Embarrassment as a Factor in Phobic Dental Anxiety

Embarrassment is scantily described in studies as a factor in extreme dental anxiety or phobia. Objective: Present qualitative study aimed to describe details of embarrassment as related to extreme or phobic dental anxiety. Methods: Subjects (Ss) were consecutive specialist clinic patients, 16 men, 14 women, 20-65 yr, who avoided treatment due to anxiety mean 12.5 yr (DAS mean = 17.8). Chief complaints in the sample: 30% primarily had fear of pain. 47% cited powerlessness in dental situations, some specific to embarrassment. 23% named co-morbid psychosocial dysfunction due to effects of sexual abuse, general anxiety, gagging, fainting or panic attacks. Electronic patient records and transcribed entrance and exit interviews were analysed using Qualitative Software Research "N4" program to aid in exploring categories or contexts related to embarrassment. Results: Embarrassment was named in all but one case. Two major categories emerged from analyses: 1) embarrassment to show the mouth to dental personnel (fears of being confronted with “bad news” and subsequent negative social evaluation) and 2) embarrassment about dental status or neglect affecting general psychosocial functioning. Most Ss hid smiles or laughter with lips, hands or changed head position. Secrecy, tabu-thinking, shame and poor self-image were all found to contribute to these embarrassment behaviors. Both categories were linked to bad conscience about years of neglect, often with complex self-punishment that reinforced social withdrawal and poor self-image in a vicious circle with anxiety and avoidance. Conclusion: Embarrassment is a complex dental anxiety characteristic deserving clinical attention. It exhibited different types and intensities. Some cases exhibited manifestations similar to known psychiatric criteria for social phobia, while most manifested embarrassment as a side effect. Funded by Danish Dental Association’s FUT.