Overcoming Dental Anxiety: Finding Solutions for Pain-Phobic Patients

Fear of pain prevents me from doing many things and makes me very anxious?

Hello, doctor.
I am unsure which specialties to consult, so I am asking here first.
I am a severe malocclusion patient, but I have been extremely afraid of pain since childhood, so I have firmly rejected any recommendations from anyone, including dentists, to undergo orthodontic treatment.
Now, I often find myself poking at my misaligned teeth with my fingers because my bite feels very uncomfortable.
In my younger years, I was unaware of my mouth being open, so I didn't feel much discomfort.
For over twenty years, I have silently endured various direct and indirect ridicule due to my teeth.
Three years ago, I could no longer tolerate it, so I began actively researching information on orthodontics.
However, dentists downplay the pain associated with orthodontic treatment, as seen in this response on the website: https://adoctor.tw/article/63802, or they say it’s just soreness and discomfort that can be tolerated.
But from what I have read from patient experiences, it sounds extremely painful and unbearable for me, with different stages of pain to endure, even with more advanced devices.
Pain relief medications have not been effective, and dentists have mentioned that the anti-inflammatory components in painkillers can hinder tooth movement.
This has only increased my anxiety, panic, and fear.

I consulted four orthodontic specialists directly, and each time I was terrified and didn't dare to express my extreme fear of pain, feeling embarrassed and worried that no dentist would be willing to treat me.
Additionally, my case requires tooth extractions, and I fear that if there is an infection, it would lead to severe pain, so I ultimately left it unresolved.
Consequently, my anxiety, panic, and depression have worsened, leading to insomnia and emotional instability, which eventually caused me to lose my job.
I no longer want to endure ridicule and bullying in society, so I am afraid to seek employment and have isolated myself at home, living off my savings.
I have tried seeing psychiatrists and psychologists, but each time, they focused on work and interpersonal issues, which only strayed further from addressing my fundamental fear of pain.
After about three years without any progress, I stopped going.

In my senior year of college, I experienced a month of anxiety and insomnia before having a horizontally impacted wisdom tooth extracted, which indirectly caused me to fail my graduate school entrance exam.
Although I managed to avoid pain after the extraction by continuously taking pain and anti-inflammatory medications, I have ignored another wisdom tooth that is deeper and not erupting because I know that dealing with it would not be easy.
After starting work, I also experienced mild stomach pain and was anxious about needing an endoscopy, but a physician friend later diagnosed it as not necessary, which relieved my anxiety.
Last year, I discovered that some people have a unique constitution that allows them to undergo orthodontics without pain.
I thought traditional Chinese medicine could change one’s constitution, so I inquired about it on this site, but the answer was also negative: https://adoctor.tw/article/114188 &SortBy=q_no&PageNo=2.
I have searched online for various pain relief and prevention medications but have not found satisfactory answers.
A relative mentioned a pain clinic, but I couldn't find any information online about whether my case would be applicable.
Should I give it a try? I have also looked for remedies to reduce my pain perception, but none have been sustainable or verifiable.
The thought of aging and facing various physical pains fills me with anxiety.
However, I cannot end my life to escape pain; I can only continue to survive.
I am even afraid to attempt something as minor as orthodontics, and many medical procedures are far more painful, which is quite embarrassing to admit.
What methods should I use to resolve my issues?

Mr. Hsu, 30~39 year old female. Ask Date: 2017/04/13

Dr. Chen Taicheng reply Family Medicine

Hello.
I understand your situation.
I have encountered many patients who have undergone surgeries, experienced fractures, childbirth, orthognathic surgery, and chemotherapy for cancer.
Pain is inevitable, but each person has a different tolerance for pain and requires different methods of pain relief (ranging from oral medications, injections, patches, epidural analgesia, nerve blocks, to cognitive-behavioral control).
Fortunately, with advancements in medical care, many large hospitals, such as medical centers, have pain clinics and specialized physicians to address pain management issues.
Some medications from psychiatry also have good effects in alleviating anxiety and pain.
I recommend that you visit a pain clinic at a large hospital for better pain control.
Wishing you good health, Dr.
Chen Tai-Cheng from the Family Medicine Department of Taoyuan Hospital is concerned about you.

Reply Date: 2017/04/13

More Info

Overcoming dental anxiety, particularly for patients who have a fear of pain, is a significant challenge that requires a multifaceted approach. Your situation is not uncommon, and many individuals experience similar fears regarding dental procedures, especially those involving orthodontics or extractions. Here are some strategies and considerations that may help you navigate your dental anxiety and find a path forward.

Understanding Dental Anxiety
Dental anxiety can stem from various sources, including previous painful experiences, fear of the unknown, or even the sounds and smells associated with dental offices. It’s essential to recognize that your feelings are valid and that many people share similar fears. Understanding that dental professionals are trained to help patients manage pain and anxiety can be the first step in overcoming these fears.

Communication with Dental Professionals
One of the most critical steps you can take is to communicate openly with your dentist or orthodontist about your fears. While it may feel uncomfortable to discuss your anxiety, most dental professionals are accustomed to working with patients who have similar concerns. You might consider:
1. Expressing Your Fears: Let your dentist know about your fear of pain and previous experiences that have contributed to this anxiety. This information can help them tailor their approach to your treatment.

2. Asking Questions: Inquire about the procedures you will undergo, including what to expect in terms of pain and discomfort. Understanding the process can sometimes alleviate anxiety.

3. Discussing Pain Management Options: Ask about various pain management strategies available, such as local anesthesia, sedation dentistry, or even nitrous oxide (laughing gas). These options can significantly reduce discomfort during procedures.

Exploring Sedation Dentistry
Sedation dentistry is a viable option for patients with severe dental anxiety. It allows you to undergo necessary treatments while feeling relaxed and pain-free. There are different levels of sedation, including:
- Nitrous Oxide: This is a mild sedative that helps you relax while remaining conscious and able to respond to questions.

- Oral Sedation: This involves taking a sedative pill before your appointment, which can help you feel calm and drowsy.

- IV Sedation: This provides a deeper level of sedation, allowing you to be in a sleep-like state during the procedure.

Discussing these options with your dentist can help you find a solution that makes you feel more comfortable.

Cognitive Behavioral Therapy (CBT)
Since you have experienced anxiety that has affected your daily life, seeking help from a mental health professional who specializes in cognitive-behavioral therapy (CBT) may be beneficial. CBT can help you:
- Identify and challenge negative thought patterns related to dental procedures.

- Develop coping strategies to manage anxiety.

- Gradually expose yourself to dental situations in a controlled manner, reducing fear over time.

Pain Clinics and Alternative Therapies
You mentioned the possibility of visiting a pain clinic. These clinics specialize in managing chronic pain and may offer therapies that could help you manage your anxiety and pain perception. Additionally, exploring alternative therapies, such as acupuncture or mindfulness meditation, may provide relief from anxiety and improve your overall well-being.

Gradual Exposure
Consider a gradual exposure approach to dental visits. Start with non-invasive appointments, such as a consultation or a cleaning, where you can familiarize yourself with the environment and the staff without undergoing any painful procedures. This can help build your confidence and reduce anxiety over time.

Support Groups
Joining a support group for individuals with dental anxiety can provide a sense of community and understanding. Hearing others share their experiences and coping strategies can be empowering and may help you feel less isolated in your fears.

Conclusion
Overcoming dental anxiety is a process that requires patience and support. By communicating openly with your dental provider, exploring sedation options, seeking mental health support, and gradually exposing yourself to dental environments, you can take significant steps toward managing your fears. Remember, you are not alone in this journey, and there are professionals and resources available to help you navigate your dental health with confidence.

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