12903-021-01869-6

Author: With over 12 years as a published journalist, editor, and writer Genni Burkhart’s career has spanned politics, healthcare, law, business finance, technology, and news. She resides on the western shores of the idyllic Puget Sound where she works as the Editor in Chief for the Incisor at DOCS Education out of Seattle, WA.

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