Definition
Avoidance and fear of dentists and dental procedures. This could be a total avoidance of dentists or avoidance of having a particular procedure performed. A true dental phobic would not be able to even consider the prospect of attending a dental practice. Dental anxiety is commoner and may involve any aspect of attending for dental treatment.

Incidence / Age / Sex
Dental phobia can affect anyone, at anytime. People can be fearful of anyone part (or combination of parts) of the dental experience. Generally speaking the most anxious patients are female and aged between 18 and 35 years of age. Dental anxiety is very common. Only half the population of the UK attend the dentist regularly. The others attend only when in pain. The most common reason for this lack of attendance is the fear of dental treatment.

Causes / Prevention
A significant proportion of people with dental anxiety have psychosocial factors. Early traumatic events at the dentists or doctors can trigger an anxiety towards dental treatment. Dental anxiety and phobia can be a manifestation of early abuse and neglect (especially in women). Many patients are concerned with regard to trust in the dentist and issues around control and feeling vulnerable. Other patients are concerned that an unfortunate event may occur whilst having dental treatment. Many of these thoughts occur early in life. It is important that children of patients who are dentally anxious do not become phobic as a result of either not being taken to the dentist or by listening to stories told by their dentally anxious parents or relatives.

Signs and Symptoms
True dental phobics will not attend the dentist even when in extreme pain. They may try to self-treat either by trying to extract their own teeth or by taking painkillers. These patients may travel considerable distances out of their way to avoid walking past a dental surgery. Other patients will avoid saying the word "dentist" or even watching television in case a scene is shown with a dentist or dental surgery in it. Patients will become nauseous, perspire a lot and will have an elevated pulse and rate of breathing. Some will feel faint at the thought of attending the dentist. Many patients become aggressive and / or violent. Many feel isolated and think that they are the only ones who have this problem. Some patients are concerned that the dentist will mock them for being frightened and lor letting their teeth get into a poor state. Many patients are concerned at the thought of loosing their teeth and really do want to try to get help.

Complications
The main problem is one of dental pain and infections. Loss of teeth may occur if dental decay and gum disease is not treated at an early stage. This may lead to a loss of chewing function and a poor appearance when speaking or smiling. This can lead to loss of confidence and social isolation. Some patients may take too many painkillers which can have potentially fatal side effects. Occasionally dental anxiety can be a manifestation of a general psychological problem.

Tests
Occasionally (although very rare), dental anxiety can be caused by other psychological problems. It could occur as a side effect of running out of tablets which are used to treat depression. It can be seen in patients with eating disorders. A questionnaire is often used to evaluate the level of anxiety.

Treatment
Treatment for dental phobics is available. In order to be treated patients have to either present themselves to a sympathetic dentist for treatment by that practitioner or referral to a dental anxiety management clinic. This is usually at a dental hospital. Occasionally family doctors may undertake this referral. Help is at hand and is usually successful. Treatments can vary depending on the severity of the anxiety. Many patients get reassurance by simply talking through their fears. Some patients may benefit from a referral to a psychologist for desensitisation. This is a gradual exposure to the feared situation. Often this is accompanied with a "coping plan" which helps the patient recognise the signs of their fear and gives them a strategy, such as relaxation training, in order to cope with it. Other techniques involve some form of sedation such as oral sedation (tablets), relative analgesia (gas and air) or intravenous sedation using midazolam. All are extremely effective at reducing dental anxiety. The dentist will discuss with the patient which is the best option for that individual. Nearly all patients can be treated using these techniques. Generally patients are no longer "put to sleep" using general anaesthesia to have minor dental treatment such as easy extractions and fillings performed.