Why am I so paranoid about my teeth? (dental anxiety)

In this article, we will answer the following question: Why am I so paranoid about my teeth? We will speak about the symptoms, causes, treatment and consequences of dental anxiety.

Why am I so paranoid about my teeth?

If you are paranoid – that is having an extreme fear – about your teeth’s health, it is possible that you suffer from dental anxiety. Dental anxiety is a state of apprehension that something terrible will happen in relation to dental treatment, which is accompanied by a sense of loss of control. 

The concern of the Dental Sciences to improve the oral health of the population is an unquestionable fact. The search for new products and technology that increase the quality of life in relation to people’s oral health advances at surprising steps. Many of these efforts seek to improve adherence to dental treatment, making a comprehensive approach to dental disease a priority.

In the specialized literature, there has often been confusion between what is anxiety, fear and phobia using these concepts interchangeably, which has made the measurement of dental anxiety even more difficult.

What is Dental Anxiety?

At the conceptual level, anxiety is understood as a psychological state that presents itself in an unpleasant way, associated with psychophysiological changes, which would be a manifestation of an intrapsychic content. Anxiety would be a feeling of fear, wherein many occasions one does not identify the reasons for said feeling, which ostensibly increases the anguish manifested. 

Another definition of dental anxiety, proposed by Al-Namankany, De Souza and Ashley establishes that it is a multisystemic response to a belief of danger or threat, which is an individual, subjective experience that varies between people, and generates a serious impact on daily life, being an important barrier to seeking dental care.

Under this background, this phenomenon must be understood as a multidimensional concept, which consists of three response components that, although they are different, they interact with each other, such as the cognitive, physiological and motor components. 

Unpleasant cognitive aspects would involve interference with concentration, attentional hypervigilance, and an inability to recall certain events. On the other hand, the physiological aspects have to do with a high degree of activation of the autonomic nervous system, which sometimes leads to shortness of breath, perspiration and palpitations. Finally, the motor component involves poorly adaptive and poorly adaptive behaviours that can range from avoidance to escape from the dental office.

Dental anxiety can also present itself in advance, just by thinking of encountering a stimulus that causes fear. This is how the person knowing that they have an appointment with the dentist, has the expectation that an aversive experience is approaching, generating high amounts of anxiety. 

Another definition of dental anxiety is a state of apprehension that something terrible will happen in relation to dental treatment, which is accompanied by a sense of loss of control. 

Furthermore, fear, unlike anxiety, is not a multidimensional concept. It can be understood as a feeling of impending harm, evil, trouble, or an emotional response. It manifests as a vague feeling of apprehension or restlessness but can reach extreme levels such as terror or panic.

Phobia, meanwhile, is a significant degree of avoidance of the stimulus that produces fear, to such an extent that it interferes with a person’s normal routine, occupational or academic functioning, and social activities and relationships.

Dental phobia represents a severe type of dental anxiety characterized by a marked and persistent concern regarding clearly discernible situations/objects (eg injections) or dental situations in general.

The causes of Dental Anxiety

The causes of why a certain subject may experience dental anxiety are diverse, with multiple studies addressing this issue. Locker, Shapiro and Liddell demonstrated that there is an important relationship between dental anxiety and negative dental experiences, establishing that it is the nature of the experience rather than the age in which it was lived, the predictor of dental anxiety. The association between dental anxiety and the history of dental pain when it is experienced at the age of 5 years or less.

Another source that explains why anxiety is generated turns out to be classical conditioning, where the mere presence of some stimulus that reminds the person of a painful or bothersome dental experience, will lead them to experience dental anxiety.

Family transmission is another important cause of dental anxiety, showing a relationship between dental anxiety of parents and children.

Other explanations have emerged that support why certain subjects present dental anxiety, such as Pohjola, Mattila, Joukamaa and Lahti (29), who concluded after evaluating 5,241 Finns over 30 years of age, than subjects with alexithymia (difficulty in identifying and expressing emotions) have a tendency to suffer from dental anxiety, suggesting that some of these people may have a personality vulnerable to anxiety disorders.

Dental anxiety treatment

Undoubtedly, dental anxiety turns out to be a worrying issue, which greatly hinders the dentist’s work, and at the same time, affects the patient multidimensionally, especially with regard to the latter’s oral health. 

To solve this phenomenon of dental anxiety, it is that during this last time basic strategies have been implemented to reduce these symptoms. Sharif (2010) recommends following a logical management order for the patient with dental anxiety. 

Initially, the idea is to promote communication between the dentist and the patient, through the delivery of information regarding what the dental procedures will be (which would lead to a decrease in their feeling of loss of control).

There are some specialists who consider hypnosis as a valid option and, although this could be an alternative when managing a patient with dental anxiety, there are no conclusive studies that show the adequate effectiveness of this type of techniques, basically due to the lack of rigour and the limited number of studies.

Bare and Dundes (2004) sought to identify which were the strategies recommended by patients with dental anxiety. 89% of the patients considered that the background music helped them to relax, while 75% considered that the presence of books and magazines decreased their dental anxiety.

In addition to the aforementioned techniques, there are other tools such as the use of relaxation techniques and distraction. Relaxation seeks both a mental and muscular relaxation, facilitating recovery and balance, towards a state of tranquillity in dental patients who present anxiety, and there are different studies that show the effectiveness of this technique.

Distraction aims to manage the anxiety, stress and pain caused by clinical procedures, by focusing attention away from painful procedures, music being a form of distraction. It can relieve pain and anxiety by consciously shifting attention away from symptoms. 

According to the theory of pain control, pain receptors work together to send signals of suffering to the brain, therefore, distractors such as music, can block certain pain pathways and decrease the amount of perceived pain.

There is also the perception of control, where the patient is given the possibility of stopping the dental procedure when he deems it convenient, which would lead to properly managing anxiety.

On the other hand, in children without health disorders, non-pharmacological management is the therapy of choice for dental anxiety. Techniques that have been shown to be effective are voice control, breath management, show-tell-do, and distraction. 

Distraction is particularly effective in young children or when thee is little time available for preparation. Types of distraction techniques include singing, watching a video, playing a game, or anything else that keeps the child’s attention out of the clinical procedure.

FAQ on Why am I so paranoid about my teeth?

Conclusions

In this article, we answered the following question: Why am I so paranoid about my teeth? We spoke about the symptoms, causes, treatment and consequences of dental anxiety.

Dental anxiety is a state of apprehension that something terrible will happen in relation to dental treatment, which is accompanied by a sense of loss of control. The causes of why a certain subject may experience dental anxiety are diverse, with multiple studies addressing this issue. 

Undoubtedly, dental anxiety turns out to be a worrying issue, which greatly hinders the dentist’s work, and at the same time, affects the patient multidimensionally, especially with regard to the latter’s oral health. 

If you have any questions or comments on the content, please let us know!

Further reading

Dental Fear and Anxiety in Pediatric Patients: Practical Strategies to Help Children Cope, 1st ed. 2017 by Caroline Campbell

Pain And Anxiety Control For The Conscious Dental Patient (Oxford Medical Publications), by John G. Meechan 

Cognitive Behavioral Therapy for Dental Phobia and Anxiety, by Lars–Göran Öst 

Dental Anxiety, by Sapna Puneet Kaur 

Tapping for Dental Fear and Anxiety: Simple Steps to Clear the Fear and Love Your Dentist Again, by Wendy Bett 

#Don’t Fear YourDentist: Dental Phobia & Anxiety: Overcome Your Fear of Dental Treatment, by Dr M Kalcay 

References

Al-Harasi S, Ashley PF, Moles DR, Parekh S, Walters V. Hypnosis for children undergoing dental treatment (Review). Cochrane Database Syst Rev 2010;4:8.      

Al-Namankany, A., de Souza, M. & Ashley, P. Evidence-based dentistry: analysis of dental anxiety scales for children. Br Dent J 212, 219–222 (2012).

Bare LC, Dundes L. Strategies for Combating Dental Anxiety. J Dent Educ 2004;68(11):1172-7.   

Locker D, Liddell A, Dempster L, Shapiro D. Age of onset of dental anxiety. J Dent Res. 1999;78(3):790-796.

Pohjola V, Mattila AK, Joukamaa M, Lahti S. Anxiety and depressive disorders and dental fear among adults in Finland. Eur J Oral Sci.

Trachsel LA, Cascella M. Pain Theory. [Updated 2020 May 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545194/

Sharif MO. Dental Anxiety: Detection and Management. J Appl Oral Sci 2010;18(2)