When was your last dental exam? For many people, regular dental check-ups are not high on their list of priorities. And the reason usually isn’t a lack of money or insurance; nor is it that they forgot to make an appointment. The reason is fear, says Dr. Michael Krochak, founder and director of the Dental Phobia Treatment Center of New York and an assistant clinical professor at Mount Sinai School of Medicine.

All too often, anxiety causes people to opt out of dental exams altogether. Krochak has a practice full of patients who, prior to seeing him, had not visited a dentist in years.

Some people are afraid of the unknown. Others are frightened by stories of negative dental experiences from family and friends. Still others associate the dental exam with a feeling of helplessness and a loss of control.

Most of the time, however, the fear and anxiety are rooted in traumatic childhood experiences, says Krochak. “Perhaps the hygienist made a careless comment during an exam. Or maybe the dentist was insensitive or rough or even inflicted pain.”

Regardless of the cause, fear of the dentist is widespread, he says, affecting as much as 20 percent of the population. What’s more, “dental anxiety knows no boundaries.” Indeed, Krochak treats a wide range of patients - men and women of all ages, races and socioeconomic groups.

One such patient is Patricia Franzino, a 43-year-old former commodities trader from New York City. Childhood office visits to her family dentist were “a nightmare,” she says. “He didn’t use novocaine, and treatment was extremely painful. He was scary.” As a result, Franzino didn’t visit the dentist with any regularity as an adult. At one point, she says, it had been five years since she had a dental exam.

The story is much the same for 49-year-old Geraldine Amaral, a teacher and writer in Arlington, VA. “I had terrible childhood dental experiences, and I’m an anxious Type-A person anyway.” That combination meant that Amaral stayed awake the entire night before a dental appointment and often panicked during treatment. She too went five years without seeing a dentist.

Unhappily, the longer a patient waits to seek treatment, the more difficult it becomes. Reagan Fletcher, 50, an archivist for a large Broadway theater owner and producer in New York, did not see a dentist for 14 years. At that point, he says, “It became a vicious circle. The longer I waited, the more apprehensive I got. I also didn’t want someone scolding me for not getting regular exams.”

Fletcher’s dental anxiety also began in childhood. The family dentist, he says, was rough and cranky with children. “He got impatient if you weren’t sitting in the chair just right.”

Then, at age 10, Fletcher fell off his bike and broke two front teeth. Suddenly, “the person I feared most was someone I had to see every week.” The trauma of those visits remained with him for years, he says. When he left home for college, he also left behind the agony of seeing the dentist.

As might be expected, Franzino, Amaral and Fletcher had to address a number of problems when they finally did seek dental treatment. They had inflamed gums, lots of cavities and old restorations that needed repair.

That’s not uncommon, says Dr. Debra Gray King, an Atlanta dentist known for her patient-friendly practice. “People who neglect regular dental exams typically suffer from numerous oral health problems, the most obvious of which is losing their teeth to decay or gum disease.” Then there’s the issue of halitosis, or bad breath, often caused by bacteria that brushing and flossing alone cannot eradicate.

More alarming, however, are recent studies that link gum disease to a host of other more serious medical problems including diabetes, heart disease and premature births. “You just can’t afford to say, ‘It’s only my teeth,” says King. “If you have an infection in your mouth, it can compromise your entire immune system.”

Krochak agrees. People with chronic gum disease have an increased risk of getting colds and flu, he says, because “the immune system is so busy fighting the periodontal infection that it can’t take care of the other problems.”

Then there are the emotional and psychological aspects of neglecting oral care. “The reluctance to smile is crippling,” states Krochak. “From a business and a social standpoint, it can really limit your success.”

Finally, the failure to seek routine dental care can result in missed opportunities to diagnose oral cancer in its earliest - and most treatable - stages. “A dentist often spots oral cancer before the patient even knows it exists,” says King. And the sooner oral cancer is detected, the greater the odds the patient can beat it.

Luckily, new technology has made comfortable dentistry a reality, says Dr. Michael Goldman, a dentist in Chevy Chase, MD, who specializes in treating anxious and phobic patients. “Advances in technology mean advances in patient care.”

At the forefront of these advances are computer-controlled anesthesia delivery systems. Many patients dread the injection of the anesthetic more than the procedure itself, says New York City practitioner Krochak. Yet it’s not the needle that causes the primary discomfort during an injection but the pressure and volume of the anesthetic going into the tissues, he explains. The new computerized systems constantly adjust both pressure and volume so that there is little or no discomfort. Moreover, the computer provides a flow of anesthetic directly ahead of the needle, which numbs the insertion site and provides an anesthesia pathway, so “patients hardly feel the needle at all.”

In her Atlanta office, King uses an electric handpiece rather than a conventional mechanical one. “Most patients can’t stand the high-pitched sound of the drill,” she says. “It’s frightening.” The electric handpiece has a lower pitch and is much quieter than its traditional counterpart, which goes a long way toward allaying patient fears.

Laser drills may soon play a part in the dental office as well. Recently approved by the Food and Drug Administration, laser drills prepare cavities for fillings and may produce less pain than conventional mechanical drills. And new anesthetics now target problem areas more effectively and wear off sooner.

Yet purchasing high-tech equipment is only one way that dentists are enhancing patient comfort. They also are turning to non-traditional treatments to make sure their patients stay relaxed.

Goldman gives his patients a cordless buzzer, much like a small TV remote control, that allows them to take a time-out. He invented the device so that nervous patients would feel a greater sense of control over their treatment. Dubbed “Speakeasy” by Goldman, the lipstick-sized gizmo works like a charm, he says. “Most people never even use it, but they feel better knowing that they could if they needed to.”

King’s practice provides massage boots and hot paraffin hand treatments to patients who request them. There is no additional charge to patients for these “extras,” she says, adding that such spa-like amenities “really make patients feel pampered.”

And at Krochak’s office, patients are treated to warm neck pillows and massage pads on chairs and can even enjoy a foot massage by a professional masseuse if they book the appointment in advance.

These dentists pay attention to the details. They use aromatherapy to eliminate the clinical smell of the office. They also provide patients with visual and auditory distractions such as virtual reality glasses, CD music collections and relaxation videotapes.

The result is happier patients. “There are lots of things that divert my attention,” says New York City patient Franzino. Now during office visits, she puts on the headphones, turns up the volume and tunes out the noise.

With all the dentists out there, how can you choose one who will understand your fears and provide empathetic care? Following are six rules for finding the right practitioner.

• Don’t wait until there is a problem to seek treatment. In an emergency situation, there’s no time to interview the dentist or to check out the practice, says Goldman. “Start developing a relationship with a dentist before there’s an emergency.”
   
• Talk with the person who answers the phone. Share your concerns about dental treatment. Although that person is not the dentist, he or she should be understanding and compassionate, says King. “If the person answering the phone isn’t friendly, chances are the dentist won’t be either. The doctor sets the tone for the entire office.”
   
• Ask for a consultation appointment. This appointment gives you an opportunity to gather information and talk about treatment, says Krochak. If a practice won’t make that kind of appointment, “check it off the list,” he advises. Likewise, if you don’t feel that the dentist is listening to you during the consultation appointment, go somewhere else. “You should feel completely comfortable with the person who will be treating you.”
    
• Book your appointment for a time of day when you will have no other stresses. Don’t book it when you know you have to be somewhere else shortly afterward, says Krochak. “That will only add to your anxiety.”
   
• Communicate with your dentist. Participating in decisions about your treatment will give you a feeling of control, says Krochak. Discuss various treatment options and ask the dentist to explain what is happening at every stage of the procedure. “Anxiety often comes from not knowing what’s about to happen. When you know what the dentist is going to do, you won’t be taken by surprise.”
   
• Start slowly. Build your confidence level one step at a time, advises Goldman. For example, begin treatment by simply getting your mouth examined. Then come back later for a cleaning. “You don’t have to do everything at once,” he says. “It’s like a blind date. You start with coffee and then move on to dinner and a movie.”

Editor's note: With this article, we welcome a new contributor to the site, Fran Worrall, and look forward to more of her informative, thoroughly researched articles in months to come.