Bite the Bullet: A Guide to Facing Dental Anxiety

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This article first appeared in the Spring 2024 issue of New Beauty. Click here to subscribe

How much discomfort would you swallow to avoid going to the dentist?

If you’re me at 21, alone in London with a minor dental emergency, the answer is a fair bit. Chipping my front tooth on a beer bottle was not the end of the world, as embarrassing as it was, but I knew that it could lead to infection and that I needed to be seen sooner rather than later.

Still, I didn’t see a dentist.

Honestly, I wasn’t happy with the state of my teeth at the time. My smile was coffee-stained and I needed to floss more, and that was enough to catapult the anxiety. What was a little discomfort compared to making the appointment, walking into the office and getting poked in the gums with sharp instruments?

And it turns out, many people feel the same way

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You’re Not Alone

According to the Cleveland Health Clinic, about a third of Americans are afraid of the dentist, and around 12 percent have an extreme phobia. However, many dentists estimate that the number of people experiencing dental anxiety is even higher. “Most patients have some fear of dental work,” says Houston cosmetic dentist Guy M. Lewis, DDS. “About a fourth of my patients have anxiety high enough that it causes serious problems, like avoiding regular dental appointments.”

Even people who manage to show up for regular appointments can be contending with serious fears, the cause of which can vary wildly. From the anticipation of pain to the way we view dentists in media, many of us have at least a mildly negative impression of the dentist. “Unfortunately, dentistry is known as a bad word, and films, TV shows and social media show dentistry in an uncomfortable or scary light,” explains New York cosmetic dentist Husam Almunajed, DMD.

Some people have their own personal horror stories from childhood, causing a persistent, lifelong anxiety to manifest. “Many patients have been hurt emotionally, if not physically by a dentist in the past,” says New York cosmetic dentist Jason Kasarsky, DDS. “A dentist saying, ‘how could you let it get this bad?’ can really impact someone emotionally. And when it comes to pain, many practitioners don’t want to give anesthesia to a child.”

61% of people have intentionally put off a dental appointment

*According to a survey conducted by Byte in 2022

Your Options for Relief

By the time Green Day released “Give Me Novacaine,” in the ancient past of 2004, Novacaine was already losing popularity among dentists as a method of numbing and pain relief. These days, we have better ways to get Comfortably Numb, as it were. According to Los Altos, CA cosmetic dentist Joseph Field, DDS, oral sedation is probably the most common and effective method for his patients with anxiety. “Using sedation is an incredible way to help patients with any kind of dental fear get the care they need,” Dr. Field explains. “Many patients in my practice use it even for routine procedures. After doing this for over 16 years, I’ve found that my patients are no longer afraid of getting dental work done because they know it can now be done in a very safe and comfortable way.

LIDOCAINE: This is a common local anesthetic used to block nerve signals in the skin and surrounding tissues at the injection site.

BENZOCANE: This topical anesthetic can be applied directly to the inside of the mouth.

NITRUS OXIDE: This relatively weak inhalational anesthetic gas causes a state of euphoria and provide anxiety relief.

IV SEDATION AND GENERAL ANESTHETIC: These are typically only used when other options are exhausted. Dentists may still perform some surgical procedures under sedation, which should be supervised by an anesthesiologist.

Dentists Want to Help

Perhaps the biggest concern raised by dental anxiety is that patients tend to avoid the dentist. According to a survey conducted by Byte in 2022, about 61 percent of people have intentionally put off a dental appointment.

“The consequences can be tragic,” Dr. Almunajed explains. Without regular treatment, the plaque in your mouth will turn to calculus, which can lead to gum recession and bone deterioration. “What’s crucial about this is that you do not even feel something is wrong. The buildup actually holds the teeth in place until the bone loss is so severe that you start to feel your teeth are loose. All the while you are still pain-free. At this point, the teeth may be hopeless, and the only treatment is extraction.”

The best way to prevent these kinds of avoidance-based consequences is for dentists to work with patients to address their anxieties. “It’s important to establish trust with patients and talk to them on their level, without a bunch of dental terminology,” Dr. Lewis says. Additionally, assuring patients involves more than just a commitment to anesthetic, but also a promise not to judge them for their teeth. “Addressing the fear of judgment is crucial in helping patients feel more comfortable and confident seeking dental care.”

Ultimately, your dentist should be your partner against anxiety. “We found that when you treat patients as human beings, they are open to giving dental work a chance, even when they are very afraid,” Dr. Almunajed says. “The number-one way to make a patient less anxious is to listen to them. Once you’ve heard their concerns, you can start to create solutions.

Facing Your Fears

The right dentist for you will want to meet you where you are and provide you care with as much comfort as possible. That includes taking steps to prevent pain. “I’ve had patients who need the most pain relief we can provide for just a regular cleaning because they’re so sensitive to pain,” Dr. Kasarsky says. “Other patients, you could drive a Jeep through their mouth and they might not feel it.”

The best way to accommodate these patients is to have a range of pain-management options. “In our practice, we offer many different types of sedation, from laughing gas to oral conscious sedation and conscious IV sedation,” Dr. Lewis says. Many offices also offer comforts like noise-cancelling headphones, overhead televisions and even scented candles to promote a calmer environment.

Talking with your provider can also help you plan for more serious dental work. “Even if there is damage and major dental work needs to be done, we don’t want to throw these patients into the deep end,” Dr. Kasarsky explains. “We keep the first few visits around 20-minutes long and then create a plan to address their concerns with smaller steps.”

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