Posttraumatic Dental-Care Anxiety: Is "dental phobia" a misnomer?

ABSTRACT: In this article, we suggest that the term “dental phobia,” as commonly applied to the experience of dental fear and anxiety, is typically a misnomer. The problem with using the term “phobia” in a dental-care context is as follows: by definition, phobias involve a fear that is “excessive or unreasonable,” which the individual recognizes as such, and in which the anxiety, panic attacks and phobic avoidance are not better accounted for by another disorder, including posttraumatic stress disorder (PTSD). In our experience, most individuals who experience dental anxiety or fear do not view their symptoms as “excessive or unreasonable” and in that sense, resemble individuals with PTSD. Further, our review of the dental-care literature suggests that true (innate) dental phobias (akin to unreasonable fear at the sight of blood or a syringe) probably account for a smaller percentage of cases, and that a larger subset of dental-care anxiety (DA) cases stem from dental experiences that are, at a minimum, aversive and/or painful, and at times highly traumatizing. Research has documented that individuals who reported having experienced painful dental treatments and perceived a lack of control in the dental situation were approximately 14 times more likely to also report higher dental fear, and approximately 16 times more likely to report being less willing to return to the dental treatment. Based on the current available research, we propose that this psychological condition should be conceptualized as Posttraumatic Dental-care Anxiety (PTDA), and should be classified as part of the Posttraumatic Stress Disorder (PTSD) spectrum in the forthcoming Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V)