For some, the shrill sound of the dental drill grinding against tooth is enough to make them jump out of their skin. For others, it could be the sight of sharp objects a dentist is waving in front of their faces. In Michael Tan’s case, the fear of needles has kept him away from the chair since primary school.
“I couldn’t avoid the check-ups during primary school because they were mandatory. To date, I think I’ve only been to the dentist as an adult not more than five times,” said the 40-year-old senior manager. Tan attributed his dental anxiety to his father, who also shares the same fear for needles. “The thought of needles makes me extremely uncomfortable, to the point of raising my heartbeat. So you can imagine how stressful it was for me when I was taking the COVID-19 shots.” Tan shared that he only goes to the dentist “when I am pushed to the limit”. “Like if I’m made to choose between jumping off a cliff and seeing the dentist,” he laughed. Or in the case of his last dental appointment the year before, an intolerable toothache caused by a wisdom tooth.
WHY ARE SOME PEOPLE SO TERRIFIED OF THE DENTIST?
Tan’s situation isn’t unique. If your Mum or Dad is afraid of going to the dentist, chances are, you might have learned the same nervousness at an early age. “Parents’ anxious expressions and their constant reassurance to ‘not be afraid’ erroneously teaches their children that there will be danger or something to be afraid of at the dentist,” said Dr Lim Boon Leng, a psychiatrist with Gleneagles Hospital’s Dr BL Lim Centre For Psychological Wellness. At times, the anxiety may be triggered by irrational fears such as claustrophobia and contracting HIV through dental procedures, he said. “Other anxiety disorders like panic disorder, where one fears that he may have a panic attack in the midst of his procedure, can result in dental anxiety or phobia.”
A not-so-good dental experience in the past may also have rippling effects. These patients may be afraid of “associated visual or auditory cues, such as the sight of dental instruments or the sound they make”, said Dr Leroy Kiang, a dentist at Orchard Scotts Dental. Unfamiliarity is another deterrent. Dr Andrew Chia, a dentist with Vista Dental Surgery, noted that about 60 per cent of his new patients show signs of apprehension in his chair. “It is to be expected. It’s like going to a new hairdresser. You’re not sure of the outcome because you’re not familiar with him or her,” he said. “The regulars already know what to expect, so they aren’t nervous.”
DO YOU HAVE DENTAL ANXIETY OR DENTAL PHOBIA?
“Anxiety towards dental treatment has been widely recognised as a significant deterrent to patients seeking dental treatment,” said Clinical Associate Professor Lui Jeen Nee, a senior consultant and the head of the Department of Restorative Dentistry at National Dental Centre Singapore.
However, dental anxiety and dental phobia aren’t the same. “Dental anxiety refers to the emotional state that develops in response to the anticipation or experience of dentistry,” she said. “Compared to dental phobia, dental anxiety is slightly less severe” and can present with “symptoms such as breaking out in cold sweat, heart palpitations and feeling nervous”.
Dr Lim added that it is “quite normal” to experience dental anxiety’s symptoms “for a few days before the appointment”. But dental phobia is something else altogether, he said. It is “characterised by a persistent and excessive fear of going to a dentist for more than six months. Those affected go to great lengths to avoid going to a dentist. If it cannot be avoided, they will experience extreme distress and anxiety.”
Dental phobia could also be experienced by patients who are victims of sexual, physical or childhood abuse, and “develop complex post-traumatic stress disorder or dissociative personalities” as a result, said Clin Assoc Prof Lui.
“There are many parallels and associations between dentistry and trauma histories, which may often account for these specific dental phobias. Unfortunately, these often go undetected due to the lack of awareness among dentists,” she said.
HOW IS PAIN MANAGED?
Naturally, the most common obstacle stopping people from going to the dentist is pain. “While we do not have the exact numbers, it is common for patients to avoid coming to the dentist unless they are in pain,” said Dr Kiang.
Painkillers, of course, are one way to allay patients’ fear of pain. These can be topical, given as a gas or injected. But painkillers in itself can be a cause of anxiety, especially when needles are involved – and that is where dentists have a few tricks up their sleeves. Dr Kiang, for instance, applies a topical anaesthetic gel first before injecting the local anaesthetic.
Dr Chia, who performed the wisdom tooth extraction on Tan, also goes topical first. But the way he administers the local anaesthetic is slightly different. “I’ll inject about a quarter of the total amount in the first jab, wait for it to take effect, then inject the rest in the second round,” he said. And to make the injections more comfortable for patients, Dr Chia does them in the fleshy part of the cheek and not directly on the gum. “Before doing anything, I like to chat with my patients first," he said. "Especially those who are already in pain from a toothache, I’ll explain to them how I’ll make them comfortable before the extraction.”
WHY YOU SHOULDN’T PUT OFF YOUR DENTAL APPOINTMENT
All the dentists that CNA Lifestyle spoke to have this same message: Don’t skip your yearly dental check-up – even when things feel fine in your mouth. “By the time a dental problem causes pain, there is a far greater likelihood that the required treatment will be more invasive and potentially, even involve losing the tooth,” said Dr Kiang.
Take, for instance, tooth decay and gum disease – the two top dental issues seen in Singapore, according to Clin Assoc Prof Lui. “It is important to understand that many of these dental diseases can be prevented if detected and managed early,” she said.
Another common and preventable issue is worn or cracked teeth, said Dr Kiang. Hairline cracks can develop, especially if your teeth have fillings or if you accidentally bite on something hard such as an unexpected piece of bone. Initially, there may be no symptoms or just a slight discomfort when chewing, he said. “But like a small crack in your car windscreen, it can end up propagating and shattering the whole windscreen.”
Certainly, oral cancers are more life threatening than cavities but they, too, can be symptom-less at the beginning. “Patients may not know that there is anything wrong” as it is not easy to self-check common sites such as the “border of the tongue, floor of the mouth, lining of the cheeks and soft palate”, said Dr Kiang.
“Oral cancer screening is an important part of patients’ regular dental examinations” and the prognosis is “much more favourable if the lesions are detected and treated early”, he said.
HOW TO MANAGE YOUR ANXIETY
To help you stay calm and carry on before your next dental appointment, here are some practical tips from the experts:
- Before scheduling your appointment
Whether it’s for a routine check-up or non-emergency situation (skip to “While waiting in the reception area” if yours is an emergency), it helps to speak to someone – a friend, family member or even a dentist – to get motivated and make the appointment, said Clin Assoc Prof Lui.
This could mean having a pre-consultation with a dentist just to talk about your anxiety and what to expect during the procedure. “It is completely acceptable to inform the dentist about any specific fears and anxieties about the treatment as it can be modified accordingly to create a calm environment for the patient,” she said.
During the pre-consultation, you can ask the dentist to walk you through the procedure and be shown videos, said Dr Lim. From there, you can have mental rehearsals in your mind about the treatment you’ll be going through, he said. “Such exposure will help to desensitise you to your fear and help with a smoother dental experience.”
You can also arrange for a friend or family member to accompany you to the appointment if the person's presence helps to keep you calm.
- The night before your appointment
There’s no point lying in bed and worrying about tomorrow’s appointment. Neither would telling yourself “worrying does not help”, said Dr Lim.
Since you can’t stop your mind from racing, you could mentally run through the procedure you’re undergoing tomorrow. (That’s where the video and talk you had with your dentist come in handy.) If that mental exercise ends up creating some anxiety in you, do some deep-muscle relaxation exercises to help youself calm down, said Dr Lim.
Or you could read or watch TV to distract yourself, and go to bed when you’re finally sleepy, he added. “If you cannot sleep, tell yourself it is okay. Pick up your book or watch TV again.”
If you have severe anxiety, you can take an anxiolytic, which you can get from the dentist or general practitioner, said Dr Lim.
- While waiting in the reception area
You could bring along music or anything that “could help distract or provide comfort while waiting”, said Clin Assoc Prof Lui.
Dr Lim agreed: “You can distract yourself with a book or watch a video clip on your handphone. You can also close your eyes and perform relaxation exercises.” Whatever you do, this is the time to make yourself comfortable, and take slow and easy breaths, he said.
But if your anxiety is making you restless, allow yourself to be, said Dr Lim. “Walk around if you need to,” he said.
- You’re finally in the chair
Close your eyes and concentrate inwards, said Dr Lim. “Continue to focus and regulate your breathing.” At the same time, know that you are in control as that will keep you at ease. “You can always inform the dentist if you are uncomfortable in any way. You can even stop the procedure,” he said.
Furthermore, dentists are big advocates of putting their patients at ease. “It can be as simple as giving the patient noise-cancelling headphones, a blanket, a stress ball, even aromatherapy,” said Dr Kiang. “Or offering the patient regular breaks for long procedures and making it a point to check in on them occasionally. Every patient is different.”
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