Development of Dental Fear:

Effects of Sound
By: Min Hee Song

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Nyctophobia, hydrophobia, and triskaidekaphobia. Never heard of them? Well, they
each represent a fear of something typical as darkness and water, nyctophobia and
hydrophobia, or perhaps bizarre as the fear of the number thirteen, triskaidekaphobia.
Literally, there are phobias for anything and everything that exist copiously among many or
provoke doubts as to their actual existence. No matter how strange their phobias may be,
most individuals are able to circumvent their fears and live a normal life. But, what if you
are afraid of something that you cant avoid? And what if avoiding it greatly affects your
well-being and the ability to live a healthy life? Imagine being terrified of something
crucial like that. Nevertheless, suppose you take the effort to finally face your fear. You
enter the battlefield, controlling every breath, taking a seat and doing whatever you can to
relax. Then, he enters the room and sits down next to you, putting on his gloves and mask.
A wave of panic washes over and you wish you hadnt come. In your head, you know that
you are not in any sort of danger, but as the procedure begins, you cant help feeling
attacked. Afflicted with this unreal, hypothetical pain, you burst out crying and screaming,
pleading to stop when in reality, your teeth are simply getting cleaned with the gentle spin
of the prophy brush and bubblegum flavored prophy paste. You wouldve never guessed,
but right now, you are at a dentist office, simply getting your teeth cleaned by a friendly
hygienist. However, coming out of the room, your fear is nowhere close to being faced
but rather, amplified, and you vow that you are going to live with your dental phobia and
never visit the dentist ever again.
Dental phobia, commonly referred to as dental fear or dental anxiety, is one of the
most serious worldwide health issue, affecting more than 50 million people in the U.S.
alone (as cited in Rowe, 219). Although not as life-threatening as cancer or heart disease,
dental anxiety is often overlooked despite the fact that about half of those who are affected
completely refuse any type of dental treatment. This strongly suggests that avoidance of

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dental care is predominantly caused by dental anxiety which ultimately leads to the
deterioration of oral health. With the realization of its significance, numerous studies have
been conducted, attempting to identify and investigate the potential anxiety provoking
stimuli present during dental procedures that may incite individuals from maintaining
proper dental measures. Commonly encountered stimuli include having unpleasant taste
from instruments, receiving an injection, having dental X-rays taken, the sight of the
needle, various aspects of the drill such as its appearance, sound, and feeling,...and...fearevoking aspects of the dental practice environment including its smell, dental personnel,
and the chair (Wong, Mak, and Xu, 385). Strikingly, majority of the stimuli concern a
persons sensory details: sight, sound, smell, touch, and taste. Among the five senses, the
sound component triggers an intense response in the left caudate nucleus of the brain, an
area of the brain that has been linked to anxiety disorders (Scared of the Dentist?). By
just hearing the sounds of the dental apparatus, patients are mentally agitated, becoming
filled with fear and even feeling pain that their minds have generated through associating
noises like that of a dental drill as an indication for pain to be felt. Thus, stimuli associated
with the sound factor are the leading causes in provoking dental anxiety; in order to
reduce and prevent developments of dental fear, dental clinics should focus on
minimizing the production of noises.
Oral health, gradually gaining more importance, has become a great interest for
many to take care of routinely. With dentist visits starting as young as the age of one, dental
offices have become a place that an average person will visit more than any other branch of
medical facilities. Since dental fear is often a disorder acquired during childhood, it is
critical for children to gain positive experiences from their first visit and onward. From
cavity fillings to extractions to just simple hygiene cleanings, children encounter wide
varieties of procedures

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that provide diverse experiences unique to each of their appointments. However, no matter
what treatments are given, one factor remains analogous to all visits: unpleasant sounds.
Stimuli that involve triggering patients audibility are inevitable and prompt the
greatest amount of fear because of its inability to be fully blockaded. Most factors that
stimulate angst through the senses are typically counteracted with numerous ways to avert
its effects. For instance, the topical jelly and local anesthetics help prevent sensation of
pain, scented N2O (laughing gas) noses block out the distasteful smells, the nauseating
tastes are immediately flushed away using suction, and intimidating instruments are hidden
and put out of view while the patients eyes are focused on the TV. Clearly, the patients
eyes, nose, and mouth are kept busy but the ears are exposed to the cacophony generated by
the drill or the dental scaler scraping off the plaque.
Various ways to measure anxiety exist, but among them, Corahs Dental Anxiety
Scale (DAS) has allowed accurate distinction between the fearful and regular patients.
Survey questionnaires based on the DAS provides heaps of data that can be analyzed for a
greater understanding. 73 stimuli that exist in the dental setting provoking anxiety have
been ranked according to the scores equated by the DAS from the questionnaires test
subjects answered. Out of those stimuli that exist in the dental setting, the sound of [the]
two items of dental equipment (dental drill and dental scaler) provoked a relatively high
level of dental anxiety with 22.27% of non-dental students tested finding the sound a huge
contributor in creating anxiety, leading to a conclusion that among the five anxietyprovoking factors eamined (sound, smell, taste, sight, and feeling), the sound of dental
equipments has a greater influence on dental anxiety (Wong, Mak, and Xu, 391).
Furthermore, a research conducted by M. Michelle Rowe, the sound of the power driven

instruments was most feared with 72.7% of the young adult sample ranking it as the most
provoking (222).

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Although, pain has been commonly known as the principal influence in causing
dental anxiety as most people have agreed that getting an injection is the most highly feared
stimuli when thinking about going to the dentist. The pain expected with the needle is
incredibly greater than the actual pain felt, causing heightened psychological fear until the
very moment the needle is injected and barely any pain occurs (Rape and Bush, 345).
Patients are not afraid of the pain they are going to experience itself but afraid of the
situation in which they dont have control over and could potentially cause acute pain in a
relatively sensitive area of their body.
However, with all their senses muffled with the variety of agents to block out the
unpleasantness, patients only have sound to rely on to give them even the slightest clue as
to what is happening. The problem arises where now, patients have come to associate the
sounds they hear as warning signals for pain to be felt. The scenario that was given,
portraying a dental phobic facing his or her fears is a classic example of the consistent
behavior observed at the pediatric dentist office. What the brain has acquired to indicate a
threat to the body is essentially glitched, providing false predictions of anticipated pain. A
dental phobic, even though he or she knows that there is no harm to be done, the brain still
processes sound the same way it has always done, linking it to pain. Even if nothing hurts,
the sound is enough to drive a phobic into extreme nervousness which may lead to thinking
he or she is feeling pain.
Sounds, while inevitable, can still be managed and controlled. With technology
quickly evolving, dental drills that are quieter are accessible. Audiovisual methods have
been proved to be effective and dental offices should be obliged to provide different

methods that may include watching TV with headphones that will effectively blockade the
loud clamors (Muppa, et al., 193). Dentist clinics should focus on finding ways to reduce
noises heard in the offices before identifying anything else that causes fear among patients.
Making even the littlest improvements and changes will not only prevent increase in
population of those who
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have dental phobia but it may bring major transformations to many individuals who already
suffer from dental fear. It only takes one negative experience for a patient to avoid dental
treatment for the rest of their life, but it may also take one positive experience for the
phobic to have success in facing their fears.
For better understanding of dental anxiety, acknowledgement of sound as the main
source of fear must be made. Taking the effort to realize the high level of influence sound
makes on a patient will allow better solutions to be made in battling the fear so prevalent in
the U.S. and the rest of the world. By working towards reducing the sound element, patients
will have better experiences and the dentist wont be a personnel to be feared.

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Bibliography
Muppa, Radhika, et al. "Comparison of Anxiety Levels Associated with Noise in
the Dental Clinic among Children of Age Group 6-15 Years." Noise & Health
15.64 (2013): 190-93. Print.
Rape, Roger N. and Bush, Joseph P. Development of Childrens Dental Fears: An
Observational Study. Journal of Clinical Child Psychology. 17.4 (1988): 345-350.
Print.
Rowe, M. Michelle. "Dental Fear: Comparisons Between Younger and Older Adults.
American Journal of Health Studies 20.3-4 (2005): 219-224. Print.
Scared of the Dentsit? This is Why, Say Neuroscientists. The Guardian. n.p. n.d. Web.
22 Dec. 2014.
Wong, Hai Ming, Cheuk Ming Mak, and Ying Feng Xu. "A Four-Part Setting on
Examining the Anxiety-Provoking Capacity of the Sound of Dental Equipment."
Noise & Health 13.55 (2011): 385-91. Print.
Development of Children's Dental Fears: An Observational Study. By: Rape, Roger N.; Bush,
Joseph P.; Saravia, Mario. Journal of Clinical Child Psychology. Dec88, Vol. 17 Issue 4, p345. 7p.