People are so scared of dentists they haven’t in decades


Say the word “dentist” to Hazel Phillips and she might faint. She can’t watch a dental procedure on TV without her heart racing and her palms getting sweaty.

Hazel even gets nervous watching toothpaste ads and avoids looking at herself in the mirror while brushing her teeth. The 38-year-old administrative assistant from Totton, Hampshire, is one of a growing number of people in the UK with severe dental phobia, or odontophobia.

It is said that up to half the population has it to some degree. The Adult Dental Health Survey found that 36% of UK adults were moderately ‘dentally anxious’ and 12% extremely anxious, meaning they would either avoid it at all costs or require sedation for their teeth. routine procedures.

This can have a significant impact on oral health. A 2020 study from Harvard Medical School found that people with a history of gum disease were 43% more likely to develop esophageal cancer and 52% more likely to develop stomach cancer.

Hazel even gets nervous watching toothpaste ads and avoids looking in the mirror while brushing her teeth.

Other research has shown that people with gum disease are two to three times more likely to develop heart disease.

Dental phobia also means there is a risk that oral cancers – which are on the rise and which dentists are looking for – will not be caught early, when they are more treatable.

The earlier a phobia is identified, the better, according to a new study by dentists in Finland. Patients who received treatment for dental phobia between the ages of two and ten had many more dental procedures in their lifetime than those treated for their fears after that age, the journal BMC Oral Health reported.

Shahir Shamsuddin, an NHS dentist in Leytonstone, east London, said ‘around 50-60 per cent’ of the patients he sees are scared in some way and that ‘a lot of fear about dentistry stems from childhood”.

Fear of the dentist often leads people to avoid visiting one, even if they have or suffer from problems such as tooth decay, adds Douglas Miller, a dentist in London who specializes in treating phobic patients.

The 38-year-old administrative assistant from Totton, Hampshire, is one of a growing number of people in the UK with severe dental phobia, or odontophobia

The 38-year-old administrative assistant from Totton, Hampshire, is one of a growing number of people in the UK with severe dental phobia, or odontophobia

“Recently, I saw a patient who wanted me to restore medium sized gaps because he had four posterior teeth missing. Unfortunately, he suffered from gum disease and such advanced decay that four more upper teeth had to be removed.

“Another gentleman had very few teeth left. He had a bad experience growing up and hadn’t been to the dentist for 30 years. He could not cope with job interviews and therefore found himself out of work.

“His wife forced him to see me. We reconstructed his mouth over several appointments, and then he was able to interview and get a job.

Bhup Gupta, an NHS dentist in Wolverhampton, sees many patients who are scared. He says: “We have a clinical hypnotherapist on site and she will often get involved before we see patients with this problem.”

Fearful patients may be given gas and air to calm their nerves or sedation. Extreme cases may be referred to specialist dental phobia clinics in NHS hospitals or in the private sector.

These clinics are often designed to look more like doctor’s offices, with neutral decor and no teeth posters on the walls. They also offer treatments such as Cognitive Behavioral Therapy (CBT) or other talking therapies alongside treatments.

Dr Gupta explains: “We talk to the patient first, and once we understand their situation, we can help them cope with techniques such as deep breathing, relaxing music, interval pauses during the treatment and starting with simpler treatments to build confidence.”

Hazel says her fear of the dentist was triggered when she had to have fillings when she was six years old.

“My mother was outside with my younger siblings, so I was alone in the room,” she recalled.

“I was so scared and the dentist was really abrupt, coming at me with this huge needle. I pushed him away, but he screamed and injected me anyway. I cried and ran terrified after. From then on, I was petrified by dentists.

Over the years, Hazel would do anything to avoid going to the dentist. “I pretended to be sick and only went there if my parents dragged me there kicking and screaming,” she says. “I started to feel a physical reaction to the idea of ​​the dentist: cold sweats, feeling sick just thinking about it.”

As an adult, Hazel decided never to go to the dentist again. Then, in her late twenties, she woke up one morning in pain.

“There was swelling at the back of my mouth,” she says. “Later that day my whole cheek swelled up. I knew it was teeth related, but I was terrified to do anything about it. Soon I could barely speak or to eat.

Over the next two days, Hazel’s face swelled up and she reluctantly went to an emergency dentist, who found an abscess under one of her molars.

“He said it was probably due to years of not seeing a dentist and the tooth and gum had become infected,” she says.

Hazel was referred for surgery to remove the infected tooth.

She remembers: “A few days later, I went to the hospital, shaking. It took every ounce of my being to not get out of there. I explained that I had a phobia and it was agreed that I would need general anesthesia or else I couldn’t let them operate.

But after the operation, Hazel woke up to bad news. “The dentist told me apologetically that in addition to removing the damaged tooth, he had mistakenly removed a ‘healthy’ tooth – but ‘saved’ it by sealing it with cement.”

“It made my fear worse. I used to be scared, but now I couldn’t even see a dental procedure on TV or a toothpaste commercial. The picture of the teeth made me nauseous.

She hasn’t been to a dentist in ten years. “I know I have plaque and my teeth are cracked,” she says. “But I don’t care.”

In addition to two cracked teeth, Hazel regularly suffers from toothaches. “I just take painkillers,” she says. “It lasts a few days but I get used to it. I prefer that to seeing a dentist again.

Dr. Miller says one of the reasons so many people are phobic of dentists is the area being treated. “The mouth is an intimate area,” he says. “When you have an injection there, it’s not like having an injection in your arm.

“Also, you’re giving someone else control to some degree, which can be difficult, especially if people have been made very anxious in the past – maybe they’ve been forced into treatment. by dentists who are not as friendly as they should be.; I have heard stories of people being held up during their treatment.

He says the key is getting the patient to understand that they are in control of their treatment.

“Nobody likes having dental procedures, but they want the benefits,” he says. “So you can focus patients on that and help them understand that you’re working with them to achieve an outcome that they find satisfying.”

Dr. Miller suggests longer appointments of 40 to 60 minutes to allow time to allay patient fears.

Historical case notes

Old medical practices still relevant. This week: ventilate to purify “germinated” air

In 15 BC, the Roman architect Vitruvius had built large public buildings, such as theaters, with many open windows because the hot, stagnant air was thought to be unhealthy.

Hundreds of years later, Florence Nightingale took this approach – writing it in a letter in 1860. According to Dr Henry Burridge, lecturer in fluid dynamics at Imperial College London: “Air cool expels the air already present in the room. Without it, more of the air we breathe has already been exhaled by someone else – and if that person is infected with an airborne disease, like flu, measles, mumps or Covid, they could exhale infected air.

Vitruvius also knew that lead water pipes were more dangerous than clay for drinking water. He noted how unhealthy the lead workers looked and suggested that lead pipes should not be used. It wasn’t until the 1970s that lead water pipes were banned in the UK.

“I increase appointments for phobic patients so that I can work at a slower pace for them,” adds Dr. Shamsuddin. “But it’s also things like speaking in a soft tone, listening, being at eye level, sitting in front of the patient rather behind him – all of that helps him feel calmer.

“I also avoid terms like ‘hurt’ or ‘needle’.”

Dr. Miller says virtual reality (VR) headsets can help distract a scared patient.

“VR headsets can be used in conjunction with CBT to provide virtual experiences that some dental patients might initially find overwhelming.

“Virtual exposure, for example, entering a dentist’s treatment room or seeing a drill, can make a patient less anxious about experiencing these situations in real life.

“If patients don’t like noise, we have headphones so they can listen to music or podcasts.”

However, some patients require sedation, adds Dr. Gupta.

“But often anxious patients forget to take their sedative beforehand and still manage to cope with the treatment.”

If you suffer from dental anxiety or phobia, you can ask your dentist to refer you to a dental sedation clinic.

Unfortunately, Hazel isn’t even able to contemplate that.

“I know I need fillings,” she says. “But I can’t imagine going back to the dentist. I could consider a specialist dentist who deals with dental phobia, but not yet.

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