Dental anxiety, fear and phobia

Being nervous about the dentist is common and nothing to apologise for. For some people it is mild unease; for others it means avoiding treatment for years, which is its own problem — avoidance tends to mean more is needed by the time they do come, which confirms the fear.

This page is about what actually helps, and what we can and cannot do about it.

Anxiety, fear and phobia are different things

Dental anxiety is apprehension in anticipation — the unease in the days before an appointment.

Dental fear is a reaction to a specific trigger: the sound of the drill, the sight of a needle, the feeling of being reclined.

Dental phobia is a clinically diagnosed condition involving marked fear and persistent avoidance. It is not simply a stronger version of nerves, and it often does not resolve with reassurance alone.

A degree of anxiety before any health procedure is entirely normal. If it is interfering with your daily life, or stopping you from getting care you need, that is worth raising with your GP — psychological approaches such as cognitive behavioural therapy have good evidence behind them for dental phobia specifically, and a referral is a reasonable thing to ask for.

We would rather tell you that than imply a dental practice alone can resolve a phobia.

Where it comes from

Often a difficult experience in childhood, at a time when techniques and pain control were less good than they are now. Sometimes a single bad experience as an adult; sometimes anxiety absorbed from a parent; sometimes it is about loss of control, or the position, or the sounds rather than pain at all.

Embarrassment is one of the most common reasons people avoid coming — worry about being judged for how long it has been, or for the state of their teeth.

Worth saying plainly: we are not going to lecture you. People arrive having not seen a dentist for ten or fifteen years. It is common, we have seen it many times, and the useful conversation is about what you want to do from here.

Find your actual trigger

"The dentist" is rarely the whole of it. Naming the specific part is what makes it manageable, because different triggers have different answers.

It is entirely reasonable to say "the injection is the only part I cannot handle" — that is far more useful to us than "I hate the dentist".

What helps

Tell us before the appointment, not on the day. With notice we can book more time so nothing is rushed. This makes more difference than anything else on this page.

Agree a stop signal. Raising your hand means we stop — not "nearly finished", but stop. Knowing you can end it at any moment is, for many people, the thing that makes it bearable, and most never need to use it.

Ask for as much or as little explanation as you want. Some people are calmer knowing each step in advance; others would rather not know. Both are fine — tell us which you are.

Start small. A first visit can be a conversation with nothing done at all. Then an examination. Then a clean. Building up over several short visits works better than forcing one long difficult one.

Bring someone, and bring headphones and your own music or a podcast.

Morning appointments often suit better — less of the day spent anticipating it.

Something to do in the chair

Slow breathing genuinely dampens the physical side of anxiety — the racing heart, the shaking, the tight chest — because a long exhale slows the heart rate directly.

Breathe in through your nose for a count of four, then out for a count of six or seven. The out-breath being longer than the in-breath is the part that does the work. Do it for a minute before you go in, and again whenever you notice yourself tensing.

Two things that are worth avoiding beforehand: strong coffee, which produces exactly the physical sensations you are trying to avoid, and alcohol, which interacts with local anaesthetic and tends to make people harder to numb rather than calmer.

Comfort and pain control

Stronger topical anaesthetic gels are used before an injection to numb the surface first. Local anaesthetic itself is very effective; if you feel anything sharp, say so and more can be given.

For suitable small cavities we can use air abrasion rather than a drill — no vibration, no noise, often no needle. It is not suitable for every cavity, particularly larger or deeper ones, but where it applies it removes much of what people find difficult.

We would not claim that dentistry is painless. What we will say is that pain is manageable, that you should not have to endure it silently, and that telling us something hurts is useful information rather than a complaint.

If you have been told you need sedation or a general anaesthetic, ask us. Treatment under general anaesthetic is carried out in a hospital or a facility set up for it, not in a general practice, and we would refer for that. It is worth knowing that sedation does not treat the anxiety — it gets one episode of treatment done, which is sometimes exactly what is needed to break a cycle, and sometimes leaves the fear untouched for next time.

What the first appointment is actually like

For anyone who has been away a long time, the unknown is most of the problem. So, concretely:

1. You arrive and complete a medical history form. Reception knows you are anxious if you told us when booking
2. You sit down and talk. The chair stays upright. Nothing is in your mouth at this stage
3. You say what you are worried about and what you want out of the visit
4. If you are willing, a look with a mirror — no instruments, no scraping. Two minutes
5. Radiographs only if you agree, and only where they would change what happens next
6. A conversation about what was found, in plain terms, with the screen turned towards you
7. A written plan, in an order you agree with, with the costs
8. Booking the next step, or not — that is genuinely your call

Steps four and five can be left out entirely at a first visit. Plenty of people stop at step three the first time and come back a fortnight later for the rest.

Costs, in advance

Money is a source of anxiety in its own right, and uncertainty about the bill is part of why people delay.

You are given a treatment plan with the costs before any new treatment goes ahead, and you authorise it. Nothing unscheduled happens without being discussed with you first.

HICAPS on-the-spot health fund claiming is available, and payment plans are accepted — see payment options for current details.

If you have been avoiding it for years

The hardest appointment is the first one, and it does not have to involve treatment. Call and say you are anxious and would like to come in and talk first. That is a completely normal request and reception will not think anything of it.

If calling is itself difficult, book online at any hour and note it there. Something like "I am very anxious, it has been a long time, I would like to talk first and not have anything done at the first visit" is all that is needed, and it will be on the file before you arrive.

For anxious children

Tell us in advance if your child has had a difficult experience elsewhere. Avoid words like hurt, needle and drill even reassuringly, and try not to pass on your own dental anxiety — children read tone closely. See first dental visit.

One more thing worth knowing: children take their cue from the adult in the room far more than from us. If you are the anxious one, it is worth saying so when you book, so we can work with that rather than around it.

Questions we are asked

Will you judge me for how bad my teeth are? No. What is in front of us is a starting point, not a verdict on you.

What if I panic or cry? It happens, it is not embarrassing to us, and it is not a reason to stop coming. We will pause, and carry on when you are ready or stop for the day.

Can I just have everything done at once so it is over with? Sometimes that is right, particularly for people who dread the anticipation more than the treatment. Often it is not. It is worth deciding deliberately rather than by default.

Can I bring my own music? Please do. Headphones are one of the most effective things on this page.

Do I have to have X-rays? No. We will explain what cannot be assessed without them so that the decision is informed, and then it is yours.

Will you tell me before you do anything? If you ask us to, yes, every time. If you would rather not know, say so and we will not narrate.

Victorian Dental Group — 291 Wattletree Road, Malvern East VIC 3145 · (03) 9088 5808 · Monday to Friday, 8:00am–5:00pm · book online

Read more about nerves and the dental visit, our clinic or what to book.

This page is general information and does not replace advice from a registered dental or health practitioner about your own circumstances. If dental anxiety is affecting your daily life, speak with your GP. Please see our Disclaimer.