By: Munir Gomaa, D.M.D.

What’s not to fear?

Author: Munir Gomaa

Four years of dental school, a license to practice dentistry in hand…and the thought of going to the dentist still gives me the chills..
I get it. Dentists are mysterious creatures who reveal only 50% of their face at a time, poke you with sharp instruments and drill through your teeth like it’s butter. When taken out of context, they actually make for a perfect villain.

It thus comes as no surprise that 5-8% of Americans are so consumed by fear of the dentist that they avoid going altogether, only to experience an abundance of oral health problems that work to fuel this fear. Around 1 in 5 Americans possess a degree of dental anxiety that prevents them from seeking out dental care unless it becomes absolutely necessary, generally due to intolerable pain or lack of proper functioning. And by the time they do seek care, it’s often too late to save the teeth in question.

Dental fear and anxiety has been, and continues to be, a widespread problem among all populations. It has inevitably contributed to a “vicious cycle dynamic”, in which fear of dental treatment, lessened use of dental services, and consequent oral diseases continuously reinforce one another.

Munir Gomaa Figure 1

A collection of variables are commonly responsible for establishing a lasting fear of the dentist. Some of these variables are discussed in this article. According to several studies, the onset of dental fear and anxiety usually occurs in childhood. Oftentimes the reason is directly related to traumatic dental experiences in the past. Sometimes this fear is deeply rooted in entirely non-dental experiences, such as childhood sexual abuse (rather disturbing findings implicating this relationship can be found here), post-traumatic stress disorder, general anxiety disorders, or even substance abuse. However, just as often, personal trauma has little or nothing to do with it.

A rather frustrating fact of life demonstrated by several studies is that parents can easily transmit their fears and anxiety to their children. Children actually learn from their parents to become fearful of spiders, social situations, or the dreaded dentist, and the mechanism of this transmission is subtle yet powerful. One study demonstrated that parents’ degree of vulnerability to certain general, non-dental related perceptions, namely uncontrollability, unpredictability, and dangerousness, reliably predicted their child’s level of dental fear. Another study found evidence that there is a genetic component to dental fear in addition to environmental influences. This study demonstrates that fear of pain is a genetically heritable trait, and that this fear is significantly associated with dental fear.

With the presented knowledge in hand, I’m prescribing a less intuitive approach to battling dental phobia. Since vulnerable perceptions of adults can be so easily and unintentionally inherited, both socially and biologically, by their children, it’s important for dentists to focus on alleviating fear and anxiety present in their adult patients. When treating the fearful adult patient, most dentists assume that fear is so fortified that it’s useless to try and address it. Instead, they focus on temporary solutions, such as distraction techniques or compromising the treatment plan, to allow for resolution of immediate dental needs. The fear lingers and is nurtured until the next visit.

It’s also important for dentists to inform their adult patients of this very apparent risk, as they can play a large role in preventing transmission by concealing their fears or reservations from their children, or even their younger siblings or relatives, as they work on eliminating or minimizing these qualities in themselves. It’s crucial to take cautious advantage of the openness and moldability of a child’s brain by encouraging a positive attitude towards the dentist and oral hygiene, preventing a plethora of dental problems down the road.

By Munir Gomaa