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Dental Phobia and Anxiety - analysis
The are Reasons for dental phobia and anxiety
Causes of Anxiety, Phobia and the Fear Response in the Dental Office
The ORIGIN of dental fear can be pictured as an overlay of four contributing factors. The RESPONSE to this fear is personal.
Within the Somatic Experiencing Model - the five elements that define our experiences are Sensation, Image, Behavior, Affect and Meaning. We will see that each of these elements takes a major role in the etiology of dental phobia and the response thereto.
FEAR: Personal factors, Dental factors, External/social factors, and Sensory Sensitivity
1. Personal factors: determined by precious history. History of trauma which overwhelmed the nervous system. History of lack of control and lack of choice, vulnerability and inescapability - these all contribute. History of trauma to the teeth is especially potent.
2. Dental treatment factors: Position, obstruction, invasive nature, remembered experience of pain in dental treatment. Also, the need for more control than experiencing, or potential conflicting personalities with the dentist.
3. External factors: parental or peer communication of fear. Some studies suggest socioeconomic and immigrant status plays a role, but this may have more to do with the likelihood of previous trauma.
4. Sensory sensitivity - hyper reaction to light, touch or sound. Sensory Processing Disorder is a possibility in these cases, although not well defined.
FEAR RESPONSE: the following sequence often ensues:
1. Cognitive - there is an IMAGE which gives the perception of threat. It may just be the image of dental instruments approaching your mouth.
2. Physiologic - there are SENSATIONS - the initiation of muscular tension and Autonomic Nervous System activation with concurrent awareness of tingling, heat, tightness ... a myriad of sensations may be noticed.
3. Sensations are misinterpreted as signs (cues) of danger or threat - in Somatic Experiencing terms we call this making a MEANING - an intellectual interpretation which may or may not be accurate and true.
4. Dread, panic, terror - emotional reactions which we include as AFFECT.
BEHAVIORS that automatically arise from the fear response:
1. Withdrawal from dental treatment - flight
2. Aggressive defense response in dental office - fight
3. Immobility - freeze. Helplessness as therapy reminds of past assult?
4. Deflection of attack - excuses not to get treatment: poor relationship with dental office personnel (skipped appointments); no treatment sought - and shame response to appearance as a result of poor dental condition
5. TMJ problems and excessive wear to opposing teeth as habitual grinding and clenching ensues from the stress of unresolved issues.