To help the woman overcome her fears, Heaton launched her
on a program of gradual, desensitizing exposure to the dental
experience and taught her effective coping strategies. Thanks to
those interventions, the woman now visits her dentist regularly,
despite some lingering nervousness. Instead of replaying
scenes from her childhood dentist’s office, she practices deep
breathing, listens to music on her iPod and raises her hand
whenever she wants the dentist or hygienist to give her a break.
“She has all kinds of coping strategies lined up,” says Heaton.
“We’ve tried to replace her negative experiences with positive
Heaton is one of several psychologists working alongside
dentists to improve patients’ oral health. Like her, many focus
on helping patients overcome dental anxiety and phobia via
cognitive-behavioral therapy and other techniques. Others are
exploring the causes of and cures for oral health problems,
such as temporomandibular joint disorder. Psychologists are
also playing important roles in training future dentists and
hygienists, bringing psychological and behavioral science to
bear on such topics as communicating effectively with patients,
managing pain and encouraging smoking cessation.
“Dentistry was never on my radar,” says psychologist Dolores
Cannella, PhD, associate dean for education at New York’s
Stony Brook School of Dental Medicine. “But there’s so much
psychologists can do in dentistry. Dentistry is about interacting;
it’s about human behavior.”
Anxiety is one of the most common problems psychologists see
in the dental arena, says Daniel W. McNeil, PhD, a professor of
psychology and clinical professor of dental practice and rural
health at West Virginia University.
In a chapter in the 2014 book “Behavioral Dentistry,” he and
doctoral candidate Cameron L. Randall note that almost half
of American adults have at least moderate levels of dentistry-related fear, with 5 percent to 10 percent reporting that they
avoid dental care as a result.
It’s not only bad childhood experiences that spur dental fear,
“It’s actually less common that dental trauma alone
contributes to dental fear and phobia,” he says. Instead, going
to the dentist often evokes other fears, such as being trapped,
getting an injection, seeing blood or having
your personal space invaded. Anxious
family members can pass on the idea that
dentistry is scary, a message underscored
by popular media depictions of dental
visits as unpleasant or painful. “I heard an
ad on the radio once that said refinancing
your mortgage shouldn’t be as painful as a
root canal,” says McNeil.
There may even be a genetic basis
to dental fear, says McNeil. McNeil is
supervising research at the National
Institute of Dental and Craniofacial
Research-funded Center for Oral Health
Research in Appalachia, focusing on a gene
variant that may contribute to heightened
pain sensitivity and thus dental anxiety.
The consequences of dental fear don’t
just include bad breath, cavities and
periodontal disease. “The research clearly
shows that having decayed or missing teeth
has a strong negative impact on self-esteem,” says McNeil. “It
also has an impact on employability.” And because periodontal
disease is associated with cardiovascular disease, diabetes, stroke
and premature birth, he adds, the fear of going to the dentist
can ultimately even be life-threatening.
Fortunately, say McNeil and others, psychologists can treat
At the clinic where Heaton works, for example, the process
begins with an assessment of patients’ specific concerns.
She then uses gradual exposure to desensitize patients to
whatever they fear. If it’s injections, Heaton teaches her patients
progressive muscle relaxation, diaphragmatic breathing and
other coping skills. A dentist then rehearses the steps of an
injection with the patient, beginning by simply inserting a
capped needle into the patient’s mouth and — as anxiety
decreases — working up to an actual injection.
Heaton also encourages patients to replace negative thoughts
with positive ones.
“Very often people are thinking, ‘This is terrible; it’s never
going to end; I can’t stand this,’” says Heaton. “We work on
The very nature of dentistry can be
trying. “Few of your patients really
want to be there, and many of them
tell you when they walk in, ‘I hate
dentists.’ The negativity wears on
Bruce Peltier, PhD
The Arthur A. Dugoni School of Dentistry, University of the Pacific in San Francisco