Why are we so scared of dentists?
An eight-year-old girl starved to death because of an apparently severe dental phobia. It's an extreme reaction to a commonly held fear. But why do so many of us dread the dentist's chair?
Even for those with a dread of visiting the dentist, the tragic case of eight-year-old Sophie Waller seems bewildering. Sophie was already scared of dentists when one of her milk teeth became loose. Her parents were later to tell the inquest into the schoolgirl's death that it had developed at the age of four, when her tongue was nicked during a routine check-up.
 Childhood memories are the source of most people's worries |
Refusing to eat or talk, she was sent to hospital to have the wobbly tooth removed under general anaesthetic. Doctors took the opportunity to remove several teeth but following the operation, Sophie was so traumatised she refused to open her mouth and continued her fast.
While Sophie grew weaker, the severity of her condition was not realised by the hospital. She died the month after the operation from the effects of starvation and dehydration.
It was a highly unusual reaction to a relatively commonplace problem. But what explains this pervasive fear?
Dread of dentistry can broadly be divided into two forms:
- dental anxiety - a term coined in the mid-1940s to explain what is often a mild fear
- dental phobia - a more extreme dread that, nevertheless, affects about 10% of people
For whose with dental anxiety, this tends to be based on childhood experience, either one's own or someone else's.
The concerned parent, fretting at their child's side as he or she is reclined in a dentist's chair, may be more of a problem than a solution. Parents can, unwittingly, pass on their own fears to their children in what comes to be an unbroken chain of generational fear, says Dr Nigel Carter of the British Dental Health Foundation.
 Advances in technology have help allay the fears of some |
"I can recollect children coming in being fine and then the parents at the end of the visit saying, 'There, that didn't hurt did it?' It would be the first time the child had thought about any pain."
Often a child's initial visit to the dentist is an urgent response - they have been in pain and need some work - so that initial memory is connected with pain. This can set up an anxiety or phobia that lasts for the rest of their life.
But thankfully not always. Professor Ruth Freeman, of the Dental Health Services Research Unit, University of Dundee, says it can depend on a child's level of imagination. A bad experience can be reinforced by a vivid imagination that is carried on into adulthood.
"If children have a very good imagination they tend to have worries about going to the dentist then as an adult they can become very frightened."
 |  Perhaps the thing with dentistry is that it feels like more of an optional treatment  Dr Nigel Carter  |
The interventionist nature of dentistry means that people don't consciously think that they're ill - in the same way they would if going to a GP - yet they have to have something done.
"Perhaps the thing with dentistry is that it feels like more of an optional treatment. More of the visits that you go to the dentist are interventionist than with a doctor," says Dr Carter.
Yet advances in technology, and a greater awareness of the problem within the profession, appears to have had a dramatic effect in allaying the fears of many.
In 1988, a survey of oral health in the UK found 60% of people were "to some extent... nervous of some kinds of dental treatment". A decade later, that figure had dropped to 32%.
Total avoidance
For the most part dentists can help those with anxiety. And they are the majority.
But one in 10 of us have a deeper problem - a genuine phobia which is more difficult to treat.
 For some, it is the white coat not the dentist that is the problem |
Ms Freeman says dental phobia can be down to one of three reasons: false connections, learning difficulties and those with a wider psychological disorder.
False connections were originally identified by Sigmund Freud and Josef Breuer in 1893. They are based on the idea that the patient, usually a child, mixes up situations, transferring thoughts from the past onto an object in the present.
Professor Freeman had one such patient, who was frightened that the local anaesthetic wouldn't work.
"He was an insulin-dependent diabetic whose injections didn't always work. He used to say that he didn't understand why he had a fear of the injection at the dentist, having used them daily himself. He'd displaced all his fears about his insulin not working and put them onto his anaesthetic."
This kind of connection is common, and medics can often work out where it's come from by reading the patient's medical notes.
| With those who have a genuine phobia, you can't find out why and they can't tell you why Professor Ruth Freeman |
A fear of dentists can also be associated to learning difficulties, and these patients can be referred to specialists who are able to spend more time explaining procedures and putting them at their ease.
If a person suffers from a variety of psychological disorders - such as agoraphobia or any kind of social phobia - it is very likely that they have a dental phobia.
"It seems to be that with those who have a genuine phobia, you can't find out why and they can't tell you why," says Professor Freeman.
Needles and drills
Other factors that can trigger a fear of all things dental are the associated sights and sounds - the needles and drills. It may not even be about the dentist, rather the surgery.
"You do get children that have really got a phobia about white coats rather than the dentistry bit," says Dr Carter.
There is no notable difference between the number of men and women who suffer from a dread of dentists, although men may not admit to it, according to Dr Carter.
"You probably tend to get it a little more in women but that's also because women might force themselves to go, whilst men might stay away."
For those who are affected by a fear, dentists have become a lot more practised at managing it. Undergraduate dentistry courses recognise the problem and cover how to deal with nervous patients.
Often a phobia of this kind does disappear, over time, when a patient finds a dentist they like and trust. This can be an ordinary dentist or a someone who specialises in dealing with anxious patients. But it is rarely immediate.
Dr Carter says although a fear of dentists can be brought on by one bad experience, it is unlikely to be reversed by one positive visit.
"What's strange is that we don't seem to learn from a pleasant experience. There's a sort of irrationality about it."
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