Breaking down fear barriers

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  Posted by: Dental Design      18th April 2024

As an endodontist, I am probably more familiar than many with dental fear and anxiety (DFA) among patients. Unfortunately, root canal treatment is rarely greeted with open arms – it is, in fact, one of the top dental treatments provoking anxiety in patients.[i] Though there may be more specific reasons why endodontics is so feared, DFA affects a wide range of patients needing a variety of dental procedures. The dental team must, therefore, not only identify when dental anxiety is present, but also navigate its hold on patients to help them manage their fears and receive the dental care they need.

DFA is estimated to affect around 15% of the global adult population, with severe phobia impacting around 3%.[ii] These feelings of unease and concern can have a profound impact on each patient’s oral health and, in turn, require a modified approach from the dental team.

The aetiology of DFA is complex. Studies show that previous traumatic experience is a leading factor, with more than half of adults having developed their fear or anxiety in childhood. It may also be a learned behaviour to some degree, as a family history of dental anxiety can increase the risk for individuals.[iii]

Certain personality traits may also predispose patients to dental fear. For example, neuroticism is associated with anxiety and self-consciousness, and studies suggest that people with this trait are more likely to experience dental anxiety.[iv]

Whatever its cause, DFA can have a detrimental effect on patients and their oral and general health.

Severe dental anxiety has been associated with reduced dental attendance, with affected patients admitting to appointment avoidance even when they have symptoms of dental caries, decay or mild-moderate pain. This not only increases the risk of disease development and therefore poorer oral hygiene, but it also begins a vicious cycle that creates embarrassment or feelings of inferiority that further exacerbate fear of the dentist. Research demonstrates consistent findings among patients of different genders and ages.[v]

As we are only too aware, a reduced standard of oral health is closely linked with higher risks for systemic health conditions. This makes it all the more important for patients with anxiety to find ways to enhance their dental hygiene. As such, dentists must understand how to support patients who may suffer from DFA.

There is no one-size-fits-all solution when treating patients who are fearful of the dentist or dental procedures. As such, care must be tailored on an individual basis, taking all the relevant factors into account.

Management techniques often include a combination of psycho-therapeutic and pharmacological solutions. The former involves interventions like cognitive behavioural therapy, which has been shown to effectively help patients improve their mental preparedness for dental treatment. Though effective, this is difficult to deliver in the dental practice and certainly requires a comprehensive and integrated care plan alongside other healthcare professionals. Pharmaceutical options often include sedation and even general anaesthesia in very serious cases,[vi] which are possible but usually kept as a last resort.

As dental professionals, there are several other techniques to consider that we can more easily implement. For example, I am always interested to browse studies that look at the power of distraction prior to treatment. One paper[vii] evaluated the effect of music on patients with dental fear and found that just 10 minutes of listening before a hygiene appointment significantly lowered their anxiety. In particular, music with a slow tempo, repetitive rhythm and gentle contours has been found to have a relaxing affect, reducing blood pressure and lowering heart rate.[viii] This provides a simple, yet clearly effective, option for any dental practice to offer patients who could benefit from a little distraction before going into the surgery. It’s something that I offer my patients as standard and find it to be very helpful.

Aromatherapy is another easy-to-implement solution that can improve the patient experience of dental treatment. Research[ix] has indicated that the use of lavender oil significantly reduces dental anxiety among patients, as found through both objective and subjective measures. It is understood that this works because the lavender oil modulates cyclic adenosine monophosphate activity – which has a similar (though much milder) effect to sedation.

Of course, there are various other techniques to assess, from acupuncture to muscle relaxation and even dog-assisted therapy. Ultimately, it doesn’t matter what you choose to offer anxious patients, what’s important is that you support them in some way. This is a topic close to our hearts at EndoCare, where we are often faced with providing complex endodontic to patients with DFA. But I can say with confidence that with careful thought, professional training and the right tools, delivering a patient to oral health despite their fears is hugely rewarding.

For further information please call EndoCare on 020 7224 0999

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Dr Michael Sultan Bio:

EndoCare, led by Dr Michael Sultan, is one of the UK’s most trusted Specialist Endodontist practices. Through the use of the latest technologies and techniques, the highly-trained team can offer exceptional standards of care – always putting the patient first. What’s more, EndoCare is a dependable referral centre, to which dentists from across the country send their patients for the best in specialist endodontic treatment.

[i] Maha A, Fahd A. Levels of Anxiety and Fear Related to Non-Surgical Root Canal Treatment Performed by Endodontic Residents and Endodontists. Frontiers in Dental Medicine. 2022; 3: DOI=10.3389/fdmed.2022.851834 ISSN=2673-4915  

[ii] Silveira ER, Cademartori MG, Schuch HS, Armfield JA, Demarco FF. Estimated prevalence of dental fear in adults: A systematic review and meta-analysis. J Dent. 2021 May;108:103632. doi: 10.1016/j.jdent.2021.103632. Epub 2021 Mar 9. PMID: 33711405.

[iii] Locker D, Liddell A, Dempster L, Shapiro D. Age of onset of dental anxiety. J Dent Res. 1999 Mar;78(3):790-6. doi: 10.1177/00220345990780031201. PMID: 10096455.

[iv] 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.

[v] Alenezi AA, Aldokhayel HS. The impact of dental fear on the dental attendance behaviors: A retrospective study. J Family Med Prim Care. 2022 Oct;11(10):6444-6450. doi: 10.4103/jfmpc.jfmpc_1030_22. Epub 2022 Oct 31. PMID: 36618260; PMCID: PMC9810871.

[vi] Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent. 2016 Mar 10;8:35-50. doi: 10.2147/CCIDE.S63626. PMID: 27022303; PMCID: PMC4790493.

[vii] Thoma M, Zemp M, Kreienbühl L, et al. Effects of music listening on pre‐treatment anxiety and stress levels in a dental hygiene recall population. Int J Behav Med 2015;22:498–505. 10.1007/s12529-014-9439-x

[viii] Hoffmann B, Erwood K, Ncomanzi S, Fischer V, O’Brien D, Lee A. Management strategies for adult patients with dental anxiety in the dental clinic: a systematic review. Aust Dent J. 2022 Mar;67 Suppl 1(Suppl 1):S3-S13. doi: 10.1111/adj.12926. Epub 2022 Jul 12. PMID: 35735746; PMCID: PMC9796536.

[ix] S PK, Aafaque S, S S, N N. Effect of Aromatherapy on Dental Anxiety Among Orthodontic Patients: A Randomized Controlled Trial. Cureus. 2019 Aug 2;11(8):e5306. doi: 10.7759/cureus.5306. PMID: 31592362; PMCID: PMC6773455.

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