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Dental Anxiety Effects on Quality of Life

by Dr Nigel Carter(more info)

listed in dentistry, originally published in issue 249 - October 2018

Being apprehensive about paying a visit to a dental professional is an incredibly common problem.  As many as one in five[1] reportedly suffer from some level of uneasiness, ranging from mild nervousness to medically recognised dental anxiety.

The UK’s largest oral health focussed charity, the Oral Health Foundation, discovered that apprehension remains one of the most common reasons people in Britain avoid their dentist.

Fear was identified as the biggest barrier by both men and women as a major barrier to dental visits, and interestingly, it was far more common in women (21%) than men (16%).

Overall, it is estimated more than ten million adults in the United Kingdom have some level of dental apprehension, with an estimated six million suffering from a much more serious dental phobia. This has now been discovered to have a much more widespread impact than may have been previously considered.

Carter 249 Dental Anxiety

Research has revealed that in cases where dental anxiety becomes a barrier to visiting the dentist, that the effects of this can go far beyond that of contributing to poor oral health. Areas commonly identified as suffering include income, education and social isolation,[3] as well as more wide-ranging effects on a person’s overall health.[2] Those questioned in the study were almost twice as likely to be on a lower income if they feared dental visits. Results also showed they were twice as likely to suffer from poor oral health.

This reinforces a previous study by McGrath and Bedi (2003) which stated that: “Those experiencing high levels of dental anxiety are among those with the poorest oral healthrelated quality of life in Britain.”[3]

The results of this research, alongside many other studies, underline the importance of implementing effective treatment methods for patients who have a genuine fear of the dentist which prevents them from receiving the treatment they require. This is not only with the purpose of alleviating their dental anxiety and improving their oral health but also because it contributes to an enhancement of their quality of life.

Quality of Life

The quality of a person’s life is something which is difficult to quantify and requires exploration into patient-centred research in order to establish the effects of different conditions and health treatments. This is across a spectrum associated with psychological, biological and social dimensions of their life and health.

Research carried out by Berggren (1993), assessed the presence and levels of emotional and social life effects among dental phobic patients, regarding the prevalence of dental fear and the length of time for which they have avoided a visit to their dental team.[4] It was shown that the majority of patients felt they had to limit social relations and many, especially long-term avoiders, reported wide-spread negative effects on social life. Often this had extended into feelings of loneliness or to overt social isolation.

What this proves is, as a direct result of dental anxiety, many people face issues with self-confidence, self-esteem and other elements of psychological well-being. These issues can have large and long-term consequences for relationships and careers – areas which in turn can further affect a person’s psychological well-being.

Health-Related Quality of Life

Dental anxiety can also have a significant impact on someone’s health-related quality of life. This covers not only undetected and untreated oral health problems in there, such as gum disease but also a negative impact on their overall general health.

Avoiding a visit to the dentist due to fear puts someone at greater risk of missing the early signs of any oral health problems, such as initial signs of tooth decay or gum disease until it gets too late to treat simply, and there is no choice but to have extensive treatment.

But oral health issues are not the only problems which could go undetected, or be exacerbated, by dental avoidance; in recent years the relationship between poor oral health and systemic diseases, such as cardiovascular disease, cancer and diabetes has become increasingly evident.

Overcoming dental anxiety could dramatically improve overall health

One area where the links to systemic disease are well established it that of gum infections and cardiovascular disease. Research has shown that undetected gum infections can increase heart disease risk by almost three times.

A study by Liljestrand et al (2016), revealed that people with undetected and untreated gum infections were 2.7 times more likely to have cardiovascular problems, such as coronary artery disease than patients who have had treatment of dental infections.[5] Dental avoidance due to anxiety was a crucial aspect of many of these undetected cases as it is estimated that cardiovascular disease is a contributor in about 30 per cent of all deaths globally.

Breast Cancer is another key area where links to poor ongoing oral health exists. Sfreddo et al (2017) discovered that women who suffer from gum disease are up to three times more likely to develop breast cancer.[6]

The study involved more than 200 women and were separated into two groups – those who were diagnosed with breast cancer and those that had no history or signs of the disease. Results found those who suffered from periodontitis, were two-to-three times more likely to develop breast cancer.

Researchers believe the link could support the theory that breast cancer may be triggered as the result of a systemic inflammation which originates in the infected gums. They also suggest that bacteria from the mouth may enter the circulatory system through the gums which then may affect breast tissue.

It is estimated that gum disease affects half of all adults in the UK during their life and up to 15% of are estimated to have severe periodontitis. If this goes undetected due to dental avoidance, as a result of anxiety, then it can have serious problems on a person’s health quality of life and also, as a result, their psychological well-being.

Implementing Effective Treatment for Anxious Patients

By using a collaborative approach where the patient works closely with their dental team, it is possible to put an effective treatment plan in place to help overcome dental anxiety. In turn, this will improve their Oral Health Quality of Life and also the overall quality of life.

This requires a level of willingness from the patient perspective which can be nurtured carefully to ensure widespread improvement. It’s very important for patients to understand that modern dentistry is very different from the scare stories on which many base their dental anxiety and, with modern techniques, all dental treatment is now virtually painless. There really is no need to fear a visit to the dentist.

Patients are advised to follow the following advice to help overcome dental fear:

  • Do research: Speak with friends and family about their positive experiences with the dentist. This can help patients find a dental professional which is empathetic to their certain needs and with whom they can build a basis of trust and understanding;
  • Make an early appointment:  This is an easy yet effective way that can really help patients overcome anxiety. By making an appointment first thing in the morning gives a patient less time to dwell upon it on the day itself and they will be less likely to back out;
  • Talk and ask questions: When it comes to an appointment, communication is key. Dentists are used to anxious patients, as it is a common problem, so they understand how to make the experience as smooth and easy as possible. Patients should discuss with them everything that will happen, if they have a question it is important that is asked. Getting as much information as possible can help to soothe anxiety;
  • Get support: If a patient needs a hand to hold, for a bit of additional reinforcement, make sure they get it. Dentists are very happy for patients to take a friend or family member to an appointment to give the support they need;
    Dentists are also very happy for patients to listen to music during treatment or take something with them to use for support. Anything that will help to keep them calm is beneficial to everyone.

References and Bibliography

  1. Oral Health Foundation  ‘National Smile Month 2018 United Kingdom Survey’, Atomik Research, Survey, April 2018, Sample 2,005. 2018.
  2. Hakeberg, M. and Wide, U.  General and oral health problems among adults with focus on dentally anxious individuals. International Dental Journal. 2018.
  3. McGrath, C. and Bedi, R. The association between dental anxiety and oral health-related quality of life in Britain. Community Dentistry and Oral Epidemiology, 32(1), pp.67-72. 2004.
  4. 4. Berggren U. Psychosocial effects associated with dental fear in adult dental patients with avoidance behaviours. Psychol Health 8: 185–196. 1993.
  5. Sfreddo CS, Maier J, De David SC, Susin C, Moreira CHC. Periodontitis and breast cancer: A case-control study. Community Dent Oral Epidemiology 45:545–551. 2017.
  6. Liljestrand J, Mäntylä P, Paju S, Buhlin K, Kopra K, Persson G et al. Association of Endodontic Lesions with Coronary Artery Disease. J DENT RES. :0022034516660509, 2016.


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About Dr Nigel Carter

Dr Nigel Carter OBE BDS LDS (RCS) has been Chief Executive of the Oral Health Foundation, the UK’s leading charity promoting the benefits of good oral health since 1997. Previously, he was Chairman and long-term trustee of the Foundation. Under his leadership, the Foundation is increasingly influential internationally, with the website recently being translated into nine major world languages, in addition to its established programmes of National Smile Month and Mouth Cancer Action Month, a wide range of educational resources and extensive oral heath product accreditation scheme.

Nigel is a qualified dentist with many years’ experience in general dental practice.  He is also chair-elect of the Platform for Better Oral Health In Europe, a lobby group based in Brussels aiming to raise the profile of oral health with the European Parliament and European Commission, in order to reduce inequalities in oral health across Europe. He is also a trustee and Treasurer of the Royal Society for Public Health and as such has broad interests in broader public health issues.

In 2012, Nigel was honoured with an OBE for Services to Dentistry and Dental Health. As the principal spokesperson of the Foundation, which represents the consumer, Nigel makes regular TV appearances and speaks annually in around 200 radio interviews on behalf of the Foundation for both local and national radio and is widely quoted across all media platforms. For further information please visit

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