Fear of future dental work

Nobody likes going to the dentist. But for some people, the problems run deeper and form a phobia. The causes of dental phobia can be many and varied. This case study is of a patient who couldn’t make a routine dental visit for fear of it escalating into further work.

The Patient

Jon was in his mid-twenties and had required significant orthodontic work as a teenager. Between the ages of 12 and 14, he had worn conventional braces with metal brackets to correct a severe overbite. As part of the treatment he had been required to undergo two tooth extractions to reduce overcrowding and to also wear head gear for a period of time. The orthodontic treatment was a success. However, the memory of such long-term treatment meant that Jon now found it very different to go back to the dentist.

Often, the memory of pain from a previous dental visit can trigger a phobic reaction. Alternatively, it could be the memory of the embarrassment of wearing a brace that creates the negative feelings about further dental work. However, the problem for Jon probably lay in the fact that the dental work had become associated with a wide variety of negative issues: long-term treatment, costs, pain and embarrassment. The phobia, in many ways, is a natural protective mechanism rather than an irrational fear. It is the brain’s instinctive attempt to shield the patient from more of the trauma that is associated with a visit to the dentist.

For many patients, overcoming this natural instinct to protect yourself is difficult. One part of the brain understands quite clearly that this is simply a check-up. But another part of the brain is refusing to accept that this could be the case – after all, previous experience points to the opposite.

The Scenario

Clearly, Jon’s inability to visit the dentist for a routine check-up meant that a number of problems could develop. By not visiting the dentist, he is in danger of undoing all the good orthodontic work that was done during his teenage years. To him, the two years where he wore braces may not have been the happiest time. But for most teenagers it is vitally important for them to grow up with a healthy mouth, attractive smile and natural facial balance.

Jon’s refusal to visit the dentist later in life could mean that this work was for nothing. Often, orthodontic work done during childhood can need further, slight correction during adulthood. It is important he visits his dentist regularly to ensure that no further work needs to be done.

Don’t forget, also, that the orthodontic work done in his teenage years will probably have been expensive. He needs to be able to see this, not as a one-off cost, but as an investment in his health that needs to be maintained throughout his life. Regular trips to the dentist that help to keep his teeth healthy are more likely to ensure he need less work done in the future, and that costs will be reduced. By not visiting the dentist regularly, he is far more likely to see his fears become reality – that his next check-up would reveal something more serious, costly and difficult.

The Symptoms

Of course, a phobia is far more than a desire not to visit the dentist. For many people, it is characterised by a physical reaction. For Jon, the memory of wearing the brace produced muscle tension around the jaw. This inability to relax meant he also suffered panic attacks prior to visiting the dentist, as he knew what to expect when he got there.

Many people feel as though the only way to tackle a phobia is by facing up to it. Jon had tried to tackle his phobia directly by visiting a dentist in the past. However, he was unable to go through with the routine check-up because of the muscle tension around his jaw and face. Effective treatment had become virtually impossible as the dentist was unable to see the teeth or evaluate them efficiently.

The result was a vicious circle. A visit to the dentist meant that Jon became tense and nervous. The knowledge that this reaction was likely also made the patient more nervous before a visit to the dentist. This only added to the tension and made the problem even worse. Furthermore, the longer the patient went without being able to visit the dentist, the more worried he became about requiring more serious dental work in the future. This naturally led to increased tension, making it even more difficult to visit the dentist.

The Solution

Jon tried relaxation techniques prior to visiting the dentist. However, the efforts to relax meant that he began thinking about his visit to the dentist even earlier in the process. So this had the opposite effect and began to increase his tension.

The solution eventually lay in counselling that helped to challenge Jon‘s perception of his previous dental work. The aim of the counselling was to encourage Jon to focus on the positive elements of his previous dental work, rather than simply the negative factors. This gradually enabled him to relax, to understand that his previous dental work was a success and that it really meant he could visit his dentist confidently expecting a quick check up and no further work. His dentist also talked him through some techniques for looking after his teeth effectively, so that he could confidently do everything in his power to make each future dental check-up as routine as possible.

The aim for Jon was to transform his dental phobia from a vicious circle into a virtuous one. By understanding that his previous orthodontic work had made his teeth healthier, he was able to appreciate that continued visits to the dentist would reduce the requirement for complex dental work. It was this change in mindset that helped him to relax, little by little, and not to feel so apprehensive before a routine check-up.