“I’m terrified of dental injections. They hurt like hell! The syringe looks like a medieval torture instrument, and the needle is about 10 inches long!” ”I’m completely terrified of all needles. It’s the thought of shots that I can’t tolerate, to the point where I avoid them even when they are absolutely necessary.”

The facts about needle phobia

If you’re very anxious about needles, you’re not alone! The Adult Dental Health Survey (UK) 1988 stated that 8% reported a fear of injections (Todd & Lader 1991). Some studies suggest that almost 5% of the population may be phobic of needles in general. The level of fear varies from person to person, and some people are afraid of dental injections in particular, while others are phobic about any sort of needle. Some people are phobic to the point of avoiding injections at all costs (including their life). Thankfully, there are various methods of help available. Local anaesthetic administration can be entirely painless. Most needle phobics have had a very bad experience with an injection. There are various reasons why a dental injection may be painful:

Lack of empathy:

Perhaps surprisingly, the very first injections dental students give to their classmates in dental school are painless, but oftentimes, their injections become increasingly uncomfortable as time goes on. Interestingly, dental students are surprised at how painless those first injections are, because some have experienced painful injections in the past when they were patients. The most likely explanation is that the students went out of their way to make the injection painless (knowing that they would be at the receiving end next, and having to face their classmates for the rest of their time at dental school!). “Taking turns” fosters empathy, but this empathy is sometimes lost as dentists move out of dental school.

Not using a topical anesthetic (numbing gel):

While it is possible to give painless injections without numbing gel in some areas of the mouth, numbing gel should always be used for injections which would otherwise be traumatic. It really works, if it is left on for long enough – the soft tissue will be so numb that you cannot feel the needle going in.

Using a dull needle

This has become very rare nowadays, because disposable needles are used, but it used to be a common cause of painful injections. The issue can still arise today with multiple injections – the needle should be changed after 3 or 4 penetrations.

Not making the tissue taught and injecting gently:

In some areas of the mouth, the tissue needs to be stretched to make the injection comfortable. Applying pressure (using a finger or a q-tip) can block out any feelings of pain (the nerves which transmit movement and pressure actually block some of the transmission of pain from the other nerves). The principle is the same as when you’re rubbing something better if it hurts, for example if you bump into something. This is also known as the “Gate Control Theory of Pain”. Applying pressure is particularly important in areas where painless injections are more difficult, especially the palate.

Administering the anaesthetic too quickly:

This is the most common cause of injection pain. Quite a few dentists administer local anesthetic too rapidly. Rapid injections can tear the tissue, which results in immedate pain followed by soreness. It’s difficult to say exactly how long a comfortable injection should take, because this varies a lot between different injections sites and techniques.

Dental phobia can have wide-ranging consequences on a person’s life. Not only does their dental health suffer, but dental phobia may lead to anxiety and depression. Laughing out loud is out of the question – too hard to hide one’s teeth… Depending on how obvious the damage is, the individual may avoid meeting people, even close friends, due to embarrassment over their teeth, or not be able to take on jobs which involve extensive contact with the public. Loss of self-esteem over not being able to do something as “simple” as going to a dentist and intense feelings of guilt over not having looked after one’s teeth properly are also very common. Dental phobia sufferers may also avoid doctors for fear that they might want to have a look at their tongue or throat and suggest that a visit to a dentist might not go amiss.

If you suffer from dental phobia, you’ll be inclined to think that nobody else feels the way you do – after all, who else would rather be dead or have open-heart surgery than meet up with a dentist?

Actually, quite a lot of people! While there are no reliable statistics (after all, few dental phobics will freely admit to never visiting a dentist… that’s if they hang around to complete the questionnaire!), the most conservative estimates reckon that 5% of people in Western countries avoid dentists altogether due to fear. And many more are anxious or scared about dentistry.

However, most people actually don’t mind going to the dentist. There is a reason for this – nowadays, dentistry can be pain-free and there are many personable, kind and compassionate dental professionals around. Many if not most people who’ve suffered with dental fears and phobias reckon that having found the right dentist for them has made all the difference.

One problem with defining dental phobia is that “dental anxiety” (a reaction to an unknown danger) may feel just as frightening as a “phobia” to a person, and they may well be defined (or define themselves) as phobic. From what little research there is available, this may be more common in people who are generally anxious. Also, some people who’ve never had a bad experience with a dentist or a dental procedure can develop dental fear or phobia – this is usually the result of vicarious learning (that is, scare-stories or media portrayal).

I like to think that “dental phobia” is simply useful short-hand for “terror at the thought of dentists and/or dentistry and/or anything dental-related”. Some people feel that their fear is justified and rational, while others feel they’re being silly for getting so upset over something which “everyone else” seems to have no problem with. “Dental Phobia” is really an umbrella term which covers a wide range of different fears, as you’ll see on the “Common Fears” pages. It would also appear that there are some fairly distinct subtypes of dental phobia, such as needle phobia or terror at the thought of gagging and being sick.