More Than Just a Checkup: Why Dental Fear Deserves Real Attention

By Ishan Kapoor: Not long ago, an elderly woman came into our clinic trembling—not from the cold, but from fear. When I asked what was wrong, she said that years ago, someone had kicked her in the mouth during an abusive relationship. Since then, she had avoided the dentist entirely. Her trauma wasn’t just emotional, it was physical, visible in her missing teeth and neglected oral health. That day, it hit me: dental fear isn’t just about drills and needles, it can be rooted in real, painful memories.

Dental fear affects over 30% of adults globally, with around 20% of Americans experiencing it even if they see a dentist once a year (Heyman et al., 2024). That’s tens of millions of people avoiding the chair, often until things get really bad. The problem is, the more they avoid treatment, the more their oral health worsens, reinforcing their fear. It’s a vicious cycle.

We’re lucky that science has a fix: cognitive-behavioral therapy for dental fear (CBT-DF). This stuff works. Studies show that CBT-DF not only reduces fear (effect sizes of d = 1.2 are no joke), but also helps people actually go to the dentist again (Heyman et al., 2018). The only problem? It’s usually only available at specialty clinics that most people never hear about.

Here’s where it gets interesting. A new app called Dental FearLess puts CBT strategies right into your phone. It teaches breathing techniques, how to challenge scary thoughts, and gives exposure practice in a safe way—like videos of dental tools and procedures. In one study, users found it helpful and easy to use, and half of them ended up no longer qualifying as "fearful" after using it (Daly et al., 2024; Heyman et al., 2024). That’s powerful.

The cool part is the app doesn’t just throw content at you. It builds a plan around your biggest fears, walks you through coping strategies, and even includes a “Just Test It” mindset, where you prepare to challenge your fears at your next appointment (Daly et al., 2024). It’s like having a therapist in your pocket—minus the high cost or waitlists.

The dental fear cycle: how negative beliefs and fear lead to avoidance, declining oral health, and eventually dental emergencies—reinforcing the cycle all over again. Image source: Dental FearLess

But we can’t forget about the human side. Like the woman I met, people’s fear is often tied to real-life trauma. You can’t erase that with an app, but you can make space for healing. CBT-DF focuses on exposure and emotional regulation, yes, but it also encourages better dentist-patient communication—a huge deal when trust is so broken (Daly et al., 2024).

Dental hygienists and assistants have also been stepping up. They’re often the first ones to notice fear, and many patients trust them more than dentists (Daly et al., 2024b). With a stepped-care model—starting with the app, then offering a one-on-one CBT session if needed—there’s now a real shot at helping patients before they spiral into avoidant behavior again (Heyman et al., 2024).

To this day, I still think about that woman. She left that visit feeling heard and finally booked her next cleaning. For her, and millions like her, the key isn’t just clean teeth—it’s feeling safe enough to even open their mouth.

References (APA Style):

Daly, K. A., Diaz-Gutierrez, K. A., Beheshtian, A., Heyman, R. E., Smith Slep, A. M., & Wolff, M. S. (2024). Afraid of the dentist? There’s an app for that: Development and usability testing of a cognitive behavior therapy-based mobile app. PLOS Digital Health, 3(12), e0000690. https://doi.org/10.1371/journal.pdig.0000690

Heyman, R. E., Daly, K. A., Slep, A. M. S., & Wolff, M. S. (2024). Leveraging technology to increase the disseminability of evidence-based treatment of dental fear: An uncontrolled pilot study. Journal of Public Health Dentistry, 84(1), 36–42. https://doi.org/10.1111/jphd.12598

Daly, K. A., Heyman, R. E., Drew, A. L., Smith Slep, A. M., Bubis, R., Lee, J., Pearce, V. V. V., Jones, R., Ruggiero, M., & Wolff, M. S. (2024). A pre-adoption assessment of a collaborative care approach to dental-fear treatment. Oral, 4(4), 589–599. https://doi.org/10.3390/oral4040046

Heyman, R. E., Wojda, A. K., Eddy, J. M., Haydt, N. C., Geiger, J. F., & Smith Slep, A. M. (2018). Dentist-perceived barriers and attractors to cognitive-behavioral treatment provided by mental health providers in dental practices. Advances in Dental Research, 29(1), 35–41. https://doi.org/10.1177/0022034517737023