Odontophobia: extreme fear of the dentist, and its treatment

You have had discomfort in your mouth for a long time, your gums bleed, you have been postponing the annual oral cleaning for more than three years and you are accumulating tartar, you think you may be starting to develop periodontitis, and you know that there is only one way to solve all this, you do not have other... But just by imagining it, you panic, the insurmountable fear, you try to convince yourself that you really it is not so necessary to go and you are willing to endure this situation before entering a consultation of a dentist.

In this article we are going to talk about a much more common phobia than you think: odontophobia, irrational fear of going to the dentist, a problem that can trigger several serious health complications.

• Related article: "Types of Phobias: Exploring Fear Disorders"

What is odontophobia? Differentiate between anxiety and phobia

As we have discussed previously, odontophobia is the irrational and persistent fear of going to the dentist. To be considered a phobia, this fear must last for at least six months.

We must clarify that it is not the same to talk about the anxiety that we can all feel before going to the dentist (something very common in society, not only in children) and another thing is talking about dental phobia (odontophobia). Whether we want to or not, sometimes going to the dentist is uncomfortable due to the invasive intervention they usually do, since the mouth is a very sensitive area. It is normal and adaptive that in some way our organism detects that there is a "danger", and that as a consequence the anxiety to "flee" or to "fight" is activated. However, odontophobia is something much more serious for the person who suffers from it, since very negatively affects your quality of life.

A differentiating element of having a simple state of anxiety and having odontophobia will be the extent to which the person actively avoids going to the dentist even though it is really necessary for them to go. A very suitable analogy to understand this is to compare it with the phobia of airplanes. Many people feel anxious before flying, but do not go further and get on the plane without the need for alternative measures. People with a phobia of flying will avoid getting on a plane as much as possible, and whenever they can they will take alternative transport, even if this objectively damages them (economically, time, etc).

In the case of the person with odontophobia, to the extent possible avoid going to the dentist at all costs, while the person with anxiety will face it without giving it much importance, despite the discomfort or pain that he may feel.

Symptoms of extreme fear of the dentist

People with odontophobia are generally afraid of invasive procedures (to be pricked, surgery, tooth extraction, anesthesia, drill ...). They experience great anxiety, which can lead to increased sensitivity to pain. Some authors associate odontophobia or dental phobia with the phobia of SID (Blood-Injection-Damage).

They are afraid of suffering pain, and in some cases they are afraid of having a panic attack at the time of the intervention. As a consequence of fear, patients tend to tense their muscles, even those of the face. Sometimes there may be a hypersensitivity to the choking reflex, especially in the case of men. Choking occurs when trying to insert objects into the person's mouth or pressing on the throat, making medical intervention difficult or impossible.

In the most severe cases of odontophobia with hypersensitivity to the choking reflex the stimuli that generate drowning are extended: thinking about the dentist, the smell of the dentist's own utensils, brushing teeth, wearing high collars, and so on.

• Related article: "Types of Anxiety Disorders and their characteristics"

Causes

In general, the causes of any specific phobia, such as odontophobia, are explained by three important factors (Barlow, 2002): biological vulnerability, generalized psychological vulnerability and psychological vulnerability specific. We are going to focus in a special way on the specific psychological vulnerability, since it is usually the one that has the greatest role in odontophobia.

This would be related to a direct negative learning experience, based on direct conditioning. More specifically, it would be the typical scene of a child going through a negative experience at the dentist and who thereafter, the dentist conditions the pain or phobic stimulus, and it generalizes to other stimuli (p. eg, white coat, the smell of the dentist, see the materials ...).

Logically, the severity and frequency of these negative experiences (feeling that every time you go to the dentist you have a very unpleasant or mildly negative) and infrequent exposure to the situation after the negative experience (increasingly expanding the frequency with which we go to the dentist because of the aversion and fear it generates: avoidance) are the most important variables for the development of this specific phobia.

Fortunately, today dental interventions are less invasive and painful than a few years ago, the result of technological innovation and the use of finer and more painless utensils.

How is it overcome? Treatment

Live Exposure is one of the most effective treatments for dental phobia or odontophobia. If the person has an uncontrollable fear it may be useful to start with exposure exercises in imagination or watch videos about dentists, to continue with the live exhibition when the patient feels more prepared.

During the live exposure it is important that the patient feels that she has the possibility of controlling the feared stimulus through signals previously agreed with the dentist (p. (e.g. deciding when she wants to be prodded, stopping the drill). It is important that there is a high degree of predictability, that is, that the patient is in control of the situation and knows what is going to happen at all times.

Obviously it's better that the client chooses a trusted dentist and that they have special empathy towards the difficult situation that the person is going through, because surely her intervention will require patience and special care. The dentist must explain the procedures to follow, what the next step will be, and apply the appropriate anesthesia for each case.

In cases of odontophobia also it is useful to train the patient in controlled breathing or applied relaxation, especially when the somatic reactions of intense fear produce muscular tension or tension in the throat).

• Related article: "Intervention in phobias: the exposure technique"