Why dental fear increases pain
Understanding the physiology and psychology behind dental fear and relations to dental pain will help dental patients manage their fear more efficaciously, and ultimately redusing the effect of pain to the maximum possible.
What is dental fear?
Fearful dental patients count for more then half of the North American population. Dental fear is known to be one of the most common challenges that dentists or dental hygienists have to face every day in regular basis. Theoretically dental fear is termed as dental phobia. A particular phobia is the experiencing of a continuous fear from a patient, characterized with avoidance of an object or situation and expressed with anxiety and physiological or physical stress. Dental fear is considered a negative sensation and an emotional distress that is caused by objects or environment related to past history of unpleasant dental treatment or multiple dental related causes.
What is pain?
In order to explain why and how dental fear increases the pain to an individual during a dental procedure we have to understand the physiological and psychological factors behind dental pain. Pain is a mental and physical discomfort caused by external stimuli ( E.g burning of the skin, needle poking ) into the brain and transmitted by special nerve endings which transport these stimuli into the brain causing a flight or flight reaction (Eg. involuntary removal of your hand from a hot object). So basically pain is nothing but a stimuli of our nerve endings that is transmitted through our nerve cells ( neurons) into our brain, which analyzes the stimuli and eventually will initiate a reaction that will aim balancing the external or internal physiological activity of the body.
Physiology of the fear into the body
When body experiences pain, brain responds by stimulating hypothalamus ( part of the brain). Hypothalamus stimulates adrenal cortex gland and adrenal cortex gland produces two hormons: 1- Cortisol ( makes nervous system more sensitive to stimuli) 2- epinephrine ( adrenaline). Both these hormones that are released in blood due to emotional stress (anxiety or fear) when combined together for a period relatively long will increase the sensitivity of the nervous system making it more transmissible to external impulses like pain from a needle or tooth extraction. In other words the more fear, anxiety or stress you experience the more painful a dental procedure will be due to increase of the sensitivity to pain stimuli.
To better understand the difference lets assume that pain is divided in units. An individual presents in a dental office for a dental filling procedure that involves local anesthesia. He is fearless and not anxious at all and experiences one unit of pain while the dentist administers a local anesthetic injection to freeze the area that will be treated. If the same patient would have been anxious, fearful and stressed about this appointment he would have experienced at least 2 units of pain for the same exact dental procedure. A dental patient who is nervous and fears the fact that he will be treated by a dentist will basically experience more pain and experiencing more pain will definitely make him even more fearful about dental procedures. There are numerous solutions and treatments to this fear. Starting with the colors of the waiting room in the dental office, the medicine smell etc etc.
Conclusion
Various studies show that dental patients that are fearful and anxious for their dental appointment experience high blood pressure, increase of perspiration ( sweating). increase of cholesterol production, immune system dysfunction ( low ability to fight disease) etc. A dental hygienist or dentist who notices these symptoms in a dental patient should immediately stop the treatment because if the pain anxiety or stress arises blood elevation can reach a level where cardiac attack may be inevitable. It is very important that a dental clinician takes professional steeps by reviewing the medical and dental history of the patient. Explaining to the patient the relationship between fear and pain not only will minimize any dental emergencies that might arise in the dental office but it will make the dental appointment more comfortable for the patient.
At least 50% of the patients fear the dentist