Dealing with dental anxiety

For some people the fear of visiting the dentist outweighs the pain of a toothache. If you're afraid of going to the dentist, you're not alone. About 8%–15% of Americans avoid regular treatment solely for this reason. But refusing to visit the dentist out of fear has a paradoxical effect. Procrastination almost invariably leads to more advanced oral health problems and lengthier, more complex procedures.

Most adults who suffer from dental anxiety can trace their fears back to unpleasant childhood experiences. Fortunately, improvements in techniques, medications, and equipment over the past 30 years mean that even the most skittish patients can be assured that their visits now will be more comfortable than those of their youth.

Medications for pain and anxiety

Many medications can relieve dental pain and anxiety. These can be used individually, in combination, or along with relaxation techniques.

Local anesthetics. Dentists use a thin needle to inject these pain control medications at the site of the procedure. In most cases, the medication takes effect within a few minutes and deadens pain for about three hours. Lidocaine (Xylocaine) and mepivacaine (Carbocaine, Isocaine, and Polocaine) have replaced procaine (Novocaine) as the most commonly used drug. Many dentists prefer to use one of these drugs along with a small amount of epinephrine, which constricts the blood vessels and keeps the painkiller working longer. However, this mixture is not an option for people with high blood pressure or other forms of cardiovascular disease.

Topical anesthetics. These can ease the sting of an injection or minimize the discomfort of cleanings and minor gum treatments. Topical preparations typically come in the form of a numbing gel or spray, which your dentist applies to the gums a couple of minutes before beginning work. Some dentists are now using a small adhesive strip that sticks to your gum and releases the painkiller into the tissue.

Anti-anxiety drugs. Your dentist can offer you diazepam (Valium) or a similar drug to calm your nerves before a dental procedure. You'll need to arrive for the appointment about an hour ahead of time if you choose this option. You should also arrange for someone else to drive you home.

Conscious sedation. This approach dulls your awareness without inhibiting body functions such as breathing and swallowing. Drugs of this type usually are used to quell anxiety, but they can be combined with other drugs to reduce pain. One of the most common choices is nitrous oxide, sometimes called "laughing gas." You inhale it through a mask in a mixture with oxygen. Nitrous oxide produces a sense of relaxation that begins almost immediately and ends when you stop breathing it. It has very few side effects and is safe for most people. For lengthy dental procedures, though, drugs administered intravenously may work better. Your dentist will mix a sedative or anti-anxiety medication with a narcotic and sometimes a barbiturate drug. Only specially trained and certified dentists are qualified to offer this type of sedation.

General anesthesia. With this form of sedation, you are unconscious and unable to breathe or swallow independently. General anesthesia is usually reserved for surgical procedures on the mouth or jaw. It's also used for people whose dental anxiety is so overwhelming that it makes routine care otherwise impossible, and for individuals with mental or physical disabilities that interfere with treatment. Although safe for most people, general anesthesia carries more risks than other forms of sedation. Only professionals trained in anesthesiology can administer it.

Mending molar? Tender tooth? Raw root? How you can ease post-treatment pain

Today's sophisticated anesthesia techniques mean that you can count on a virtually pain-free stint in the dental chair. After a procedure, though, your mouth will still need anywhere from a few hours to a few days to get back to normal. Here are some things you can do to ease your discomfort:

Reduce swelling by applying ice wrapped in a damp cloth to the affected area.

Relieve soreness following gum treatments by rinsing with a mild solution of salt or baking soda.

Take over-the-counter pain medication such as acetaminophen or ibuprofen. (Aspirin shouldn't be used after surgical procedures.) Your dentist can prescribe stronger medication following procedures that are likely to cause more intense pain, such as extractions, implant placements, and root canal therapy.

Alternative therapies for anxiety

For some people, anxiety triggered by the sight of the dental chair, nervousness at the sound of the drill, or fear of gagging or choking can loom as large as concerns about pain. Hypnosis, guided imagery, relaxation exercises, and counseling can ease anxiety and fear. For people who don't have dental anxiety but can't tolerate pain medication, these approaches can also help with pain control. In either case, you should discuss your concerns with your dentist.

A few of the most popular techniques are briefly described here. To learn more about these techniques, you may want to enroll in a stress management program or mind/body program, or check your library or bookstore for books on stress management techniques.

Guided imagery

You can take your mind off what's happening in your mouth by visualizing a pleasant, restful setting. Concentrate on sensory details — for example, the warmth of the sand, the gentle sound of water lapping against a shore, the bright blue of the sky. Allow yourself to be transported into the image you've created. Breathe deeply and slowly as you imagine this place. If other thoughts intrude, accept them and then try to return to the haven you've created. Practice guided imagery a few times before your next dental appointment, as practice makes it easier to conjure up a soothing scene.

Relaxation exercises

Relaxation techniques such as breath focus, progressive muscle relaxation, and mindfulness meditation can slow your heart rate and bring about a state of restfulness. You may want to explore different methods to see which works best for you. In the meantime, here are two simple relaxation exercises to try.

Make yourself as comfortable as possible in the dental chair. With your eyes closed and your muscles relaxed, breathe in slowly and deeply. Choose a focus word such as "calm" or "peace" to repeat mentally as you exhale. Keep your mind as clear as possible. If thoughts intrude, return your concentration to your breathing and focus word.

Place your hand just beneath your navel so you can feel the gentle rise and fall of your belly as you breathe. Breathe in. Pause for a count of three. Breathe out. Pause for a count of three. Continue to breathe this way for several minutes.

Hypnosis

For many people, hypnosis can take the place of all other forms of pain control during dental procedures. It can be used successfully in people who can't tolerate anesthesia because of health issues, as well as those who are afraid of the needles that deliver medication. Self-hypnosis may be a practical approach; a professional hypnotherapist can teach you the steps to follow to enter a hypnotic state.

Self-care tips for dental anxiety

Looking for ways to keep calm during a visit to the dentist? Here are some tips that might relieve your apprehension:

Find a dentist committed to helping you reduce your anxiety. Discuss your fears with your dentist and learn about the options for treating pain and anxiety.

Have your dentist agree on a "stop" signal so you can take a time-out from the procedure if you need to.

Avoid caffeinated beverages before your visit. They are likely to make you more jittery.

Schedule your appointment for early in the day, and try to get a good night's sleep beforehand.

Bring a friend or family member for reassurance.

Bring along a portable music player with headphones to use as a distraction before and during treatment.

Practice relaxation exercises and guided imagery techniques.

Get regular dental checkups. Frequent visits help in several ways: You build a good rapport with your dentist, you become familiar with the dental staff and office routines, and you enable your dentist to catch problems early, potentially avoiding more extensive procedures at a later date.

Review Date: 2007-04-01

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