The Derryn Hinch Drive Show

Media item: radio interview

Programme: the Derryn Hinch drive programme, Melbourne commercial radio

Date broadcast: 28 September 2008

This page records the media item. The audio is the property of the broadcaster and is not reproduced here.

No individual's dental treatment is described here, and section 133 of the National Law prohibits testimonials about clinical care in advertising a regulated health service. What follows is general information on dental anxiety — which, with cost, is one of the two documented reasons Australians avoid dental care.

It is common, and it is not irrational

A large proportion of adults report some anxiety about dental treatment, and a smaller but substantial group avoid care entirely because of it. The Australian numbers are specific. Armfield, Stewart and Spencer, drawing on the 2002 National Dental Telephone Interview Survey — a random national sample of 6,112 people aged 16 and over — found that 11.9% were “very” afraid of going to the dentist and a further 5.2% “quite” afraid, with another 15.1% “a little” afraid and 67.7% not at all. Internationally, a 2021 meta-analysis in the Journal of Dentistry pooling 31 studies and 72,577 adults estimated the prevalence of dental fear and anxiety at 15.3% (95% CI 10.2 to 21.2), high dental fear at 12.4% (95% CI 9.5 to 15.6) and severe dental fear at 3.3% (95% CI 0.9 to 7.1). Read that last confidence interval before quoting the figure: it runs from under 1% to over 7%, and 28 of the 31 studies were assessed as high risk of bias, so “around three per cent” is defensible and “3.3% of adults” as a flat fact is not. The Victorian Department of Health, for its part, declines to give a prevalence figure at all, saying only that dental anxiety “is common and can affect people of any age” and that “Dental phobia is less common.”

It is not a character failing and it is rarely irrational. The common origins are specific, and the Victorian Department of Health's own list names them: “a traumatic dental experience or other healthcare experience”, previous trauma to the head and neck, other traumatic experiences including abuse, generalised anxiety, depression or post-traumatic stress disorder, “the view that the head is a personal area and accessing the mouth is an invasion of personal space”, “fear of loss of control”, trust issues, and anxiety associated with agoraphobia, claustrophobia or obsessive compulsive disorder.

A bad experience, usually in childhood. Frequently a painful procedure where the local anaesthetic did not work properly — which is a genuine and well-documented event, not a misremembering. Teeth affected by molar incisor hypomineralisation are notably harder to anaesthetise, and a child who was told ‘you can't be feeling that' while they were, in fact, feeling it has learned something entirely reasonable. One qualification worth having: the same Australian researchers noted that “many highly anxious people can not recall an aversive event which might explain the origin of their dental anxiety”, so not being able to name the appointment does not mean the fear is groundless.
Loss of control. Lying flat, unable to speak or swallow, with someone working in your mouth.
Embarrassment about the state of your teeth, or about how long it has been. This one keeps more people away than fear of pain does.
Fear of cost, and of what will be found.
A gag reflex, which is involuntary and distressing.
Past trauma unrelated to dentistry. Being reclined, restrained or unable to communicate is difficult for many people for reasons that have nothing to do with teeth.
The sounds and smells, which are strong retrieval cues.

It also has physical signs that people are often embarrassed by and should not be. The Victorian Department of Health lists sweating, a racing heartbeat or palpitations, low blood pressure and possible fainting, visible distress, crying or signs of panic, and withdrawal — or using humour or aggression to mask anxiety. Every one of those is a recognised presentation, not a failure of nerve.

Why avoidance is the expensive part

The cycle is the whole problem:

Anxiety leads to avoidance. Avoidance means disease progresses undetected. When the person finally attends, it is usually in pain and needing more invasive treatment — an extraction rather than a filling. That visit confirms the fear. The fear deepens, and the next gap is longer.

That is not a figure of speech; it is a named and measured phenomenon. The Victorian Department of Health calls it “the ‘vicious cycle of dental anxiety'” and notes that avoidance also “prevents people from ‘extinguishing' the anxious or fearful state as a result of non-traumatic dental experiences” — in other words, staying away removes the only thing that could disconfirm the fear. The Australian survey data put numbers on each step. Among people who were very afraid: 43.9% had last seen a dentist more than two years earlier, against 29.1% of those with no dental fear; 67.3% usually attended only because of a problem, against 44.9%; of those, 72.3% usually attended for relief of pain, against 54.7%; and 29.2% fitted the full profile of delayed visiting, dental problems and symptom-driven attendance, against 11.6% of people with no fear — an odds ratio of 3.33 (95% CI 2.67 to 4.15) after adjustment for sex, dentate status, employment and household income. The outcome side follows: perceived need for an extraction was 18.6% among those who had not attended for more than two years against 7.3% among those who had, and people who were very afraid had significantly more teeth missing due to decay. The study was cross-sectional, and its authors are careful that “causality cannot be inferred from the results” — but the pattern is consistent across every measure they took.

Which is why the most valuable thing this page can say is: going back after a long absence is the hardest appointment and the most worthwhile one. A small filling and an extraction are the same disease caught at different points.

And nobody is going to lecture you. A practitioner who makes someone feel judged for a ten-year gap has made the next ten-year gap more likely, and they know it. How we approach it is set out separately.

What actually helps

Most of it is unglamorous and most of it works — though the evidence is uneven, and the honest version separates what has been shown from what is simply sensible.

Say so when you book. The most useful sentence available: ‘I'm anxious about dental treatment.' It changes the appointment before it starts — longer booking, a quieter time of day, a first visit that is talking rather than treatment.
Agree a stop signal. Raising a hand means stop, and it must be honoured every time. Being able to stop is what restores control, and people who know they can stop rarely need to. This is on the Victorian Department of Health's own list of coping techniques — “agreeing with your dentist on a signal to stop during the treatment for a break (such as raising your left pointer finger or hand)” — and paediatric guidance adds a detail that applies just as well to adults: “The patient should practice this gesture before treatment is initiated.”
Ask for it to be explained first. ‘Tell-show-do' — explain, demonstrate, then proceed — is standard technique with children and works just as well with adults.
Ask them not to explain, if you would rather not know. Either is fine; say which. Worth knowing that the evidence for information by itself is weak: a 2024 meta-analysis of randomised trials found that pre-operative video information, compared with ordinary verbal information, produced no significant reduction in state anxiety (SMD −0.04, 95% CI −0.19 to 0.12, moderate certainty). Being told what will happen is your right; it is not a treatment for the fear.
A first appointment with no treatment. Just talk, sit in the chair, leave. Entirely reasonable to request.
Bring someone.
Headphones and your own music — and here the sources genuinely disagree, so we will not pretend otherwise. The Victorian Department of Health lists “distraction (such as listening to music or the use of devices)” among its psychological coping techniques. But the 2024 meta-analysis found, with moderate certainty, that background music did not significantly reduce state anxiety (13 trials, 923 participants, SMD −0.25, 95% CI −0.49 to 0.01; and with one outlier removed, −0.10, 95% CI −0.23 to 0.03). It reported the same null result for virtual reality distraction, virtual reality exposure therapy, acupuncture and, with low certainty, lavender aromatherapy. Its authors say directly that “our results contradict a recent network meta-analysis” — Hao and colleagues, 2023 — which had found music and virtual reality distraction helpful, and attribute the difference to heterogeneity in that analysis. So: if music helps you, use it. It is free, harmless and you are the best judge. Just do not let anyone sell it to you as an evidence-based treatment, because on the best current synthesis it is not one.
Morning appointments, so the day is not spent dreading it.
A written plan you take home, so decisions are not made under stress.
Ask about topical anaesthetic gel before the injection, and say if you have had anaesthetic fail before — there are techniques and agents for that, and it is a clinical problem rather than a complaint. The evidence for topical gel is real but narrower than its reputation: a meta-analysis of 22 randomised trials and 1,029 patients found it reduced the pain of the needle going in in the upper jaw — significantly in both the vestibular (P = 0.0002) and palatal (P = 0.005) regions — but found no statistically significant difference in the lower jaw (P = 0.07) and no difference in the pain of the anaesthetic solution being injected (P = 0.11). The authors' own conclusion was that using topical anaesthetics “only relieves pain during needle puncture and in the maxilla.” They also reported considerable statistical heterogeneity. So it is worth asking for, and it is not a guarantee of anything.
For a strong gag reflex: sitting more upright, smaller instruments, nasal breathing, and short bursts with breaks. Say it at booking.

Sedation, honestly

Sedation has a genuine place, and it is oversold as a first answer.

Nitrous oxide — inhaled through a nose mask, mild, adjustable, and wears off within minutes, so you can usually drive home. Good for mild to moderate anxiety and for gagging. You remain awake and able to respond. Paediatric guidance describes its properties in terms that hold for adults too — onset is rapid, “the effects easily are titrated and reversible”, and recovery is “rapid and complete” — while listing among its cautions any condition “that inhibit nasal breathing”, such as a cold, cough, tonsillitis, sinusitis or seasonal allergies. The same guidance notes that above 50% concentration, or combined with other sedating medication, the likelihood of moderate or deep sedation increases, at which point different rules apply.

Oral sedation — a tablet before the appointment. Simple, but the effect is not adjustable once taken, and you need someone to bring you and take you home. The measured benefit is modest: pooled across six randomised trials and 581 patients, oral sedative medication reduced state anxiety with a standardised mean difference of −0.43 (95% CI −0.74 to −0.12) against placebo, rated low certainty. A real effect, and a small one.

Intravenous sedation — deeper and titratable, delivered by an appropriately qualified practitioner with monitoring. Most people remember little of the procedure. An escort is required.

General anaesthetic — in a hospital or day-surgery setting, with an anaesthetist. The most resource-intensive option, and the one with the most significant risks. Usually reserved for extensive surgery, for some children, and for people for whom no other approach is workable.

Three honest caveats:

Sedation does not treat the anxiety. It gets you through an appointment. If nothing else changes, the next appointment needs it too. The 2024 review makes the same distinction in clinical terms: “Clinicians should ensure that interventions match their purpose—managing acute emotions during treatment, or alleviating chronic anxiety and avoidance tendencies.” Sedation does the first. It does not touch the second.
It costs substantially more, and health fund coverage differs — hospital cover rather than extras generally applies to a general anaesthetic admission.
Your full medical history and medication list matter enormously here. Sleep apnoea, respiratory and cardiac conditions, and a number of medications all affect what is safe.

For entrenched dental phobia, psychological treatment works — and it is the one intervention in this whole field that carries a moderate-certainty recommendation. The 2024 meta-analysis found that to reduce chronic dental (trait) anxiety, “evidence with moderate certainty supports employing CBT”: pooled against untreated or waitlisted controls, cognitive behavioural therapy gave a standardised mean difference of −0.43 (95% CI −0.68 to −0.17) on the more conservative analysis. For dental phobia specifically, psychotherapies including CBT gave −0.48 (95% CI −0.72 to −0.24), moderate certainty. Hypnosis has moderate-certainty support for acute anxiety during extraction — −0.31 (95% CI −0.56 to −0.05). These are small-to-moderate effects rather than transformations, and the authors say so. A GP referral is the route, and it is rarely mentioned.

And the two things that reduce future fear most

Prevention. The person who never needs anything done is not tested. Fluoride, cleaning between teeth, reduced sugar frequency and regular examinations are anxiety management as much as disease management.
Not using the dentist as a threat with children. ‘If you don't brush, the dentist will…' costs that child a decade of avoidance later. It is the single most avoidable cause of adult dental anxiety — what helps instead. The reason to get this right in childhood rather than later is stated plainly by the Victorian Department of Health: “Children who have had bad dental experiences can likely overcome their fear if they are supported during further dental visits. Adults who are anxious about dental care tend to remain anxious throughout life.” That is not a counsel of despair for adults — the CBT evidence above is real — but it is an argument for not creating the problem.

Common questions

I take medication for anxiety or depression. Does that matter at the dentist?

Yes, and not for the reason people expect. Bring the list, because several classes of medication reduce saliva: Bollen and Beikler record that “When tricyclic antidepressant medication is used, xerostomia can appear”, and a dry mouth is one of the strongest decay risk factors there is. Do not stop a prescribed medicine to protect your teeth — that is the prescriber's decision, and dentistry manages the consequence.

One specific trap. Australian Prescriber states that essential-oil mouthwashes “are not recommended for patients suffering from xerostomia”, because of “possible ethanol-induced mucosal irritation and dryness” — so the rinse many people reach for makes the problem worse. It recommends instead a plain sodium bicarbonate rinse, one teaspoon in a glass of water, in “patients suffering from xerostomia or erosion”, because it raises salivary pH and does not irritate the lining of the mouth.

I am pregnant. Can I put it off until afterwards?

Deferring is the common instinct and it is the wrong one. The ADA's consumer survey of 25,000 Australian adults found that 75% of women did not have a dental check-up before conception, and describes that check as “vital because poor oral health in pregnant mothers is associated with poorer pregnancy outcomes like low birthweight babies.” Note the word associated — the ADA is not claiming the gum disease caused it.

Routine dental care is appropriate during pregnancy, and hormonal change makes gums respond more strongly to plaque, so this is the period in which they need attention rather than less of it. Some elective treatment and some imaging is reasonably deferred; an examination and a clean are not. Tell the practice you are pregnant and how far along, and see is it safe to visit the dentist in pregnancy?

My problem is the cost, not the chair. Does that change the advice?

It changes what you say when you ring, and it is the other documented reason Australians stay away. The figure usually quoted is that 32% of people aged 5 or older delayed or avoided dental care because of cost — an AIHW survey finding, but one that reaches us second hand through an advocacy submission to a Senate inquiry, and from a 2013 survey, so treat it as an order of magnitude rather than today's rate.

Practically: say that cost is the barrier, and ask for the plan in stages with a cost against each stage, plus what deteriorates if a stage waits. Ask for item numbers, which are standard and let you compare quotes line for line — worth doing, because the ADA's own Dental Fees Survey reports “considerable variation in the fees charged within and between states” and Australia has no national fee schedule. And note that the cheapest moment to treat anything is the earliest one, which is exactly what waiting removes.

The dentist is the frightening part. Could I see a hygienist instead?

For cleaning and prevention, often yes — and it can be a sensible way back in. Dental hygienists, dental therapists and oral health therapists hold their own registration, separate from a dentist's, and the AHPRA register shows which division a practitioner is in, so you can check before you book.

What it cannot be is a substitute for diagnosis. The Dental Board's Scope of practice registration standard requires every dental practitioner “to practise within the scope of their education, training, and competence at all times” — which means a hygienist appointment is a hygienist appointment, and anything found that falls outside that scope gets referred on. Used deliberately, that is a feature rather than a limitation: a first visit for a clean, with a dentist's examination scheduled once you have been in the building without incident, is a legitimate way to stage your own return. Say that is what you are doing when you book.

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Every practitioner's registration can be verified free on the AHPRA public register at ahpra.gov.au.

This page records a broadcast and its date, with general information. It is not a diagnosis, a treatment plan or advice about sedation, which carries risks and is assessed individually. No individual's clinical information is published here. Third-party broadcast content is not reproduced.

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