Addressing dental fear and anxiety to improve oral health outcomes   

By: Mark S. Wolff, DDS, PhD, Morton Amsterdam Dean, University of Pennsylvania School of Dental Medicine

Did you know that 21% of individuals report fear, anxiety, or stress about going to the dentist?1 Furthermore, as many as 11% report severe fear, and, in one study, 17% of patients stated their fear was so severe that they avoided seeing the dentist even when they were in pain.2

Causes of dental fear and anxiety can vary, but most commonly include:

  • Past negative experiences at the dentist, especially during childhood
  • Tendency to be anxious in general
  • Concern or shame about poor oral health or hygiene
  • Anxiety about paying for treatment
  • Fear of possible pain, needles, dental drills, or gagging

Dental fear and anxiety can cause patients to miss or cancel appointments — keeping them from getting necessary preventive care. Avoiding necessary dental care can result in worsening oral health outcomes and lead some patients to require extensive emergency care. In the U.S. Surgeon General’s report, avoidance of oral health care leads to pain and suffering, which can impact an individual’s overall health and well-being and significantly diminish their quality of life.

Desensitization techniques are provided as part of dental training to all dentists to help reduce fear and anxiety in their patients; however, other creative solutions to this problem exist. A recent study by the National Institute of Dental and Craniofacial Research (NIDCRI), conducted at the University of Pennsylvania School of Dental Medicine and New York University College of Dentistry, adapted an existing in-person dental-fear counseling treatment for adults into a monitored at-home program modified to an individual’s needs.

This new treatment approach helps patients modify what they do, think, and feel to improve their dental experience by using a free app called Dental Fearless, which helps identify fears and create a list of ways to reduce those fears. For example, these techniques can include discussing a signal with the dentist to convey, “please stop working,” (e.g., by raising a hand); discussing each phase of treatment before it starts or, alternatively, not discussing what the dentist is going to do if that makes someone feel more comfortable; or using suction to prevent gagging. Patients with fear levels of four plus on a zero to 10 scale are eligible for this treatment option as part of the ongoing NIDCR study.

Managing the fear of dental care is imperative to improving or maintaining ones oral and overall health and creates a more comfortable patient experience. Additionally, it can also be effective in lowering dental expenditures by reducing emergent and extensive care for patients and decreasing cancellations or missed appointments.

Overall, it is important to maintain an open line of communication between patients and dentists to ensure that their experience is positive and comfortable, allowing them to maintain great oral health and avoid serious issues that can be complicated to treat in the future. 

1Gatchel RJ. The prevalence of dental fear and avoidance: expanded adult and recent adolescent surveys. J Am Dent Assoc. 1989 May;118(5):591-3. doi: 10.14219/jada.archive.1989.0068. PMID: 2785546.

2Gatchel RJ, Ingersoll BD, Bowman L, Robertson MC, Walker C. The prevalence of dental fear and avoidance: a recent survey study. J Am Dent Assoc. 1983 Oct;107(4):609-10. doi: 10.14219/jada.archive.1983.0285. PMID: 6579095.