An eight-year-old girl starved to death because of an apparently severe dental phobia. It's an extreme reaction to a commonly held fear. But why do so many of us dread the dentist's chair?
Even for those with a dread of visiting the dentist, the tragic case of eight-year-old Sophie Waller seems bewildering. Sophie was already scared of dentists when one of her milk teeth became loose. Her parents were later to tell the inquest into the schoolgirl's death that it had developed at the age of four, when her tongue was nicked during a routine check-up.
Childhood memories are the source of most people's worries
Refusing to eat or talk, she was sent to hospital to have the wobbly tooth removed under general anaesthetic. Doctors took the opportunity to remove several teeth but following the operation, Sophie was so traumatised she refused to open her mouth and continued her fast.
While Sophie grew weaker, the severity of her condition was not realised by the hospital. She died the month after the operation from the effects of starvation and dehydration.
It was a highly unusual reaction to a relatively commonplace problem. But what explains this pervasive fear?
Dread of dentistry can broadly be divided into two forms:
- dental anxiety - a term coined in the mid-1940s to explain what is often a mild fear
- dental phobia - a more extreme dread that, nevertheless, affects about 10% of people
For whose with dental anxiety, this tends to be based on childhood experience, either one's own or someone else's.
The concerned parent, fretting at their child's side as he or she is reclined in a dentist's chair, may be more of a problem than a solution. Parents can, unwittingly, pass on their own fears to their children in what comes to be an unbroken chain of generational fear, says Dr Nigel Carter of the British Dental Health Foundation.
Advances in technology have help allay the fears of some
"I can recollect children coming in being fine and then the parents at the end of the visit saying, 'There, that didn't hurt did it?' It would be the first time the child had thought about any pain."
Often a child's initial visit to the dentist is an urgent response - they have been in pain and need some work - so that initial memory is connected with pain. This can set up an anxiety or phobia that lasts for the rest of their life.
But thankfully not always. Professor Ruth Freeman, of the Dental Health Services Research Unit, University of Dundee, says it can depend on a child's level of imagination. A bad experience can be reinforced by a vivid imagination that is carried on into adulthood.
"If children have a very good imagination they tend to have worries about going to the dentist then as an adult they can become very frightened."
The interventionist nature of dentistry means that people don't consciously think that they're ill - in the same way they would if going to a GP - yet they have to have something done.
"Perhaps the thing with dentistry is that it feels like more of an optional treatment. More of the visits that you go to the dentist are interventionist than with a doctor," says Dr Carter.
Yet advances in technology, and a greater awareness of the problem within the profession, appears to have had a dramatic effect in allaying the fears of many.
In 1988, a survey of oral health in the UK found 60% of people were "to some extent... nervous of some kinds of dental treatment". A decade later, that figure had dropped to 32%.
For the most part dentists can help those with anxiety. And they are the majority.
But one in 10 of us has a deeper problem - a genuine phobia which is more difficult to treat.
For some, it is the white coat not the dentist that is the problem
Ms Freeman says dental phobia can be down to one of three reasons: false connections, learning difficulties and those with a wider psychological disorder.
False connections were originally identified by Sigmund Freud and Josef Breuer in 1893. They are based on the idea that the patient, usually a child, mixes up situations, transferring thoughts from the past to an object in the present.
Professor Freeman had one such patient, who was frightened that the local anaesthetic wouldn't work.
"He was an insulin-dependent diabetic whose injections didn't always work. He used to say that he didn't understand why he had a fear of the injection at the dentist, having used them daily himself. He'd displaced all his fears about his insulin not working and put them onto his anaesthetic."
This kind of connection is common, and medics can often work out where it has come from by reading the patient's medical notes.
A fear of dentists can also be associated with learning difficulties, and these patients can be referred to specialists who are able to spend more time explaining procedures and putting them at their ease.
If a person suffers from a variety of psychological disorders - such as agoraphobia or any kind of social phobia - it is very likely that they have a dental phobia.
"It seems to be that with those who have a genuine phobia, you can't find out why and they can't tell you why," says Professor Freeman.
Needles and drills
Other factors that can trigger a fear of all things dental are the associated sights and sounds - the needles and drills. It may not even be about the dentist, rather the surgery.
"You do get children that have really got a phobia about white coats rather than the dentistry bit," says Dr Carter.
There is no notable difference between the number of men and women who suffer from a dread of dentists, although men may not admit to it, according to Dr Carter.
"You probably tend to get it a little more in women but that's also because women might force themselves to go, whilst men might stay away."
For those who are affected by a fear, dentists have become a lot more practised at managing it. Undergraduate dentistry courses recognise the problem and cover how to deal with nervous patients.
Often a phobia of this kind does disappear, over time, when a patient finds a dentist they like and trust. This can be an ordinary dentist or a someone who specialises in dealing with anxious patients. But it is rarely immediate.
Dr Carter says although a fear of dentists can be brought on by one bad experience, it is unlikely to be reversed by one positive visit.
"What's strange is that we don't seem to learn from a pleasant experience. There's a sort of irrationality about it."
Here is a selection of your comments:
I had some very bad experiences of the dentist at a very young age (including a dentist who never ever used any anaesthesia when drilling). This left me with an extreme fear of the dentist to the point that as a teenager I remember passing out with the pain of an abscess rather than see a dentist. I cannot rationalise my way out of this fear, and in the dentist's chair I am a quivering wreck. I am so pleased to read that undergraduate courses now address how to deal with nervous patients, and I know that dentists these days are much more geared up in how to treat children. I would not wish a fear like this on my worse enemy.
Pauline Silverwood, Christchurch
My four-year-old son doesn't seem to mind the dentists at all. The first time he went for a check, we sat him in the "magic chair" and the dentist made it go up and down to the delight of my son. The last time he went, he still remembered the chair and when told he would be going to the dentists he asked "Can I go in the magic chair. It's cool!"
James Hill, Mansfield
After having a phobia about dentists for most of my adult life, I finally succumbed and went to my local dentist last week after an old filling collapsed. This was my first visit in over 17 years! The dentist was very professional about my phobia and took time to explain what they were doing. Also, advances in dentistry and anaesthetic in the past 17 years helped enormously too! Four fillings and a scale and polish later and I'm now getting over my irrational fear and will return in six months time!
A ten week course of hypnotherapy in the late 80s finally got rid of my 35-year phobia where I would faint just sitting in the dentist's chair. I would recommend trying hypnotherapy to anyone as it is drug-free and helps across the board with getting relaxed.
John Rymell, London
My generation's fear of dentists stems from the quite barbaric way we were treated by the 1950s NHS school dentists - held down with a rubber gas mask shoved over your face. Recently, at an historical reconstruction, I saw grown men blanch at the experience.
Given the lack of local NHS dentists, my wallet is the thing that hurts the most as a result of a visit.
I remember as a child going to the dentist to have a tooth filled (my first and only filling). The dentist struggled to numb the required area, and kept injecting me with more local anaesthetic. My throat became numb, I lost the ability to swallow, leaving me to choke on my own saliva whilst my heart began to race erratically. I then had to go to hospital as I had been given an overdose by a dentist who clearly didn't know what he was doing. I never went back to have the tooth filled and it took me six years before I went back to see the. I now force myself to go for regular checkups. I have a nice female dentist who explains everything to me.
My mum grew up being terrified of the dentist, so always made an effort to be honest with us in order to dispel any fears (including pinching us to demonstrate the pain level of an injection, but that's another story).
For some reason I've always enjoyed going to the dentist. In fact as a child my mother threatened my bad behaviour with not being allowed to go the dentist! I think this is partly due to my very first dentist's approach to needles. I was told to look up at the ceiling and some "cold gas" would be sprayed on my gums - for years I was convinced this was true. Still - nearly 30 now and not a single filling!
Remember what Bill Cosby said: "The dentist tells you never to put sharp pointy objects in your mouth. The first thing a dentist does is put a sharp pointy object in you mouth!" The rest is pain.
Chris King, Pensacola, USA
Maybe a free simple idiots' guide to what dentist terms mean would ease the worry. "Filling you in" might be a good title!
Glyn Thomas, Oswestry
I have never read such complete nonsense. Has no one told these doctors that maybe some people actually feel genuine pain when undergoing work on their teeth? My dentist has realised this and gives me double the dose of anaesthetic. I cannot have a filling but I don't mind extraction with the right medication.
Mike Charlton, Pontefract
I never had a fear of dentists as a child, but as an adult five years ago I had my jaw dislocated by a very rough dentist who didn't care for my warnings that I struggle to open my mouth very far. I have only been back to the dentist once since and was in tears and shaking i found it so traumatic.
One of my earliest memories is of waiting in the dentists with my mother. I could feel her fear and how uncomfortable she was and this passed to me. I made sure my husband took our daughter so my fear would not be passed on.
Frances Whiteman, Slough
Last year I went to a new dentist advertising "pain-free" dentistry. We didn't get off to a great start after he injected me with all the finesse of a ship's riveter. Contrast that with the wonderful lady dentist I now have. So confident am I in her skills, I have been back six times to put right thirty years of neglect. I swear that I have not felt even the slightest twinge from beginning to end.
Much of the distress is caused by the positioning of the patient. Head back, mouth full of saliva and water used by dentists causes a feeling of drowning and choking. Dentists should be aware the prone position causes fear, and it would help if they could allow the patient to sit in a more upright position. It wouldn't be a cure but it could reduce much of the apprehension.
Rex Tee, Dartford
I've never had any dental work done but the thought of having a filling scares me witless. It's not just going to the dentist I don't like. It is everything to do with teeth. I can't even watch someone brush their teeth. My son is just getting his first baby teeth and I go weak at the knees whenever I hear them bump against his spoon or even just seeing them. His father has to brush my son's teeth as I can't stand the noise of the brush on his teeth.
Caroline, St Andrews