Dental anxiety
Tools to help you feel calmer and more in control — before, during, and after appointments
The spiral
It can be overwhelming at the dentist. Loss of control, a multitude of stimuli —sensations, sounds, smells, the vulnerability of lying back with your mouth open. Even the thought of the dentist can be too much when you have dental anxiety. Actually making it to the chair is another thing altogether.
The cycle of anticipation and dread, is a well-oiled loop by the time you’re at the appointment. And for someone who is already on high alert — attention narrows and fixates which leads to even more stress.
But – this is simply a pattern of learned behaviour. And the way forward is the same as in all health anxiety, that is, teach the brain to expect a more manageable experience.
The predictive brain
This might help explain:
It’s a boiling hot day, you’ve climbed an impossible hill, and you reach for a bottle of water — believing that you have immediately quenched your thirst. But actually, the body itself, its tissues and its muscles, don’t even feel the effects of the water for another 20 minutes. This is your brain predicting you will be quenched — based on past experience. And that’s neuroscience.
In dental anxiety, your brain has filed the dentist under ‘threat’ on previous visits. However, once you learn to realise that your brain is predicting your situation, you can learn to give it different or positive expectations.
Through mental rehearsal, gradual exposure – the pairing of a calm physiology with the visualisation of the appointment — the brain begins to update and expect ‘manageable‘ instead of ‘danger.’
Releasing the tension
A flexible body creates a flexible mind, and vice-versa. We work on this.
Say it’s raining, and we’re rushing along the street without protection. The face is grimacing, the body bracing, our forms shrinking — we are creating a lot of tension. And yet, we get wet either way! The bracing doesn’t change the outcome. What changes is the suffering on top. When we’re more relaxed, things require less effort.
Acceptance
Another effective technique to stop the suffering is acceptance. This is not passive. This is working with what is.
Imagine you’re swimming with a beach ball. The beach ball is your fear, your gag reflex, your panic — and you’re trying to push it under the water. Imagine the struggle. The effort.
This work is about just letting it be there. Letting it float on the surface while you focus on your breathing, your tools, your communication with the dentist. Learning to move forward with your appointment rather than battling with the sensations.
Which group are you?
I fondly put dental anxiety into three groups: the white-knucklers, the cancellers, and the avoiders.
The White-Knucklers
The white-knucklers have made it to the chair, but they have not yet prepared themselves to cope and therefore suffer through — the stress ramped up to 90. They leave the appointment rattled — their fears confirmed — they ‘just knew it would be that bad’.
The Cancellers
The cancellers have a brain that has a cunning plan! which is to get them out of the situation at the last minute. This is quite a clever strategy, but unfortunately the short-term relief does not update the brain’s expectations and therefore the fear and inability to cope remain firmly in place until the next time. The overall mood may turn from relief to a festering frustration with oneself.
The Avoiders
There is no shame in avoiding — it’s the brain trying to protect you. But the costs are pretty high in terms of urgent, more stressful outcomes from neglect, and more financial cost from invasive treatment. We go slowly with avoiders.
How we work together
The goal in dental anxiety is, realistically, to have a more manageable experience in the chair. And so we work together to find the best, most appropriate tools for you to use.
We look at your level of anxiety and when the triggers start. Is it at the thought of the dentist? The day before? Walking up the stairs? Standing at reception, or only once you’re in the chair?
In all situations, the preparation is key. Here are the tools we use:
The tools
This work draws on the integration of CBT, mindfulness, clinical hypnosis, and Acceptance and Commitment Therapy, along with my personal interest in neuroscience and Stoic philosophy.
You learn:
• Breath work and tension release work to down-regulate the nervous system
• To use it with mental rehearsal of the dental appointment — rapidly and effectively embedding the mashup, and therefore updating the brain with new, more helpful experiences
• Grounding techniques to help you be present and curious in the moment — instead of letting your mind race back to the catastrophic past and projecting towards the doom-filled future. Our actual experience is usually far more manageable than our imagined experience
• Communication skills with the dentist — because when we are stressed, attention is narrowed to the point that we become unable to grasp completely what is being communicated. Listening and responding helps us feel more in control
• How to actually ‘do’ hypnosis — a trainable skill — by using the power of your imagination, focused on a dominant idea
• Graded exposure — taking micro steps towards a particular challenge (e.g. gagging) and using self-talk to calm your associations ahead of your appointment
• Self-hypnosis to use in the chair — strategically turning the volume up on your preferred experience, such as going to the beach, whilst turning the volume down on the actual experience
Desensitisation
Graded exposure, or desensitisation, is when we do tiny behavioural experiments to give the brain new information. These are between-session tasks that you will be asked to carry out if you have a very strong gag reflex.
They involve employing breathwork, tension release, and self-talk until the body feels safe, and only then, in your own time, inserting a toothbrush into the mouth by half a centimetre. Then, repeating the cycle — inserting the brush another half a centimetre. Gradually building up self-efficacy.
The same evidence-based method is used in all phobia work, such as needles too.
If you grind your teeth
If your issue is TMJ or teeth grinding (bruxism), one of your specific tools will be tension release techniques that can be used throughout the day — reminding the brain just what it feels like to be totally relaxed in the jaw.
What about sedation?
Sedation can be extremely useful. My work doesn’t encourage you to stop it. Instead, we build skills alongside it, so over time you may have more options and feel less dependent on medication — if that’s your goal.
Some people use sedation and would like to feel more mentally prepared. Some people can’t access it due to cost or medical reasons. Some people simply want another option.
Wherever you are, this work meets you there. And if you do choose to reduce sedation gradually, you’ll have a solid toolkit to support you through that transition.
Clinical hypnosis
Clinical hypnosis is a key part of this work because it helps embed new patterns faster and more effectively. We use it in three ways:
The first is a light hypnosis called mental rehearsal, where we repeatedly practise the appointment.
The second is to use guided hypnosis, and then self-hypnosis in the chair.
The third is to use it for ‘turning down’ sensations/discomfort during and after the appointment when the anaesthetic has worn off. Alternatively we can employ mindfulness and realistic assumptions about the sensations.
What to expect
In the free consultation, we look at your triggers, your level of anxiety, and whether there are specific issues that need to be worked on.
In sessions we then work flexibly with the toolbox, until you become aware of what’s happening in your mind and body — and know how to handle it.
I want you to finish our work together knowing that you can cope with the dental experience. That you can estimate the risk rationally, estimate your coping realistically. That you can reassure yourself, be kind to yourself, as you teach the brain new patterns — creating a loop of self-efficacy amd empowerment.
And luckily, these tools generalise into other areas of your life where fear shows up. Working through your dental anxiety will just be the start.
Why I do this
I know from personal experience how stress can amplify a situation in the short and long-term. How it can live in the body, sometimes unnoticed. How our thoughts and feelings and beliefs can become embedded so automatic we forget to question and test them.
However, once we discover we don’t have to be swept along by this rush of default behaviour, once we notice our experience, know that we can cope — we can create a different outcome.