​Many people dislike going to the dentist, but for some, it can be a debilitating anxiety or phobia. 

When Ms Katherinne Kuan was about 11 years old, her mother took her to the dentist to fix her lower jaw, which protruded outwards. 

The experience was so nightmarish that it led to a deep-seated fear of dentists, says Ms Kuan, who is now 51. 

The treatment involved extracting four of her good teeth and starting her on a palatal expander, an orthodontic device designed for children and adolescents to correct a narrow upper jaw. 

The device was used to counter the effect of her lower jaw protrusion by pushing out her upper jaw. By doing so, her teeth became more aligned, leading to an improved overall facial profile. Removing specific teeth creates the room for the palatal expander to be placed.

“I was in constant excruciating pain for several years due to the pushing and pulling on the teeth to align the jaw. I also had to deal with bleeding gums. It’s one of the worst things a child could go through,” says Ms Kuan, founder of business consultancy firm Victory Consulting and Services.

She would go to the dentist every other month and dreaded it each time. 

“Nobody asked for my opinion. My mother didn’t tell me much except that I had to do this or I wouldn’t be pretty enough to get married,” says Ms Kuan, who is married and has no children. 

The palatal expander was removed several years later in secondary school, but her fear of dentists lingered. Ms Kuan decided that she did not want to go near a dentist again. 

In 2019, however, she started feeling pain in her left ear, coupled with dizzy spells. She saw an ear, nose and throat specialist, who found nothing wrong and advised her to go to a dentist instead. 

She lived with the pain for a year before going to the dentist in 2020. 

“I kept telling myself to calm down and that it would be okay, but when I reached the dentist, I became very nervous. I broke out in a cold sweat and found myself shivering,” says Ms Kuan. 

After an X-ray, Dr James Ho, founder and chief executive of G Dental Center and GPlus Dental Center, found that her wisdom tooth was pushing the second molar into a position that resulted in pain in her ear. She was advised to extract her second molar.

Vision became blurry 

She left the dentist without undergoing any treatment and hoped the pain would go away on its own. But it did not.

In 2022, she panicked when the vision in her left eye became blurry, and she returned to Dr Ho to extract her second molar.

A few days later, the pain in her ear went away and her vision returned to normal.

Dr Ho advised her to use Invisalign as her teeth had misaligned over the years, and she had dental malocclusion due to the incomplete orthodontic treatment during her childhood.

Dental malocclusion refers to a misalignment or incorrect positioning of the teeth when the jaws are closed, while Invisalign is a brand of clear aligners used to gradually straighten teeth. 

Now, Ms Kuan goes to the dentist regularly for follow-up appointments and is learning to overcome her anxiety.

Facing fear

Dental anxiety is a term that is used to describe feelings of unease, stress or fear before or during a dental appointment. 

Dental phobia is a more severe form of anxiety. It presents as an intense and often irrational fear that results in complete avoidance of dental care. 

Dr Ho says only 1 or 2 per cent of the population consider going to the dentist a pleasurable experience. “The rest are neutral or have some fear and would rather be somewhere else,” he says. 

Many people fear visiting the dentist due to sensory discomfort. 

Dental treatments are near vital facial areas, such as the nose, eyes and skull, thus the rattling sounds and noises can be unsettling, says Dr Ho.  

Dr Kiran Kaur Arora, a senior dental associate who heads The Dental Studio’s Potong Pasir branch, says one in three of her patients have some degree of dental anxiety. 

Based on her experience of over 10 years, she observes that while dental anxiety affects both women and men, women tend to be more vocal about their fears and willing to seek help.

Signs of dental anxiety include increased sweating, elevated heart and breathing rate, clenched fists or a stiff posture, and remarks reflecting a negative perception, such as “I hope this won’t be too painful”.

Dr Yang Jingrong, who heads National Dental Centre Singapore’s Geriatric Special Care Dentistry Clinic and is a consultant with the Restorative Dentistry department, tends to see more women than men with dental anxiety. 

Patients with high levels of dental fear, she says, are more likely to delay or avoid visiting a dentist if they feel pain. 

“They may often cancel or fail to show up for appointments. This fear of pain keeps them from seeking necessary dental care until the pain, which is exacerbated by the fear, ultimately forces them to go to the dental clinic,” she adds. 

When they eventually turn up at the dentist, they often appear highly anxious and acknowledge that they can be challenging to manage. They are also aware that they will need extensive dental treatment due to years of not visiting the dentist, she adds. 

Dr Arora had a patient who insisted on being put to sleep for a tooth extraction. 

Growing up, the patient had positive experiences at the dentist’s. However, she had a traumatic experience when she was forced to see a different dentist during the Covid-19 pandemic.

The patient, Dr Arora says, recounted how the local anaesthetic had not fully kicked in and the dentist appeared to be in a rush to get her out of the chair. She ended up experiencing a lot of discomfort during the extraction. 

“We opted for intravenous (IV) sedation to help address her more immediate concern. Gradually, we reacclimatised her to dental procedures, so she no longer needed sedation on subsequent visits,” adds Dr Arora.

IV sedation involves administering sedative medications directly into the bloodstream through a vein, usually in the arm or hand. It induces a state of deep relaxation and decreased awareness in a patient.

While generally safe, IV sedation carries some risks. These may include respiratory depression, which refers to a slow and shallow breathing rate, and potential complications with pre-existing medical conditions.

Patients require close monitoring during sedation to mitigate these risks, says Dr Arora.

Patients who opt for IV sedation will have to pay an additional fee, which can start at a three-figure sum, on top of the cost of the dental procedure they undergo, she adds.

How dentists soothe patients

Dr Arora’s and Dr Ho’s clinics are tailored for people who feel anxious in a dental setting. Treatment rooms have a television to distract the patient during procedures, and for entertainment. 

Dr Arora also encourages certain coping strategies, such as deep diaphragmatic breathing, playing relaxing music and applying the emotional freedom technique. The technique involves pressing down or tapping on specific acupressure points that are said to help to activate the parasympathetic nervous system, increasing feelings of calm. 

Dr Yang does a dental anxiety questionnaire with her patients to encourage them to talk about their fears, and so she can tailor the treatment accordingly.

She also tells patients they can ask her to stop a procedure anytime, giving them a sense of control. 

Dr Ho keeps his patients informed. For example, before giving patients an injection for a procedure, he tells them that he is using numbing paste before injecting the area. By reminding them that the area is already numb, patients are not as fearful, he says. 

He also ensures the needle does not approach the patient’s mouth from the front, as the patient might feel startled by the sharp point.

Dr Ho often hears patients say that they are afraid of the vibration caused by the slow-speed handpiece, which is used to treat tooth decay, drill holes and polish teeth.

“Actually, the vibration is caused by the contact with the healthy tooth structure, and it means that the decay is gone. When I explain this to the patient ahead of the procedure, what I’ve done is remove the negative association with the vibration, and now the sound becomes something good,” says Dr Ho. 

Six ways to soothe your anxiety at the dentist

Overcoming dental anxiety is a gradual process that involves various strategies and coping mechanisms. Dentists share six ways to ease your fear in a dental setting.

1. Gradual exposure

Dr Ho suggests starting with minor dental visits to acclimatise and build confidence before undergoing more extensive procedures. Minor dental visits involve procedures such as teeth scaling and polishing.

2. Relaxation techniques

Practising deep breathing or mindfulness exercises before and during dental appointments can make you feel better, say dentists.

Rubbing essential oils such as lavender on your wrists or drinking chamomile tea before a dental appointment can also help you feel relaxed, says Dr Arora.

3. Stress ball 

Squeezing a stress ball can ease dental anxiety during treatments, says Dr Ho. 

If the patient is a child, parents can take along a toy or a blanket that the child typically holds to feel secure, he adds. 

Dr Arora also provides her patients with a blanket and cushion for comfort if needed.

4. Support network

Take along a friend or family member for moral support during dental visits, as it can help alleviate anxiety.

5. Education

Ask your dentist for infographics or videos that explain dental procedures to better understand your treatment. 

This will help by reducing the fear of the unknown.

6. Inform the dentist

Tell the receptionist or dentist about your fears, so dental treatment can be modified accordingly.

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