Mind Your Mouth. Part 2.

My first post on the relationship between mental health and oral health focused on risky behaviors like drug, alcohol, and tobacco use, and the damage they cause the teeth, gums, mouth and throat. (http://mydentalhygienist.blogspot.com/2018/01/mind-your-mouth.html )

The link between oral health and mental health, however, is a two way street. People who don’t like how their teeth look or who have crooked, missing, or decayed teeth can suffer from low self-esteem. They may not want to smile or talk and lack confidence because they feel ashamed by the condition of their mouth. They may avoid social situations and have difficulties finding or keeping a job. Isolation, worry, and lack of employment can further deepen a person’s depression. They may blame themselves for how their mouth looks, even if it is not their fault. Some people have dental conditions which may stem from childhood or may be economic in nature, such as a family’s inability to afford braces or to have trauma to the teeth repaired. This can further cause a person to feel helpless and hopeless about the condition of their mouth.

Many people feel anxious about dental treatment but those who avoid going to the dentist out of fear may develop oral health problems due to a lack of regular care and check-ups. Dental phobia, the fear of going to the dentist or having dental treatment, is a recognized condition and a very real problem for some people. It can be caused by fear of pain, lack of control, feelings of shame over neglect of health, or traumatic past experiences. People may wait to seek care until they are in extreme pain, their condition is much worse, or they may not seek treatment at all, which can result in severe or life-threatening infection or tooth loss. Lack of dental care, dental anxiety and oral health problems can be a very damaging combination for a person’s physical overall health and their mental well being.

People with self esteem or depression due to oral health problems and people suffering from dental phobia need help from both dental and mental health professionals. Receiving proper dental care can help to restore a person’s confidence and motivate them to get help for the mental health issues they developed as a result of their poor oral health. Behavioral and cognitive therapies can help a person explore the reasons for their phobia and develop the tools that they need to help get them through dental care visits. Some people may require anti-anxiety or anti-depression medications.

Dental health professionals should recognize that dental phobia affects many people and is more common than people realize. It is estimated that between 9 – 15% of Americans have true dental phobia. Pain management in the dental office through the use of good and proper anesthesia based on a person’s medical, dental, and mental health conditions is needed, as is empathy about the person’s phobia. Patients should be asked about their fears and be invited to use coping strategies, such as listening to music on headphones, or relaxation techniques like deep breathing. Open discussion can help to build trust and get patients to the resources they need to help them heal.

Sources

https://www.colgate.com/en-us/oral-health/basics/dental-visits/what-is-dental-anxiety-and-phobia

https://www.webmd.com/oral-health/controlling-dental-pain#2

Kisely S. No Mental Health without Oral Health. Canadian Journal of Psychiatry Revue Canadienne de Psychiatrie. 2016;61(5):277-282. doi:10.1177/0706743716632523.

This blog is not intended to diagnose, advise, or treat any condition. Please get help from your medical, dental or mental health professional if you need it - you'll be relieved that you did.

Are you afraid of the dentist?

Fighting Dental Fear

Fear that affects one’s ability to seek or receive dental treatment has real consequences. Ignoring gingivitis, gum disease characterized by bleeding, puffy gums, can cause it to progress to periodontitis, advanced gum disease characterized by bone loss in the jaw and loose teeth. Cavities left untreated only get bigger. A sore in the mouth that does not heal may be a sign of oral cancer and ignoring it can be deadly. Neglecting the teeth during pregnancy can result in low birth weight.

Avoiding dental treatment also has financial consequences. A small cavity that could have been treated with fluoride or a filling may end up needing more extensive treatment like a root canal, crown, or other expensive restoration. These treatments also require multiple visits leading to more time off from work. A restored tooth is more likely to need future treatment versus a natural tooth.

Dental fear that prevents a person from getting treatment is recognized as a debilitating phobia called odontophobia. Fear of the dentist or of dental treatment may be related to a person’s tolerance for pain and is often an issue for people who have suffered from abuse. Estimates on the number of people affected by true dental phobia varies widely from 9% to over 30%, however, most people can testify to the fact that going to the dentist for treatment is no walk in the park. 

Dental Fear. (image:ym)

There are a variety of things that may cause dental fear. Some patients may be ashamed that they have waited so long to see the dentist. Aside from being afraid that something is seriously wrong, they fear “the lecture” they may get for not taking care of their teeth. 

Pain is a also common fear. While dentistry has come a long way, it still involves the administration of anesthetic with needles or other methods that can be scary for some people. 

Bad childhood experiences with dental treatment are a cause of fear, too.  People with dental fear have also cited feelings of loss of control during treatment and a general discomfort with the sights, sounds and even smells of a dental office. Some people feel uncomfortable with treatment because they have a strong gag reflex or report feeling like they may choke during dental procedures. 

Whatever the reason, dental fear is real and can be troubling for people. Still, dental treatment and regular dental check ups are absolutely necessary for health.

There are a number of ways to try to cope with dental fear:

Ask questions and discuss your fears with the dentist or dental hygienist. It’s not necessary to reveal your innermost secrets but being upfront about your dental fear will help guide them with your treatment. For example, if you fear the sight of needles, the tray can be covered or they can adjust their approach to keep the needle out of the line of your sight.

Find a dentist and dental hygienist you like and whose staff make you feel comfortable and welcome. 

A dental office’s environment is important. An environment suited to your personality can help you deal with the anxiety you feel when visiting the dentist. Perhaps you favor a soothing environment with soft music or prefer an office with lots of stimuli, like televisions mounted on the ceiling for patient viewing.

Set the mood with music.  Listening to music on headphones during treatment can be very helpful for people who are sensitive to noise.

Wearing sunglasses or goggles while receiving treatment can help with harsh lights.

It is important to set your appointment when you are least likely to be stressed. If rushing to an appointment after a day at work stresses you out, consider making early morning or weekend appointments instead. Dental office staff should be willing to work with you and help keep you on track for your appointments.

Resist the urge to cancel. It is important to keep your appointments since delaying treatment or not going for regular dental hygiene visits is only likely to worsen your dental issue.

Stress reducing methods like guided relaxation techniques and biofeedback, or other professional help like counseling or hypnosis, may help reduce anxiety in the dental setting as well. 

Do you have dental fear? Answer TRUE or FALSE to the questions below:

I hate going to the dentist

I had a bad childhood experience at the dental office

I don’t trust what my dental hygienist tells me

I don’t trust what my dentist tells me

I hate having my teeth cleaned

I frequently cancel appointments for no reason

If you answered TRUE to most of these questions you may have dental anxiety. Think about the reasons you don’t like to or want to go to the dentist and ways you can cope with them. If you are avoiding treatment because of your fear talk to your doctor or dentist to get the help you need.

One of the best ways to deal with dental issues is to not have them in the first place! It is worth the small effort it takes to brush and floss every day.

Sources: http://jada.ada.org/article/S0002-8177(16)30966-7/fulltext; Milgrom, P., Weinstein, P., Heaton, L.J. Treating Fearful Dental Patients: A Patient Management Handbook. 3rd ed. Dental Behavioral Resources.Com, Seattle, WA; 2009; http://www.dentalfearcentral.org/; https://www.health.harvard.edu/blog/dental-fear-our-readers-suggest-coping-techniques-20100825327; 1. Moore R, Birn H. [Phenomenon of dental fear] Tandlaegebladet. 1990;94:34–41. [PubMed]

This blog is not intended to treat or diagnose any illness or condition. Please see your medical or dental professional for treatment and care.