A visit to the dentist is one of the situations that causes the most anxiety in people, sometimes to such an extent that the patient stops going to appointments and abandons treatment. It is clear that such behavior is detrimental to these individuals’ oral health. Furthermore, the patient’s high level of anxiety significantly affects the quality of treatment, as well as the dentist’s mental health.
This fear, which is so common among the general population, may be due to individual factors (bad experiences), social factors, or the psychosocial significance attributed to the mouth.
According to Freud, the mouth is the first organ of contact with the world, and it is through the mouth that the newborn gains its first experience of the self. The mouth is the psychological seat of the earliest physiological needs and emotional gratifications; it is through the mouth that we develop a taste for the world around us. The mouth provides the first sensations of security, pleasure, satisfaction, and success, and all this oral activity leads to the earliest perceptions of the self.
Psychosocial Meaning and Perception of Threat
Beyond the presence of developmental abnormalities in the oral phase, what is important is to understand the profound psychosocial significance that the oral region holds for human beings; in a sense, we are fully represented in it, and our intimacy is revealed there. For this reason, it is understandable why it is difficult to expose this very intimate part of the body to another person—such as a dentist—who, in many cases, is a stranger.
Psychologist Anthony Gale designed a scale that allowed him to assess which dental care situations caused patients the most fear. When ranking the statements that received the highest scores, the following emerged as the most feared: tooth extraction, dental drilling, and a dentist’s negative assessment of the patient’s oral health—with the latter surpassing even the act of holding a syringe with the needle exposed in front of the patient.
Lazarus designed an experiment in which subjects were subjected to different types of anesthetic injections, ranging from those involving the injection of anesthetics with a vasoconstrictor to others in which the syringe with the needle was simply placed inside the patient’s mouth, without actually puncturing the skin. Interestingly, regardless of the situation, people developed a similar pattern of physiological responses indicative of stress (as measured by the electrodermal response). This demonstrates that the stress response is not to the harm itself but to the subjective perception of threat.
The patient arrives at the dentist’s office with mixed feelings. On the one hand, just as in the medical profession as a whole, the patient perceives the dentist as someone endowed with powers that will allow him or her to relieve the patient’s ailments. At the same time, however, the dentist is a threatening figure, given the invasive and potentially painful procedures performed in the oral cavity.
The patient is also experiencing another conflict: he knows he needs dental treatment, but at the same time he perceives the situation as threatening.
This emotional complex leads the patient to a state of anxiety, constant interruptions of the dentist’s work, postponement of appointments, or suspension of treatment.
That is why it is important for the patient and the dentist to work toward a common goal; in this regard, dental anxiety is a barrier to such a partnership.
Strategies for Managing Anxiety in Patients
Corah et al. point out that patient anxiety is a variable that significantly interferes with the quality of dental care and highlight the need to implement strategies to manage it. They divide possible interventions into three categories: relaxation, distraction, and perceived control over stimuli. To evaluate each of these, they designed an experiment involving three groups: a control group, a group subjected to relaxation techniques, and a group subjected to a distraction method; all groups underwent the same dental treatment (amalgam restorations). They concluded that the greatest reduction in anxiety was observed in the group subjected to relaxation, with a greater response among women than among men. Distraction was also effective in reducing anxiety, primarily among men. In a previous study, the same author evaluated the perception of control using a device that allowed the patient to signal when to interrupt the dental procedure; however, he found no significant differences in the discomfort caused by dental care between the groups in which the strategy was applied and the control groups. He therefore concluded that the perception of control was not an adequate method for reducing anxiety in patients with dental fear.
It is important to take the results of these studies into account in order to improve the quality of care provided at clinics, recognizing that the underlying problem is psychological in nature and applying the necessary techniques to provide patients with a more satisfying experience.
References: Rojas Alcayaga G, Misrachi Launert C.
The patient-dentist interaction, based on the psychological significance of the mouth.
Av. Odontoestomatol 2004; 20-4: 185-191.