Oral Health Group

Dental Anxiety What Are We Missing?

February 1, 2015
by Jonathan Campbell, DDS

Dental professionals have become highly proficient in providing local anaesthesia. Local anaesthesia reduces pain by blocking sodium channels, however, many patients find the injection process anxiety-inducing.1 It is not only just pain that makes many patients uncomfortable. The plethora of instrument sounds and smells, the violation of personal space, and experiencing unusual sensations, can make many feel anxious and or fearful.2 Accordingly, local anesthesia is not the sole solution for many patients.3 A viable adjunct to local anaesthesia that is highly effective at reducing anxiety levels is sedation or anaesthesia.4

Currently, the Canadian literature provides researchers with the following studies regarding dental anxiety prevalence. In 1997, 2609 adults were surveyed at random from a Toronto-based voter list.5 The participants informed the authors that 10.7 percent of them had fear and anxiety when Corah’s Dental Anxiety Scale score, a widely validated tool to assess dental anxiety, was set to 13.5 In 1999, a mail-based survey of adult dental patients reported that more than half of the dental anxiety reported by respondents commenced during childhood and that 16.4 percent were dentally anxious.6 In a 2005 article by Chanpong, regarding a nation wide telephone survey of 1,101 people, 5.5 percent of Canadians reported being very afraid or terrified of dental treatment.7 Accordingly, it is likely that a great proportion of people would be interested in sedation for certain dental procedures. Similar levels of anxiety and fear are reported from surveys conducted the United States.8


As research shows, fear and anxiety are quite prevalent within our population as are the negative effects associated with it. The primary reason that people avoid seeking dental care stems from their fear and anxiety towards treatment.9 Consequently, numerous patients who live with dental fear or anxiety postpone seeing their dental professional.10,11 Quality of life is affected as these patients struggle to attend their dental appointments. Therefore, they suffer the consequences of not accessing their required dental care. This results in consequences such as odontogenic pain and swelling, missing teeth, limited masticatory function, temporal mandibular joint discomfort, poor esthetics, and lower self-esteem.12 Furthermore, there is an inverse relationship between quality of life and dental anxiety. Finally, a vicious cycle is created in which a patient does not seek dental care until they a problem exists. Regrettably these patients do not return for a comprehensive examination and treatment but rather wait until another serious enough problem arises.13

Unfortunately dentists’ ability to perceive their patients’ needs and preferences for sedation and anaesthesia services is not equal. Dentists consistently underestimate the need for these services.14,15 This situation was evident in the survey study conducted by Patodia et al. in 2013. This survey, which focused on Ontario dentists, had the following results. Dentists estimated that 66.8 percent of patients were not interested in sedation/anaesthesia (GA), while 43.9 percent of patients indicated they were not interested in sedation/GA only.16 Dentists estimated that 19.8 percent of patients would be interested in sedation/GA depending on costs versus patients’ actual interest of 43.9 percent.16 Furthermore, estimates by dentists regarding patients being definitely interested in sedation/GA was 13.5 percent while the patients indicated that 12.4 percent of them would definitely be interested.16 The reason for the mismatch between dentist perceptions and patient preferences has not yet been determined.16

Dentists perceptions for the need and demand for sedation and anaesthesia is clearly not corresponding to what patients would like, however, patients are leading us to believe they are attracted to these services.9 In the UK and US, numerous surveys demonstrate that roughly half of the respondents would prefer to have sedation if the choice was presented.8,17,18 In Canada, Chanpong et al (2005), reported that, in respondents with low fear, 12.4 percent were definitely interested in sedation or GA and 42.3 percent would be interested depending on cost.7 These numbers increased in the high fear group: 31.1 percent and 54.1 percent, respectively.l,7 Preference for these services by procedure type were: 7.2 percent for cleaning, 18 percent for restorative, 46 percent for extractions, 54.7 percent for root canals, and 68.2 percent for periodontal surgery.7 Moreover, these procedure-specific preferences were larger than the actual amount of sedation/GA being delivered.7 In summary, patient demand for sedation and anaesthesia services is not being addressed fully by dentists.19

We now know that there is significant fear and anxiety towards dental care within our population. Within Canada, the most recent study shows that 5.5 percent are very afraid, and 9.8 percent are somewhat afraid.7 However, in Ontario, where numerous fear and anxiety studies surrounding dental treatment have been conducted, the literature displays a higher value at roughly 10-17 percent.20 This situation has serious negative cycle effects that are evident in patients’ behavior, including. failed or postponed dental visits, lack of preventative care, and overall poor oral health. Dentists sometimes fail to perceive their patients’ desires for methods to reduce their anxiety when seeking dental care. In contrast, patients want to have more dental procedures completed with sedation or anaesthesia.OH

Jonathan Campbell, DDS,
Dental Anaesthesia MSc candidate

Dr. Campbell is a third-year resident in the Dental Anaesthesia program at the University of Toronto, Faculty of Dentistry.

Oral Health welcomes this original article.


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