Although there are various anxiety scales and practice specific questionnaires, most dentists assess patients anxiety levels with a face to face meeting, either in the dental surgery or in another room in the practice. The acceptable location for the patient in itself is an indication of the anxiety level with various patients, although agreeing to sit in the surgery, are often reluctant to go to the next level and actually sit in the dental chair rather choosing to sit in a side chair while discussing their anxiety and fear with the dentist.

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WHAT CAUSES DENTAL ANXIETY
There are many reasons why patients become anxious about dental treatment. Unfortunately fear of the dentist is far too common and is usually associated with a previous bad experience where the dentist was not too compassionate or sympathetic with the patient or the patient went through a painfully traumatic experience in the surgery. The fear of pain can also stay with the patient for a long time causing the patient to develop an aversion to treatment and even hearing about other people’s painful experience can trigger thoughts that the patient will have the same painful experience themselves.

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Some patients’ poor dental health may be an embarrassment to them and they have a fear that opening their mouth to the dentist will show the true level of their rotten teeth or swollen gums or even their bad breath.

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The fear of the dental drill or needle is also common among dental phobics but this is not always associated with a previously bad experience personally but may be associated with an experience for someone else that the patient has heard about. While pain from a dental drill may be a reason for the anxiety others are more concerned with the noise or vibration that it causes. The needle itself can be feared for the perceived pain or discomfort it may cause while others are just averse to having an injection or the feeling afterwards with the mouth feeling numb. In addition to that some patients have previously not numbed up completely and fear the situation will always be the case leading to pain. Previous reactions to dental anaesthetic can also instill fear in patients worrying the experience will be repeated again.

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Some patients simply fear losing control in a dental chair and being at the mercy of a dentist who could potentially hurt them or they may end up in a situation where the dental treatment is unfamiliar to them leading to uncomfortable thoughts or feelings. This is especially true for patients that fear choking or have a sensitive gag reflex which is intensified with increasing anxiety levels. Patients can also simply worry about losing control and making a fool of themselves by crying uncontrollably.

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The fear of needing extensive treatment that keeps the patient in a dental chair for long periods of time or perceiving the treatment is not necessary or is costly can also cause great anxiety levels so much that even the smell, sound or sight of a dental surgery may cause patients to revert back to negative thoughts.

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HOW COMMON IS DENTAL ANXIETY
According to the NHS Dental Health Survey from 2009, approximately 48% of the population suffer from some form of dental anxiety, 36% of the population had moderate dental anxiety and 12% had extreme dental anxiety.

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DENTAL ANXIETY SYMPTOMS
Generally patients are apprehensive about the appointment feeling nervous and slightly uneasy with the situation but some patients may think and worry about the appointment so much that they have a troubled sleep the night before. This feeling of nervousness may escalate on the day that they may cry or feel physically ill at the very thought of visiting the dentist. This intensified feeling may get to the point where objects placed in the mouth may cause the patient to suddenly feeling an inability to breathe which may progress into a panic attack.

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With a panic attack the most common feeling is that of chest pain or general feeling of discomfort that leads to the patient thinking they are about to have a heart attack. In addition to this palpitations or a pounding heart, shortness of breath, nausea, light-headedness or dizziness, upset stomach, numbness or tingling sensation in the hands, shaking or trembling and a paralysing sense of fear or terror.

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HOW TO PREVENT DENTAL ANXIETY
It is difficult to prevent patients from developing dental anxiety as feelings and past experiences of patients cannot be directly influenced but it is certainly possible to help control these feelings and try to overcome them.

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HOW TO CONTROL DENTAL ANXIETY
The first step is to find an understanding and sympathetic dentist by asking friends and colleagues or by searching on specific dental anxiety or phobia websites such as www.dentalphobia.co.uk

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It may be helpful to go to the surgery to meet the dentist and the team even before booking the first appointment. Telling the dentist that you have anxiety issues helps their preparation for your visit.

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Arranging an appointment in the early morning means that you don’t have time to dwell on thoughts about visiting the dentist and asking a friend or family member to go with you is also a good idea.

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The first visit can be a simple examination or dental health check or it can be just a chat to establish a relationship with the dentist letting the dentist know the source of your anxiety and for the dentist to discuss with you the options for treatment. If an examination is to take place then establishing a sign or signal with the dentist to stop for a break is an excellent idea in giving the anxious patient full control during their visit.

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HOW TO OVERCOME DENTAL ANXIETY
Good communication between the patient and dentist is absolutely vital in the management of dental anxiety. Once this is established there are a number of recognised methods to help in overcoming anxiety with various techniques ranging from distraction, hypnosis or Cognitive behavioural therapy or some form of sedation. Key to any technique is that the patient must feel in full control having an ability to signal to the dentist to stop whenever the patient needs to take a break. Once the patient feels that they are in control the confidence levels increase while the anxiety levels decrease.

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• Distraction techniques: this can involve the surgery playing relaxing and soothing music or the patient taking their own music player to listen to music they find most relaxing. It is also possible to wear DVD eye glasses that show either relaxing scenes with soothing background music or for the patient to watch their favourite show taking their mind away from the procedure in hand.
• Relaxation techniques: the patient is encouraged to concentrate on relaxing each body part in turn while thinking of a happy event such as a holiday they may be looking forward to.
  Breathing techniques: controlled breathing actually relaxes your body and shifts your thoughts to other things to preoccupy your mind away from the source of your anxiety.
• Hypnotherapy: this can be very effective for some patients but not for all with the added advantage of not involving the use of any medication. The patient is safe in the knowledge that you cannot be made to do anything against your wishes under the effects of hypnosis.
• Cognitive behavioral therapy: this is a combination of dealing with your thinking process and your behavioral response to that thinking process. This is often termed “talking therapy” in a problem-solving approach where negative thoughts are replaced with positive ones with the development of skills to cope with the situation.
• Sedation: this involves the use of sedatives to relax the patient so that the patient can stay conscious throughout the procedure and follow instructions by the dentist while having the treatment. Sedation can be oral in the form of a tablet or can be administered through inhalation or intravenously through a vein. The simplest way is to prescribe some diazepam (Muscle relaxant) for the night before and for the morning of the appointment. Sedation by inhalation involves the use of a mixture of oxygen and nitrous oxide gas known as relative analgesia while sedation through a vein involves the administration of Midazolam another muscle relaxant. Obviously, the latter is contraindicated if the source of the anxiety is fear of needles.

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If someone you know in the Wimbledon area has a fear of the dentist or is a nervous patient then please do let them know about us.

Although there are various anxiety scales and practice specific questionnaires, most dentists assess patients anxiety levels with a face to face meeting