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Surveys report that 13 percent to 24 percent of people are afraid of going to the dentist.

In most cases, dental anxiety is unpleasant but doesn't interfere with health. People whose dental fear is severe, however, may so dread the thought of going to the dentist that they cancel appointments, delay seeking care, and sometimes wind up needing more invasive and painful procedures as a result -- thereby meeting some of the criteria for specific phobia described in the "Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV)".

In the DSM-IV, dental phobia is considered a type of specific phobia (the blood-injection-injury type). A large Dutch study using DSM-IV criteria to assess the prevalence of 11 specific phobias found that dental phobia was the most common (followed by phobias of heights and spiders). While it may be possible to avoid heights and spiders, dental problems such as toothaches or broken teeth necessitate a visit to the dentist.

Similar to findings about prevalence in other types of anxiety disorders, women are more likely than men to report experiencing dental fear and phobia. About half of adults who suffer from dental phobia can trace their fears back to unpleasant childhood experiences -- memories that may be triggered at the sight of a dentist's chair, the sound of a dental drill, or the smell of antiseptic chemicals.

Although medications such as diazepam (Valium) and lorazepam (Ativan) may help reduce anxiety, they're best used in conjunction with various cognitive, educational, and behavioral strategies -- especially those that help patients gain a sense of control in a situation where they may feel helpless. The following techniques are easy to learn, get better with practice, and can be combined during a dental visit:

• Breathing techniques. Physical tension and emotional stress can increase the subjective experience of pain. People who are anxious tend to hold their breath or breathe rapidly. This sort of breathing pattern only heightens anxiety and muscle tension.

Deep breathing can counter physical and mental tension. One simple method to foster deep breathing is to breathe in slowly and count to five before exhaling to another count of five. Another technique is to place one hand beneath the belly button and breathe so that the abdomen rises and falls with each breath.

• Muscle relaxation. Progressive muscle relaxation (tensing and then releasing one group of muscles at a time in order to promote whole-body relaxation) can help to slow heart rate and promote calmness. Just a few minutes of progressive muscle relaxation, focused on two or three major muscle groups, may help during an appointment.

• Desensitization. This approach combines deep breathing and relaxation with gradual exposure (either through audiotapes, videotapes, or the patient's own imagination) to the cue that most triggers dental phobia. A patient afraid of needles, for example, may look at pictures of a dentist's needle in a safe environment, such as at home or in a therapist's office, while practicing relaxation and breathing techniques. The goal is to help the patient learn to relax while confronting a trigger of dental fear.

• Distraction. Putting the mind's focus elsewhere is another way to diminish the anxiety and pain of dental visits. The more complicated the task meant to distract, the better (listening to soothing music may not be enough). Children who are anxious may be distracted with stories or riddles.

Adults can try counting (such as tiles on the ceiling, or slats on a window blind) as a way of turning attention away from the procedure itself. Another technique is to have the patient try to raise both legs at once whenever anxiety starts increasing, to provide a physical distraction.

• Hypnosis. Hypnosis involves a state of deep relaxation attained through a combination of deep breathing, muscle relaxation, and attention modification. People who can't tolerate anesthesia and those who are afraid of needles may want to try hypnosis. It may be difficult to find a dentist trained in this technique, however.

Because children tend to have more vivid imaginations than adults and are more open to suggestion, hypnosis may be a particularly good technique for pediatric patients. Some patients may also be able to hypnotize themselves by combining relaxation techniques with positive imagery or focus words.

• Combined approach. Many patients with dental phobia may need a backup strategy in case the first one is not sufficient. The best relief may come from combining approaches and finding a dentist who is willing to incorporate them into the visit.

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