Fear of the dentist: what helps, and how to ask for it
A systematic review pooling 31 population studies and 72,577 adults puts the global prevalence of dental fear and anxiety at 15.3 %, with 12.4 % reporting high dental fear and 3.3 % severe dental fear, consistently higher among women and younger adults (Silveira et al., 2021). In England, the Adult Dental Health Survey figures quoted in the NHS clinical standards give a similar picture from the other direction: around 51 % of adults report low anxiety about dental treatment, 36 % moderate levels, and 12 % anxiety at a phobic level (NHS England, 2023).
Those numbers matter because they change what you should be asking for. Mild nerves are handled inside an ordinary appointment. Anxiety at a phobic level has its own NHS care pathway, its own assessment tools and its own referral routes, and knowing they exist is the first step towards using them. This article sets out where you sit, what each available option genuinely changes, and the words that get you the right kind of appointment.
Dental anxiety or dental phobia: where you sit
Dentists in the UK use a five-question questionnaire, the Modified Dental Anxiety Scale (MDAS), to place patients on a scale instead of relying on impressions. The NHS clinical standards read the score in three bands (NHS England, 2023).
| MDAS score | What it indicates |
|---|---|
| 5 to 10 | Mild dental anxiety |
| 10 to 18 | Moderate dental anxiety |
| 19 and above | Severe or phobic anxiety |
Alongside the score, practices use the Indicator of Sedation Need (IOSN), which weighs your anxiety together with your medical history and the complexity of the treatment you need. The two tools together decide whether you are managed in an ordinary practice, referred to a team experienced in sedation, or referred on to a specialist service.
The distinction between anxiety and phobia is not simply a matter of degree of discomfort. Dental phobia sits at the severe end of a continuum, and the feature that separates it from ordinary anxiety is documented avoidance of treatment rather than the intensity of the feeling itself. If you dread appointments but attend them, you are anxious. If you have not registered with a dentist for years because of how appointments make you feel, that is the pattern clinicians look for.
Why dental fear runs deep
Part of the answer is cultural memory. The martyrdom of Saint Apollonia, now the patron saint of dentistry, was painted and illuminated across Europe for centuries: a woman said to have lived in third-century Alexandria, whose jaw was broken and whose teeth were pulled out by her persecutors before she died in a fire. The image tied tooth extraction to torture in the Western imagination long before dentistry existed as a profession.
The tooth-drawer, by contrast, really existed. Seventeenth-century engravings show him working in the open air, forceps deep in a patient’s mouth, the patient held still by bystanders who are visibly enjoying themselves. Dentistry spent two centuries distinguishing itself from that performance, and the imagery outlived it.
The modern picture is more varied. Patients describe fear of invasive procedures and of pain, fear of the anaesthetic injection, the sound of the handpiece transmitted through the bones of the skull a few centimetres from the ear, the sight of blood, and the characteristic smells and tastes of dental materials. For many, the fear traces back to a single distressing appointment in childhood.
Specific parts of routine treatment come up again and again. The rubber dam, the thin sheet clamped over the tooth being treated, is often experienced as a gag that makes breathing and signalling feel impossible. Impression trays block the whole arch and set off the gag reflex in patients prone to it. The water spray from the handpiece, if suction is not keeping pace, produces a sensation close to drowning. Underneath all of it sits the position itself: lying flat, unable to speak, with someone working a few inches from your face. Loss of control comes up as often as pain itself in patients’ accounts, and it is also the easiest of these triggers to do something about.
The part people rarely say out loud
Embarrassment is the element that keeps people away longest, and it is the least discussed. A qualitative study of 30 patients at a specialist dental anxiety clinic, who had avoided treatment for a mean of 12.7 years, found embarrassment reported in all but three cases. Fear of pain was the chief complaint for 30 % of them, while 47 % described powerlessness in the social situation of the surgery rather than the treatment itself. Most of the embarrassed patients had developed habits of hiding the mouth when smiling or laughing, with lips, a hand or a turn of the head, and the intensity of their embarrassment correlated with both the number of years avoided and the degree of mouth-hiding (Moore et al., 2004).
Two things follow from that study. Your dental team has seen mouths in every condition, and the state of yours is clinical information, recorded and treated as such. The embarrassment is itself part of what needs treating, which is why the assessment questionnaires ask about how you feel and not only about your teeth.
On the day, anxiety shows itself in ways you will recognise: sweating, a racing heart, gripping the armrests, tears, or a cancellation made the night before. The single most useful thing you can do costs nothing and happens on the phone, at the moment you book. Say that you are anxious. A practice that knows adapts the length of the appointment, the order of treatment and the way each step is announced, and it will do none of that if nobody has told it.
Three patients on their own apprehension
The accounts below come from people who travelled to Body Expert for treatment they had put off. Each describes one person’s experience, on one treatment plan, and carries no prediction about your own.
Laetitia: “I was afraid of going to the dentist”
Laetitia, from Le Havre in France, had an implant and 22 crowns placed after years of self-consciousness about the colour of her teeth, damaged following orthodontic treatment when she was young. “I was afraid of going to the dentist, and I was scared at that moment too. But it was just apprehension because I didn’t feel any pain at all,” she says, comparing the experience with earlier appointments she remembers badly.
Lila: an agreed signal to stop
Lila travelled for a set of veneers. Her account turns on a detail that belongs squarely to the control techniques described further down this article: “He told me every time: if you have the slightest doubt, the slightest thing, just raise your hand. I didn’t even raise my hand once.” The stop signal was never used, and knowing it was available changed the appointment.
Laurent: treatment spread over two trips
Laurent, 31, from the Toulouse region, had 7 implants and 28 crowns placed, along with a gummy smile correction and a bone graft, across two visits. His advice is aimed at people who cannot bring themselves to book: “honestly, do not hesitate, they are there to guide you, to reassure you.”
Before your appointment: what to ask for
The NHS clinical standards group a set of low-level interventions that every dental practitioner is expected to be able to offer, and they cost nothing to request. They cover building rapport and communication, adjusting the environment, enhancing your sense of control through agreed stop signals and genuine choices, physiological management through controlled breathing and progressive muscle relaxation, and positive feedback afterwards. Controlled breathing and progressive muscle relaxation are singled out as having an established evidence base for reducing anxiety (NHS England, 2023).
A review of anxiety management in the dental surgery reaches the same practical conclusion from the clinical literature: the techniques that work range from good communication and rapport through to systematic desensitisation, several of them are usable with any patient regardless of known anxiety, and success depends on identifying the fear first and then working in a phased way across several visits (Armfield & Heaton, 2013).
In practice, that translates into a short list. Tell the receptionist when you book, and ask for a first appointment with no treatment, for examination and planning only. Agree a stop signal, usually a raised hand, and ask the dentist to confirm out loud that the drill stops when it goes up. Ask the dentist to announce each step before starting it. Book a time when you are neither rushing to arrive nor due somewhere immediately afterwards. Bring someone with you if it helps, provided that person is calm themselves.
One piece of advice circulates widely and deserves correcting: that modern dentistry is painless, so there is nothing to fear. Local anaesthetic makes the great majority of procedures pain-free, the injection itself is still felt, and inflamed tissue responds to anaesthetic less reliably. Accurate information is what holds up across a course of treatment, appointment after appointment.
During treatment: what each option changes
The options offered to anxious patients act on different targets. Local anaesthetic removes the pain of the procedure. Sedation, whether breathed or given through a vein, works on the anxiety around it and, in the intravenous form, on how much of the appointment you remember. General anaesthesia removes awareness of the treatment altogether. Psychological treatment is the only one of them that addresses the fear itself. Confusing those targets is how patients end up disappointed by a technique that was never meant to deliver what they hoped for.
The second question is who can provide each of them, since that determines whether you stay with your own practice or need a referral.
| What you ask for | Where it is provided |
|---|---|
| Stop signal and pacing | Any dental practice |
| Inhalation sedation | Trained practice team |
| Intravenous sedation | IACSD-trained sedationist |
| CBT for dental phobia | Trained dentist or service |
| General anaesthesia | Hospital or surgical unit |
Inhalation sedation with nitrous oxide
Nitrous oxide and oxygen, breathed through a small nasal hood, produces light sedation with mild pain-relieving properties. You stay awake, breathe for yourself, answer questions, and the effect clears within minutes of the gas being stopped. In primary care it is delivered as titrated inhaled nitrous oxide and oxygen by teams trained to the standards of the Intercollegiate Advisory Committee for Sedation in Dentistry, which sets the training and supervision requirements for anyone providing sedation in UK dental practice (NHS England, 2023).
A systematic review of 19 randomised trials covering 1,293 patients found a cumulative success rate, defined as completion of the planned treatment, of 94.9 %. The adult subgroup reached 99.9 %, though it rested on six trials and only 195 adults, against 13 paediatric trials and 1,098 children, so the adult figure carries a wide confidence interval and should be read as encouraging without being settled (Rossit et al., 2021). Inhalation sedation does not replace local anaesthetic for anything that would otherwise hurt, and a nasal blockage or a recent respiratory problem can rule it out on the day.
Intravenous sedation
Intravenous sedation, in UK primary care usually titrated midazolam, puts you into deep relaxation while you remain conscious and able to cooperate. The drug has an amnesic effect, so most patients keep only a hazy recollection of the appointment, which is part of why it is used for people whose fear has been reinforced by previous visits. It has no analgesic action of its own and is always combined with local anaesthetic. Our article on conscious sedation in dentistry covers the preparation, the escort requirement and the monitoring involved.
What it leaves untouched is how you feel about the next appointment, which needs planning for from the outset: it makes a course of treatment possible while the underlying fear is addressed separately.
Hypnosis
Some practitioners with specialist training offer hypnosis, alone or alongside local anaesthetic. The patient keeps their eyes closed, stays responsive to instructions and communicates through agreed signals. Hypnosis appears in the clinical literature on dental anxiety management as one of the techniques requiring specialist training (Armfield & Heaton, 2013), and it is not among the methods the NHS clinical standards list as having an established evidence base for anxiety reduction. Treat it as an option some patients find genuinely helpful, on weaker published evidence than the techniques above it in this section.
When it is a phobia
At the severe end of the scale, two very different routes exist, and the order in which they are considered is set out in national guidance.
General anaesthesia
General anaesthesia is reserved for situations where less restrictive methods have failed or cannot be used, and a referral is expected to show that behavioural techniques and conscious sedation have both been considered first. It requires a hospital or an authorised surgical setting, an assessment with an anaesthetist, fasting, and recovery time afterwards. Shared care planning between your own dentist and the specialist service is treated as essential (NHS England, 2023).
Its place follows from what it acts on. General anaesthesia removes awareness of a single episode of treatment, which is exactly what is needed for multiple extractions or extensive surgery in a patient who cannot tolerate being awake. It leaves the fear of the next appointment where it was.
Cognitive behavioural therapy
Cognitive behavioural therapy is the treatment aimed at the fear itself. It works by identifying the automatic thoughts attached to the dental situation, testing them against what actually happens, and then working through graded exposure to the components of an appointment, from the waiting room to the instrument, with the pace set by your reactions. The NHS clinical standards describe a course of 6 to 10 sessions of around an hour and record a strong evidence base for dental phobia (NHS England, 2023).
Two findings put its reach into perspective. A meta-analysis of 38 studies of behavioural interventions for dental fear found a large overall effect on self-reported anxiety, and an effect on actually attending subsequent dental appointments that held up between six months and four years after treatment (Kvale et al., 2004). More recently, a randomised trial in ordinary general dental practice allocated 96 anxious patients, 85 % of whom scored 19 or more on the MDAS, either to a short course of CBT delivered by their own general dental practitioner or to treatment under midazolam sedation combined with a structured communication model. Both arms produced a significant fall in anxiety scores, with a mean MDAS reduction of 6.6 points and no difference between them, which led the authors to conclude that suitably trained general dental practitioners can provide effective first-line treatment for dental anxiety of varying severity (Hauge et al., 2021).
The practical consequence is that you do not necessarily need a psychology referral to start. A dentist trained in these methods can begin the work, and a specialist service takes over when the anxiety is more entrenched or the treatment more complex.
Getting back into care
The NHS organises anxiety management in three tiers, and asking about them by name shortens the conversation. Tier 1 covers non-complex patients treated in ordinary practice with behavioural techniques and, where appropriate, sedation. Tier 2 covers more complex treatment or a more complex medical history, handled by experienced sedation teams. Tier 3 covers specialist services in secondary care (NHS England, 2023). If your own practice cannot manage your anxiety, a referral into the next tier is the mechanism, and your dentist can also write the letter that explains your history to whoever sees you next.
Where teeth have already been lost, the treatment plan itself becomes an additional obstacle. Extractions, dental implant treatment and prosthetic work take time and money on top of an appointment you were already dreading, and untreated periodontitis is the usual route from a delayed filling to a missing tooth. Our page on dental treatment and teeth care sets out what each option involves depending on where you are starting from.
Some patients consider treatment abroad at this point, and our guide to choosing a country for dental care covers how to compare destinations. It answers a question of cost and of concentrating a long treatment plan into a few days, and the fear is worked on separately, before the trip and after you come home. At Body Expert, the arrangements include an English-speaking patient coordinator from first contact to return, transfers between airport, hotel and clinic, five-star hotel accommodation and 12 months of post-operative follow-up, with a free quotation issued within 24 hours. Mentioning your anxiety during that first exchange is as relevant as your medical history, because it shapes how the appointments are paced once you are there.
Sources
- Armfield, J. M., & Heaton, L. J. (2013). Management of fear and anxiety in the dental clinic: A review. Australian Dental Journal, 58(4), 390-407. https://doi.org/10.1111/adj.12118
- Hauge, M. S., Stora, B., Vassend, O., Hoffart, A., & Willumsen, T. (2021). Dentist-administered cognitive behavioural therapy versus four habits/midazolam: An RCT study of dental anxiety treatment in primary dental care. European Journal of Oral Sciences, 129(4), e12794. https://doi.org/10.1111/eos.12794
- Kvale, G., Berggren, U., & Milgrom, P. (2004). Dental fear in adults: A meta-analysis of behavioral interventions. Community Dentistry and Oral Epidemiology, 32(4), 250-264. https://doi.org/10.1111/j.1600-0528.2004.00146.x
- Moore, R., Brødsgaard, I., & Rosenberg, N. (2004). The contribution of embarrassment to phobic dental anxiety: A qualitative research study. BMC Psychiatry, 4, 10. https://doi.org/10.1186/1471-244X-4-10
- NHS England. (2023, 17 January; updated 19 July 2024). Clinical standards for dental anxiety management. https://www.england.nhs.uk/long-read/clinical-guide-for-dental-anxiety-management/
- Rossit, M., Gil-Manich, V., & Ribera-Uribe, J. M. (2021). Success rate of nitrous oxide-oxygen procedural sedation in dental patients: Systematic review and meta-analysis. Journal of Dental Anesthesia and Pain Medicine, 21(6), 527-545. https://doi.org/10.17245/jdapm.2021.21.6.527
- Silveira, E. R., Cademartori, M. G., Schuch, H. S., Armfield, J. M., & Demarco, F. F. (2021). Estimated prevalence of dental fear in adults: A systematic review and meta-analysis. Journal of Dentistry, 108, 103632. https://doi.org/10.1016/j.jdent.2021.103632