Say the word ‘dentist’ to Hazel Phillips and she might actually faint. She can’t see a dental procedure on TV without her heart pounding and her palms going clammy.
Hazel even feels nervous watching adverts for toothpaste and avoids looking in the mirror when brushing her teeth. The 38-year-old admin assistant from Totton, Hampshire, is one of a growing number of people in the UK with a severe dental phobia, or odontophobia.
Up to half the population is said to have it to some degree. The Adult Dental Health Survey found that 36 per cent of UK adults were moderately ‘dentally anxious’ and 12 per cent were extremely so, meaning they would avoid it at all costs, or require sedation for routine procedures.
This can have a significant impact on oral health. A 2020 study by Harvard Medical School found that people with a history of gum disease were 43 per cent more likely to develop oesophageal cancer and 52 per cent more likely to develop stomach cancer.
Other research has found that people with gum disease are two to three times more likely to develop heart disease.
Dental phobia also means there is a risk that the oral cancers — which are on the rise and which dentists look for — aren’t being picked up early, when they are more treatable.
The sooner a phobia is identified the better, found a new study by dentists in Finland. Patients who received treatment for dental phobia between the ages of two and ten had significantly more dental procedures in their lives than those treated for their fears after that age, reported the journal BMC Oral Health.
Shahir Shamsuddin, an NHS dentist in Leytonstone, East London, says ‘about 50 per cent to 60 per cent’ of patients he sees are scared in some way, and that ‘a lot of fear regarding dentistry stems from childhood’.
Fear of the dentist often leads people to avoid visiting one, even if they’re in pain or suffering from problems such as decay, adds Douglas Miller, a dentist in London who specialises in treating phobic patients.
‘Recently I saw a patient who wanted me to restore some medium-size gaps, as he had four missing back teeth. Unfortunately, he had gum disease and decay so advanced that a further four upper teeth needed removing.
‘Another gentleman had very few teeth left. He had a bad experience in his youth and hadn’t been to the dentist in 30 years. He couldn’t face job interviews so was left without work.
‘His wife forced him to see me. We rebuilt his mouth over several appointments and afterwards he was able to go for interviews and got a job.’
Bhup Gupta, an NHS dentist in Wolverhampton, sees many patients who are scared. He says: ‘We have a clinical hypnotherapist on-site and she will often get involved before we see patients with this problem.’
Fearful patients can be given gas and air to calm their nerves, or sedation. Extreme cases may be referred to specialist dental phobia clinics in NHS hospitals or the private sector.
These clinics are often designed to look more like doctors’ surgeries, with neutral decor and no posters of teeth on the walls. They also offer treatments such as cognitive behavioural therapy (CBT) or other talking therapies alongside treatments.
Dr Gupta explains: ‘We talk to the patient first, and once we understand their situation we can help them cope with techniques such as breathing deeply, relaxing music, pausing at intervals during treatment and starting with simpler treatments first to build their confidence.’
Hazel says her fear of the dentist was triggered when she had to have a filling at the age of six.
‘My mum was outside with my younger siblings, so I was on my own in the room,’ she recalls.
‘I was so scared and the dentist was really brusque, coming at me with this huge needle. I batted it away, but he shouted and injected me anyway. I cried and ran out terrified afterwards. From then on, I was petrified of dentists.’
Over the years, Hazel would do anything to get out of going to the dentist. ‘I’d feign illness and only went if my parents dragged me there kicking and screaming,’ she says. ‘I began to feel a physical reaction to the idea of the dentist: cold sweats, feeling faint just at the thought of it.’
As an adult, Hazel decided never to go to the dentist again. Then, in her late 20s, she woke up one morning in pain.
‘There was a swelling at the back of my mouth,’ she says. ‘Later that day, my whole cheek swelled. I knew it was teeth-related but was terrified to do anything about it. Soon I could barely talk or eat.’
Over the next two days, Hazel’s face swelled up and she reluctantly went to an emergency dentist, who found an abscess under one of her molars.
‘He said it was most probably caused by years of not seeing a dentist and the tooth and gum had become infected,’ she says.
Hazel was referred for surgery to remove the infected tooth.
She recalls: ‘A few days later I went to hospital, shaking. It took every ounce of my being not to run out of there. I explained I had a phobia and it was agreed I’d need a general anaesthetic, otherwise I could not let them operate.’
But after the operation, Hazel woke to bad news. ‘The dentist told me apologetically that as well as removing the damaged tooth, he’d taken out a “healthy” tooth by mistake — but had “saved” it by sealing it with cement.
‘That compounded my fear. I was scared before, but now I couldn’t even see a dental procedure on TV or a toothpaste advert. The image of teeth made me queasy.’
She hasn’t been to a dentist in the ten years since. ‘I know I have plaque and my teeth are cracked,’ she says. ‘But I don’t care.’
As well as two cracked teeth, Hazel suffers regular toothache. ‘I just take pain relief,’ she says. ‘It lasts a few days but I get used to it. I’d rather that than ever see a dentist again.’
Dr Miller says one reason so many people are phobic of dentists is because of the area being treated. ‘The mouth is an intimate area,’ he says. ‘When you have an injection there, it’s not like having an injection in the arm.
‘Furthermore, you are to some extent giving over control to someone else, which can be difficult, especially if people have been made very anxious in the past — perhaps having had treatment imposed upon them by dentists who are not as sympathetic as they should be; I’ve heard stories of some people being held down while they had treatment.’
He says the key is to make the patient understand they’re in control of their treatment.
‘No one likes having dental procedures, but they want the benefits of it,’ he says. ‘So you can focus patients on this, and help them understand that you’re working with them to get an outcome they find satisfactory.’
Dr Miller offers longer appointments of 40 to 60 minutes to allow the time to allay patients’ fears.
History Case Notes
Old medical practices still relevant today. This week: Ventilating to clear ‘germy’ air
By 15 BC, the Roman architect Vitruvius had built large public buildings, such as theatres, with plenty of open windows as it was felt that hot, stagnant air was bad for health.
Hundreds of years later, Florence Nightingale espoused this approach — writing of it in a letter in 1860. According to Dr Henry Burridge, a lecturer in fluid dynamics at Imperial College London: ‘Fresh air flushes out the air already in the room. Without it, more of the air we breathe in has already been exhaled by someone else — and if that person is infected with an airborne disease, such as flu, measles, mumps, or Covid, they might be breathing out infected air.’
Vitruvius also knew that lead water pipes were more dangerous than clay for drinking water. He noted how unhealthy lead workers looked and suggested lead pipes should not be used. It took until the 1970s for lead water piping to be banned in the UK.
‘I increase appointment times for phobic patients so I can work at a slower pace for them,’ adds Dr Shamsuddin. ‘But it’s also things such as talking in a soft tone, listening, being at eye level, sitting in front of the patient rather behind them — these all help them feel calmer.
‘I also avoid language such as “hurt” or “needle”.’
Dr Miller says virtual reality (VR) headsets can help distract a patient who is fearful.
‘VR headsets can be used in conjunction with CBT to deliver virtual experiences that some dental patients might initially find upsetting.
‘Virtual exposure of, for example, entering a dentist’s treatment room or seeing a drill, can make a patient less anxious about experiencing these situations in real life.
‘If patients don’t like the noise, we’ve got headsets so they can listen to music or podcasts.’
However, some patients do need sedation, adds Dr Gupta.
‘But often, anxious patients forget to take their sedative beforehand and still manage to cope with the treatment.’
If you suffer with dental anxiety or phobia, you can ask your dentist to refer you to a dental sedation clinic.
Unfortunately, Hazel is not able even to contemplate this.
‘I know I need fillings,’ she says. ‘But I can’t imagine ever going to the dentist again. I may consider a specialist dentist who deals with dental phobia — but not yet.’
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