During the 32nd Annual General Congress of the Ghana Dental Association, various speakers shed light on advancements in dentistry and oral health. In Ghana, technological innovations in dentistry particularly in the field of teeth alignment and the use of invisible clear trays to straighten teeth i.e. aligners / Invisalign are taking hold.

Despite increasing awareness of oral health, dental anxiety in Ghana is rarely addressed even though it affects approximately 30% of the population, with 12% having extreme fear and 3% avoiding the dentist at all costs even when in extreme pain. Dental anxiety is defined as fear, apprehension or stress associated with being in a dental setting that often leads to a delay or outright avoidance of dental treatment. In its most severe form and when it is a totally irrational fear, it can be classified as dental phobia.

Anxious patients can sweat, have palpitations, have low blood pressure which can lead to fainting; and exhibit visible signs of distress including crying, withdrawal, use of control, humour or aggression to mask their anxiety.

But what actually causes it?

Dental anxiety stems from multiple sources including, a previous traumatic dental or other healthcare experience, fear of the unknown, anticipation of pain or discomfort, fear of loss of control, and a general feeling of vulnerability in a medical setting. Anxiety associated with other conditions such as agoraphobia – fear of being in situations where one cannot escape and claustrophobia – fear of closed spaces can also be a factor.  It is important to note that some level of anxiety is perfectly normal and common. However, when it leads to avoidance, then non-management of dental anxiety can result in dental problems getting worse which results in a greater need for emergency care and more complex treatment, which in turn feeds the ‘vicious cycle of dental anxiety’ making each visit more difficult and unpleasant. Regular check-ups, cleansing, and x-rays of the teeth can prevent dental disease and enable the dentist to find problems early so that less invasive and less costly treatments are needed. 

During regular check-ups, dentists also check for signs of mouth cancer, which is especially important for those who smoke or regularly drink alcohol, and even more so for those who do both. If you notice a mouth ulcer that lasts for longer than 2 weeks, get it checked by a dentist as soon as you can.

The lifestyle factors that lead to dental disease are very similar to those that lead to diabetes, obesity, heart disease, stroke and some cancers (regularly consuming sugary food and drinks, smoking and regularly drinking alcohol). So, taking care of your oral and general health and remembering to brush your teeth twice a day and floss once a day is still very important.

Anxiety is experienced by both young and adult patients. Children are likely to overcome their fear if managed properly, whilst many adults tend to remain anxious throughout life and develop coping mechanisms. 

There are a multitude of ways to manage dental anxiety or phobia. What is clear is that addressing this is crucial to the 30% of the population that experience this, and currently, there is a lack of a clear pathway for such clients to access dental care in Ghana.  

The most important and first step is finding a dentist who truly has a keen interest in treating dental phobics as the approach required is different to the treatment of regular patients. The physical environment of the clinic – can the anxious client be seen and overheard by other clients, is it a serene and welcoming space with sufficient material to keep your mind engaged? It is crucial that you have an honest and frank discussion with your dentist about what makes you anxious and how this makes you feel. The more explicit and honest you are about what triggers your anxiety, the better. These initial steps are important and allow a personalised and tailored plan to be formulated to manage your anxiety. This plan will incorporate elements such as frequency, duration and timing of appointments, how to communicate when you need a break, how to stay hydrated and how to ensure a good night's sleep the night prior to your dental appointment.

Initially, your dentist will try the use of psychological coping techniques including deep breathing, meditation, distraction (such as listening to music or the use of screen devices), guided imagery and muscle relaxation. 

Where these techniques are not adequate and the client is still anxious, then the next step is medical management with relative analgesia (happy gas), anxiety-relieving medication, conscious sedation (twilight sedation) or general anaesthesia.

Dental sedation is particularly good for those who are very anxious about the sights, sounds, smells, and sensations associated with dental treatment; those who have had a previous bad experience in the dental chair; those with a fear of needles, or who do not numb up easily; those who have very sensitive teeth and have an active gag reflex, and those in need multiple or complex procedures.

The use of Nitrous oxide/inhalation sedation / laughing gas /happy air as this method is often called is a proven method. When used in dentistry, a nasal hood is placed over your nose, and you breathe in a mixture of nitrous oxide and oxygen. It takes effect within a few minutes and helps people to relax during dental treatment whilst staying awake. It induces relaxation, reduces anxiety, and provides some pain relief. You can talk to the dentist, and hear what they say to you, but you won’t necessarily remember everything once the visit is over. For most people, the relaxed sensation created by nitrous oxide sedation is very pleasant. It is simple to use, painless and safe. In fact, it is so safe, that it is what most women use in the initial stages of labour.  It also wears off quickly allowing patients to resume their activities promptly.

An alternative and a less reliable alternative is an oral pill which is prescribed by your dentist or doctor and taken an hour before the dental appointment or the night before, however, the results are highly variable and inconsistent.

When a deeper level of sedation is required, IV sedation/twilight sedation can be used. In this scenario, the medication is received through a drip placed into a vein. This is provided by a dental sedationist (a dentist with advanced training in sedation) or an anaesthetist. It can be undertaken at a dental practice that has additional equipment, or in a hospital. Once again, a highly relaxed medical state is achieved such that your mind is calm, and your body relaxed. When having twilight sedation, you are awake but very relaxed and can respond to verbal prompts and hold a conversation.

However, your mind is calm, and your body is relaxed.  Perhaps the best bit about IV sedation is the fact that many people cannot remember the event. It is efficient – as treatment can be completed faster, and just the reduced physical tension speeds up healing, but the most important thing is how calm, comfortable and pleasant clients find it and how it opens up a safe option to those who experience significantly heightened levels of anxiety. One can remain drowsy after the procedure so a ride to and from the appointment is a must.

Of course, in extreme cases, one can be fully put to sleep i.e. given a general anaesthetic in a hospital setting by an anaesthetist. This would seem ideal, but it has more possible risks and side effects and does not help you learn coping mechanisms for the future. Due to the risks and cost, dental treatments that require several visits are not usually offered, thereby limiting the treatment options available and it is often reserved for treatments that are the most difficult to cope with. Some pre-existing medical conditions or medications may affect the type of sedation you can have, and driving is not recommended when a sedative has been taken.

In conclusion, addressing dental anxiety is a pivotal aspect of oral health care. By utilising various strategies, from patient interaction and environmental enhancements to medical sedation, dental professionals can create a more positive and anxiety-free experience for their patients of all ages.

The provision of such services in Ghana is extremely limited, if not nonexistent; and the awareness of coping mechanisms and avenues to make treatment more tolerable for the 30% of dentally anxious clients, is minimal. Platinum Orthodontic and Dental Services as industry leaders have over the last 6 months invested in international training and certification of selected personnel, as well as fully equipping the facility to offer these services (except for General Anaesthesia). Our aim in launching this service is to make dentistry as safe and atraumatic as possible and to offer the full range of services available in a dental facility internationally.  

If you do experience dental anxiety, then we are here to help. Call or visit our website to book a consultation with one of our dentists today. Our staff will walk you through the process.