You are not unusual for staying away
The number of UK adults who avoid the dentist due to anxiety is larger than most people realise. Government data from the UK Adult Oral Health Survey 2021 found that 12% of adults with natural teeth had a Modified Dental Anxiety Scale (MDAS) score of 19 or above — a threshold that indicates extreme dental anxiety consistent with dental phobia. A further 42% scored in the moderate anxiety range. Across the population, women were consistently more anxious than men, with 16% of women scoring in the extreme anxiety bracket compared with 8% of men.
Research published in the British Dental Journal confirms what most dentists already know from clinical practice: people with dental phobia are significantly more likely to be irregular attenders, to present only in pain, and to have higher rates of untreated caries and poorer oral health-related quality of life than the general population. The cycle is self-reinforcing — the longer a person avoids the dentist, the more they fear what might be found, and the more difficult it becomes to take the first step.
Understanding that anxiety about the dentist is both extremely common and entirely treatable is, in our experience, the first step for most patients who eventually do come back.
What actually triggers dental anxiety
Dental anxiety rarely has a single cause. Common triggers identified consistently in peer-reviewed literature and in our own patient conversations include:
- Fear of pain — the most frequently cited trigger. Worth noting: modern local anaesthesia is highly effective, and no ethical dentist will proceed with a procedure if you are not comfortable. If something hurts, say so immediately.
- Loss of control — lying in a reclined chair while someone works in your mouth is an objectively vulnerable position. A stop signal (simply raising your hand) restores a sense of agency and is used routinely at Tower Dental.
- Past negative experiences — a painful procedure years or decades ago, or an experience of feeling dismissed or judged, can leave a lasting imprint. These experiences are valid and we take them seriously.
- Anticipatory anxiety and catastrophising — many patients describe a spiral in which imagining the worst-case scenario feels indistinguishable from the reality. Cognitive frameworks for dental anxiety management, summarised in clinical guidelines from the British Society of Dental Anxiety Management, address this directly.
- Sensory triggers — the smell of a dental practice, the sound of an instrument, or the sight of equipment can all trigger a conditioned fear response in patients who have had difficult experiences. We are aware of this, and we adjust our environment accordingly where we can.
A note from Dr Metias: The patients I see after long absences almost always say the same thing — that the build-up was far worse than the appointment. The consultation is always a conversation first. There is no pressure to have any treatment on the day, ever.
What the first appointment actually involves
When a patient who has been away for several years contacts us, we structure the first appointment as a purely assessment-based visit. This is what happens, in sequence:
- A conversation before anything clinical. We ask about your last dental experience, what your main concerns are, and what would make you feel most comfortable. There is no rush.
- A clinical examination. This involves looking at your teeth, gums, and soft tissues. We use a mirror and a probe. We take X-rays where clinically indicated and with your consent — these are digital at Tower Dental, which means a fraction of the radiation dose compared to older film X-rays.
- An honest report of what we find. We tell you plainly what is present, what the priorities are, and what can wait. We do not sensationalise. The vast majority of returning patients find that their situation is more manageable than they had feared.
- A treatment plan with no obligation. We put a proposed plan in writing, including costs. You take it away, think about it, and decide if and when to proceed. You are never pressured.
If you feel anxious during the assessment, we stop. The stop signal is simply raising your hand. Every clinician at Tower Dental will stop immediately and without question.
Managing anxiety: what we actually offer
We want to be clear about what is available, rather than making vague references to "nervous patient care." Here are the specific approaches we use:
Tell-Show-Do
Before any instrument is used, we explain what it is, show you it, and explain what it does. Nothing appears without warning. This approach is well-established in anxiety management literature and is standard practice for all our patients, not only nervous ones.
Structured pacing and agreed breaks
We do not rush. Appointments for anxious patients are booked with additional time so that breaks can be taken without any pressure to continue. You decide the pace. If you want to stop for two minutes and breathe, we stop.
Topical anaesthetic before injections
Local anaesthetic injections are the most commonly cited fear after avoidance. Topical anaesthetic gel applied before the injection numbs the gum tissue, which substantially reduces the sensation of the needle. We use this routinely, not on request — because there is no good reason not to.
Distraction
Many patients find that listening to music through headphones during treatment reduces anxiety considerably. You are welcome to bring your own headphones and playlist to any appointment. We also offer a verbal commentary of what is happening if you prefer to be informed throughout.
What we tend to find after a long absence
This is the part that many people most fear to hear about, so we will be direct and honest.
Gum disease is the most common finding in patients who have been away for several years. The early stage — gingivitis — is reversible with professional cleaning and improved home care. More advanced gum disease (periodontitis) requires a structured course of treatment but is manageable in the vast majority of cases. We do not extract teeth unnecessarily and always explore conservative options first.
Tooth decay varies considerably. Small cavities can be treated with a tooth-coloured filling in a single short appointment, often without any injection. Larger areas of decay may need a crown or, in some cases, extraction — but this is by no means the automatic outcome for a tooth that has been unattended.
Cosmetic concerns — discolouration, chips, or worn edges — are almost always treatable. Many returning patients are surprised to learn that the smile issues they have been self-conscious about for years can be addressed relatively quickly.
Why delaying makes things harder
We recognise the difficulty of taking the first step, but we would be doing a disservice to patients by not being clear about the clinical consequences of continued avoidance. Research published in the British Dental Journal found that people with dental phobia had significantly higher rates of untreated caries, higher PUFA scores (teeth showing signs of pus, ulceration, fistulae, or abscess), and worse oral health-related quality of life than non-phobic individuals.
This is not intended to cause alarm. It is intended to be honest: dental problems do not resolve on their own. Early-stage issues are always simpler and less expensive to treat than advanced ones. The most common regret we hear from returning patients is that they did not come sooner.
How to take the first step
When you call or message Tower Dental, tell us you have been away for a while and that you are anxious. Those two pieces of information allow us to book the right length of appointment, ensure the right clinician is available, and prepare appropriately before you arrive. You will not be judged. We see patients in exactly this situation regularly.
If the idea of calling feels like too much, you can use our online contact form, WhatsApp, or simply send an email. We will always respond the same day during working hours.
Clinical References
- UK Government. Adult Oral Health Survey 2021: Service use and barriers to accessing care. GOV.UK, January 2024. Available at: gov.uk/government/statistics/adult-oral-health-survey-2021
- Hill K et al. Oral health status of non-phobic and dentally phobic individuals. British Dental Journal, 137(10), 2015. doi:10.1038/sj.bdj.2015.853
- Grossman S. The Surgical Dental Anxiety Scale (SDAS). British Dental Journal 237, 2024. doi:10.1038/s41415-024-7846-1
- Humphris G et al. UK population norms for the modified dental anxiety scale. BMC Oral Health 13:29, 2013. doi:10.1186/1472-6831-13-29
- Peric R, Tadin A. Associations between Dental Anxiety Levels, Self-Reported Oral Health, Previous Unpleasant Dental Experiences, and Behavioural Reactions. Medicina 60(8):1303, 2024. doi:10.3390/medicina60081303
Tower Dental Blackpool is a member of the British Dental Association. All clinicians are registered with the General Dental Council.