If you believe you need extensive dental treatment but feel anxious about seeing a dentist, taking the first step can be difficult. Some people postpone appointments for months or years because of fear, embarrassment or a previous distressing experience.
Dental anxiety is not something to feel ashamed about. Letting the dental team know how you feel can help them adapt the assessment, communication and treatment process to your needs.
You do not have to agree to treatment at your first appointment. An initial visit can simply be used to discuss your concerns, assess your oral health and understand the available options.
Why are some people scared of the dentist?
Dental anxiety can have many causes. Common concerns include:
- Fear of pain or injections
- A previous difficult dental experience
- Feeling unable to stop the procedure
- Sensitivity to sounds, smells or sensations
- Concern about being judged
- Uncertainty about what treatment will involve
- Worry about treatment costs
- A sensitive gag reflex
- Difficulty becoming numb
- Fear associated with sedation or medication
- Feeling overwhelmed by the amount of treatment required
Some people experience mild nervousness, while others may have significant dental anxiety or a specific phobia. The most appropriate support will depend on the individual and the proposed treatment.
What should you tell the dental practice?
When booking, tell the practice that you feel anxious and may need additional time. You can ask whether the first appointment can focus on discussion and examination rather than treatment.
It may help to tell the dentist:
- What you are most worried about
- Whether you have had a difficult experience before
- What helped or did not help at previous appointments
- Whether you are concerned about injections or local anaesthetic
- Whether you experience panic attacks or have a diagnosed anxiety condition
- Whether you take medication for anxiety or another health condition
- Whether you would like a support person present
- How much information you prefer during treatment
Providing this information allows the dental team to consider reasonable adjustments and discuss an approach with you.
What happens at the first appointment?
An initial dental assessment may include:
- A discussion of your concerns and priorities
- Review of your medical and dental history
- Review of your medications and allergies
- Examination of your teeth and gums
- Dental X-rays where clinically indicated
- Identification of urgent and non-urgent concerns
- Discussion of treatment options and alternatives
- An explanation of likely risks, fees and appointment requirements
If you are not ready for a complete examination, tell the dentist. Depending on the circumstances, the assessment may be divided across more than one appointment.
Further tests may be required before a definitive diagnosis, treatment plan and quotation can be provided.
You may not need to complete everything at once
Needing extensive dental work does not necessarily mean that every procedure must be completed immediately.
After examining you, the dentist may divide the proposed care into stages. Priorities may include:
- Managing pain, infection or another urgent condition
- Stabilising tooth decay or gum disease
- Addressing teeth at risk of further damage
- Restoring chewing function where required
- Considering longer-term restorative or cosmetic treatment
- Establishing preventive care and ongoing maintenance
Staging treatment can make the process more manageable and allow you time to consider each decision. However, delaying certain conditions may increase the risk of pain, infection or more complex treatment. Your dentist should explain which problems require prompt attention and which may reasonably be monitored.
Ways to make dental appointments more manageable
Several non-drug strategies may assist anxious patients. Their usefulness varies between individuals.
Agree on a stop signal
Before treatment begins, agree on a clear hand signal that means “please stop.” The dentist can then pause when it is clinically safe to do so.
You can also ask the dentist to explain what will happen before each stage.
Begin with a shorter appointment
A brief consultation or examination can provide an opportunity to become familiar with the practice before undertaking treatment.
Schedule appointments at a suitable time
Some patients prefer appointments early in the day so they have less time to anticipate the visit. Others need a particular time because of work, medication or support-person availability.
Use distraction where appropriate
Listening to music, using headphones or watching a screen may help some patients. These measures do not remove all anxiety, and you must still be able to communicate with the dental team when required.
Discuss local anesthetic
Local anesthetic is commonly used to numb the treatment area. The dentist should allow sufficient time for it to take effect and assess the area before proceeding.
Tell your dentist if you have previously experienced difficulty becoming numb. Additional assessment or a modified approach may be required.
No dentist can guarantee that treatment will be completely free from discomfort, but pain-control options and your concerns should be discussed before treatment begins.
Consider psychological support
For significant dental phobia, psychological approaches such as cognitive behavioural therapy or graded exposure may be helpful. Your general practitioner or mental health practitioner can advise whether this may be appropriate.
Could sedation help with dental anxiety?
Sedation may be considered for some patients who experience significant anxiety or who are undergoing particular procedures. It does not replace a careful explanation, informed consent, appropriate local anaesthetic or respectful communication.
The available options depend on the practice, the treating practitioners, your health and the proposed dental procedure.
Minimal sedation or anxiolysis
Minimal sedation may involve an inhaled agent or a prescribed medicine intended to reduce anxiety while the patient remains responsive.
Suitability depends on your medical history, medications and the planned treatment. Even minimal sedation can have side effects and requires appropriate assessment and instructions.
Conscious sedation
Conscious sedation uses medication to reduce awareness and anxiety. The patient remains able to respond purposefully to verbal instructions or light physical stimulation.
Conscious sedation is not the same as general anaesthesia. Some patients may remember little about the appointment, while others may retain more memory. Lack of awareness or memory cannot be guaranteed.
Intravenous sedation
Intravenous, or IV, sedation involves administering medication through a vein. It must be provided by an appropriately qualified practitioner with suitable monitoring, equipment and staff.
During IV sedation, the patient is usually drowsy and less aware of the procedure but is not necessarily unconscious. Local anaesthetic may still be required for dental treatment.
General anaesthesia
General anaesthesia produces a controlled state of unconsciousness. It is different from conscious sedation and is generally provided in an appropriately equipped facility by a suitably qualified anaesthesia team.
General anaesthesia may be considered in selected circumstances but is not necessary or appropriate for every anxious patient.
What are the risks of dental sedation?
Sedation is not risk-free. Potential effects and complications depend on the medicine, dose, level of sedation and individual health factors.
These may include:
- Drowsiness
- Dizziness or impaired coordination
- Nausea or vomiting
- Headache
- Changes in breathing, heart rate or blood pressure
- An unexpected or paradoxical reaction
- Allergic or medication-related reactions
- Excessive sedation
- Delayed recovery
- Inadequate reduction in anxiety
- The need for additional medical care
Certain health conditions, medicines, pregnancy, alcohol or other drug use may affect suitability.
Before sedation, provide a complete medical history and an accurate list of prescribed medicines, non-prescription medicines and supplements. Do not stop or alter prescribed medication unless instructed by the prescribing practitioner.
Preparing for sedation
Instructions vary according to the proposed sedation method. You may be asked to:
- Follow specific eating and drinking instructions
- Arrange for a responsible adult to accompany you
- Organise transport home
- Avoid driving, operating machinery or making important decisions for a specified period
- Arrange for an adult to remain with you after the appointment
- Wear suitable clothing
- Allow time for monitored recovery
Follow the instructions provided by the treating practitioner. If you do not understand them, ask for clarification before the appointment.
Questions to ask about sedation
Before agreeing to sedation, consider asking:
- What type of sedation is being proposed?
- Why is it being recommended for me?
- Who will administer and monitor it?
- What qualifications or endorsement does that practitioner hold?
- Will I remain conscious?
- Will local anaesthetic also be required?
- What are the material risks in my circumstances?
- What alternatives are available?
- What preparation is required?
- Will I need an escort?
- What restrictions apply afterwards?
- Are sedation and monitoring included in the quotation?
- What happens if the planned treatment cannot be completed?
You should have an opportunity to ask questions before providing consent.
What if you feel embarrassed about your teeth?
Some people avoid dental care because they are worried about being criticised. A dental assessment should focus on your current oral health and the options available—not on blaming you for how the condition developed.
You can tell the practice that you are concerned about feeling judged. If you do not feel respected or sufficiently informed, you can pause the process or seek another opinion.
When should you seek urgent dental care?
Contact a dental practitioner promptly if you have:
- Significant or increasing dental pain
- Facial or gum swelling
- Dental trauma
- Persistent bleeding
- A broken tooth causing pain
- Signs of spreading infection
- Difficulty opening your mouth
Seek urgent medical attention if swelling affects your breathing or swallowing, or if you become significantly unwell.
Taking the first step
If you are scared of the dentist and believe you need extensive dental work, the first step can be a conversation rather than a treatment appointment.
An assessment can help identify what is urgent, what can be treated in stages and which anxiety-management or sedation options may be appropriate for you.
To discuss dental anxiety and treatment options, contact Smile Design Studio in Mosman Park, Perth, on (08) 9468 3322 or request an appointment online.
Important information
This article provides general information only and does not replace individual dental, medical or psychological advice.
The suitability, effects and risks of dental treatment, local anaesthetic and sedation vary between patients. Comfort, lack of pain, completion of treatment and loss of memory cannot be guaranteed.
A clinical assessment and informed consent process are required before treatment or sedation can be recommended.
