Japanese researchers get to root of dentist phobia

SOUNDS SCARY::A team of experts and psychiatrists found that dentist-phobic people’s brains respond differently to dental noises than non-scared patients’

The Guardian, SAN DIEGO, California

Wed, Nov 13, 2013 - Page 7

The whir of a dentist’s drill might bring on the shakes and a racing heart, but what happens in the brain has long been a mystery.

Researchers in Japan now believe they are closer to an answer after scanning people’s brains while playing them sounds of dental drills and suction instruments.

People who were terrified of visits to the dentist showed marked differences in their brain responses, compared with those who were more relaxed at the prospect, according to work reported at a meeting of the Society for Neuroscience in San Diego, California, on Sunday.

Unraveling how the brain reacts to the sounds, particularly in the most anxious dental patients, could help scientists assess different ways to make patients more at ease, by seeing how they alter neural activity, said Hiroyuki Karibe at Nippon Dental University in Tokyo.

Working with psychiatrists, Karibe asked 21 women and 13 men aged 19 to 49 to complete a survey that measured how much they feared a trip to the dentist. Karibe divided the volunteers into high and low fear groups according to their scores on the survey.

He then scanned the participants in a functional magnetic resonance imaging machine (fMRI) while playing them a series of sounds, including screeching dental drills and rasping suction tools.

People in the low fear group were not overly anxious about going to the dentist.

When they heard dental sounds, parts of the brain called the left and right superior temporal gyri responded more than when they heard neutral sounds.

This means that dental sounds triggered more activity in the primary auditory areas of the brain, Karibe said.

Anxious people responded differently.

Instead of a surge of activity in the auditory areas of their brain, Karibe said he saw a more intense response in a region called the left caudate nucleus, which may play a role in learning and remembering the sounds of the dental instruments.

About 10 percent of the population have severe anxiety about trips to the dentist and many put off their visits until they have a toothache or another emergency, such as a dental abscess.

The behavior can lead to a negative cycle of events, with patients becoming ever more afraid because emergency treatment can be more traumatic.

Martin Tickle, professor of dental public health at Manchester University, said dental anxiety was more common in children whose parents feared the dentist and who had a history of having teeth extracted.

However, a recent survey by Tickle found that pain is actually quite rare in dental surgeries.

Tickle compiled reports from 451 adults visiting dentists in northwest England and found that 75 percent of patients reported no pain at all during their visits. Those having the most invasive procedures, such as tooth extractions and root canal treatment, reported some of the higher pain scores, but even many of these claimed to experience no pain at all.

“The strongest predictor of pain during dental procedures was dental anxiety. Anxious patients were four times more likely to experience pain than non-anxious patients after controlling for other factors,” he said.

“I don’t think the answer for the NHS [the National Health Service, the UK’s publicly funded healthcare system] lies with giving dentally anxious patients brain scans. The first thing we need to do is prevent dental caries in young children to stop them having to have extractions, as the most common reason why children have a general anesthetic is to have decayed teeth extracted,” Tickle added.