Dental Anxiety: The causes, consequences and management strategies.

Hi, I'm Riya Patel, currently a Year 13 Sixth Form student and an aspiring dental surgeon!
Dental Anxiety became a keen interest of mine after researching it for my EPQ. Therefore, I felt it was important to share what I had learnt so it is accessible to the public so more people can tackle managing their dental anxiety.

Dental Anxiety is a prevalent condition defined as “an excessive dread of anything being done to the teeth” (CORIAT, 1946). It is estimated that between 5.7% to 20.6% of the population suffer from dental anxiety (Coxon et al., 2019). This can result in the avoidance of dental treatment and consequently poorer oral health and quality of life (Coxon et al., 2019). It has been found that approximately only half of the British population attend dental check-ups (Woolgrove and Cumberbatch, 1986). The reason for this may be due to the repercussions of dental anxiety, cost of dental treatment or time constraints reducing the ability to attend appointments. There are many causes of dental anxiety outlined within the literature and some will be explored in this blog post.

Causes:

1. “4 S” rule

The sensory specific triggers highlighted in the “4 S” rule are (Hmud and Walsh, 2008):
• Sights (e.g. needles, drills)
• Sounds (drilling)
• Sensations (high frequency vibrations – with a high annoyance factor)
• Smells (clinical odours, such as eugenol and bonding agents

The advantage of this “4 S” rule is that dental professionals can change the way that they operate and act to reduce the impact of these sensory triggers. Therefore, the dentists have a set objective to ensure that these sensory triggers are managed as much as possible in order to combat the consequential effect that these sensory triggers have on dental anxiety.

2. Personality traits

Costa and McCrae (1992) defined a Five-Factor Model of Personality traits (Table 1).

Table 1: Five factor model personality traits (Kelland and Open Textbook, 2015)

There is sufficient evidence to conclude that females tend to have a higher level of neuroticism so may be at an increased risk of suffering from dental anxiety (Weisberg et al., 2011, Djudiyah et al., 2016). A study in Indonesia found that neuroticism is also higher in younger students than older college students (Djudiyah et al., 2016).

Extraversion has also been found to be low in dentally anxious individuals (Hägglin et al., 2001).

3. Media

Aside from individuals who already are dentally anxious, many movies are portraying dentists as evil characters to children. A prime example is Finding Nemo. As Glazman’ (2014) thesis rightfully wrote, “In Finding Nemo, the person who abducted Nemo was a scary dentist who always had patients screaming in his chair. All the fish characters ever talked about was escaping from him, which can be perceived as patients metaphorically wanting to escape from the dentist” (Glazman, 2014). As this is the image that we are showing to children who are still cognitively developing habits, these stereotypes can be carried into adulthood and avoidance of dentists can occur in a similar way to conditioning experiences and vicarious learning. This then gets children into the cycle of being dentally anxious, avoiding dental treatment, worsening their oral health and further impacting their quality of life as well as their families’ as Coxon et al. (2019) outlined that any illness a child has impacts the family unit too.

Consequences:

As there has been a relationship between dental anxiety and the avoidance of dental treatment it has been referred to as a “vicious cycle” (Beaton et al., 2014).

Model of the “Vicious cycle” of Dental anxiety.

The “vicious cycle” of dental anxiety is fundamental to explaining the consequences of dental anxiety (or fear).

Management Strategies:

Even though there have been many technological advancements within dentistry, dental anxiety is still common. (Mohammed et al., 2014)

Many management strategies can be used to overcome dental anxiety, but wider awareness is necessary so individuals are aware of the strategies that they can implement to help overcome their anxiety. It has been suggested that a promotional campaign is required to alter the negative image of pain and discomfort that people tend to associate with dentistry (Finch and British Dental, 1988). This may be done through positive portrayal of dental images in TV soap dramas or 'sit-coms' as it may help to redress the negative image associated with dentistry (Cohen et al., 2000).

There are many other management strategies dentists can use:
• Relaxation Strategies
• Guided Imagery
• Cognitive therapy
• Sedation

Conclusion:

Dental fear and anxiety in dental practice is a significant problem for both the patient and the dentist. These patients need to be identified with their severity of dental anxiety and their concerns should be addressed at the earliest in order to avoid highly invasive dental treatment which may be needed due to an avoidance of dental treatment.

(This is a blog post highlighting the main points of the dissertation I wrote detailing the Causes, Consequences and Management Strategies of Dental Anxiety as I felt it was important to share the research I had found to help others manage their dental anxiety and understand the consequences).

Bibliography:

BEATON, L., FREEMAN, R. & HUMPHRIS, G. 2014. Why are people afraid of the dentist? Observations and explanations. Med Princ Pract, 23, 295-301.
COHEN, S. M., FISKE, J. & NEWTON, J. T. 2000. The impact of dental anxiety on daily living. Br Dent J, 189, 385-90.
CORIAT, I. H. 1946. Dental anxiety; fear of going to the dentist. Psychoanal Rev, 33, 365-7.
COSTA, P. T. & MCCRAE, R. R. 1992. Neo personality inventory-revised (NEO PI-R), Psychological Assessment Resources Odessa, FL.
COXON, J. D., HOSEY, M. T. & NEWTON, J. T. 2019. How does dental anxiety affect the oral health of adolescents? A regression analysis of the Child Dental Health Survey 2013. Br Dent J, 227, 823-828.
DJUDIYAH, M. S., HARDING, D. & SUMANTRI, S. Gender Differences in Neuroticism on College Students. Dalam Asean Conference 2nd Psychology & Humanity (hal. 723–728), 2016.
FINCH, H. & BRITISH DENTAL, A. 1988. Barriers to the receipt of dental care : a qualitative research study, [London], British Dental Association.
GLAZMAN, J. 2014. Dental Anxiety: Personal and Media Influences on the Perception of Dentistry. Psychology, Place University.
HMUD, R. & WALSH, L. 2008. Dental anxiety: Causes, complications and management approaches. 2.
HÄGGLIN, C., HAKEBERG, M., HÄLLSTRÖM, T., BERGGREN, U., LARSSON, L., WAERN, M., PÁLSSON, S. & SKOOG, I. 2001. Dental anxiety in relation to mental health and personality factors. A longitudinal study of middle-aged and elderly women. Eur J Oral Sci, 109, 27-33.
MOHAMMED, R. B., LALITHAMMA, T., VARMA, D. M., SUDHAKAR, K. N., SRINIVAS, B., KRISHNAMRAJU, P. V. & SHAIK, A. B. 2014. Prevalence of dental anxiety and its relation to age and gender in coastal Andhra (Visakhapatnam) population, India. J Nat Sci Biol Med, 5, 409-14.
WEISBERG, Y. J., DEYOUNG, C. G. & HIRSH, J. B. 2011. Gender Differences in Personality across the Ten Aspects of the Big Five. Front Psychol, 2, 178.
WOOLGROVE, J. & CUMBERBATCH, G. 1986. Dental anxiety and regularity of dental attendance. J Dent, 14, 209-13.