A lot of us don’t have what you might call a “great” relationship with dentists. When you poke around on the internet looking for a new tooth doc, you might find related searches including “What is it called when you hate the dentist?” and “Is it possible to never go to the dentist?” Some have wondered if it’s mutual: “Do our dentists hate us?” The Cut asked in 2019. (Answer: No, but it does sometimes seem that way.) In any case, it’s clear that there’s a lot of anxiety wrapped up in a trip to see the folks who poke at our teeth and gums. People feel anxious about the dentist for all kinds of reasons: because they're worried they’ll get shamed for not coming in sooner, because they don’t have insurance right now and fear they can’t afford the care they need, or because dental procedures can be painful. There are the long needles and assorted medieval-looking instruments, the judgmental-seeming questions about your flossing habits, the having of some person’s hands all up in your mouth for an extended period of time. Cameron L. Randall , a clinical psychologist and assistant professor at the University of Washington School of Dentistry in Seattle, told VICE that dental anxiety is incredibly common. “Dental anxiety and dental fear exists on a kind of a spectrum,” said Randall, who specializes in this area of research. “It’s not that people are either fearful of the dentist or not; there really is a range in the severity or intensity of the fear.” And where you are on that spectrum can determine how you handle your dental health. According to Randall, roughly half of Americans report “mild to moderate dental anxiety”—or an uneasiness around visiting the dentist that doesn’t necessarily keep you from seeking treatment. About 20 percent of people experience more significant distress or even avoidance, and 10 percent or so have dental phobia that causes them to delay visits for a long time or avoid seeking treatment altogether. (When I mentioned a friend who’s avoided the dentist for nine years, he told me, “That’s not super rare.”) Ada S. Cooper, a New York-based dentist and spokesperson for the American Dental Association, said dental anxiety can be the result of bad past experiences or feelings of guilt around the situation going on in your mouth—or it might boil down to the idea that, hey, no news is better than bad news. But, of course, that’s not always the case. “Ironically, by not seeing a dentist because of those concerns, patients actually find themselves faced with increased treatment time, increased cost, and more significant dental problems than they would face if they were to see a dentist on a regular basis,” Cooper told VICE. “In forgoing seeing a dentist, they’re actually making the reasons they’re afraid to see the dentist even worse.” So how do you keep anxiety from causing you greater stress down the line? Here’s what experts suggest for getting yourself into that chair. Communicate your anxieties. “I think the most important thing a patient can do is to communicate with your dentist,” Cooper said. “And once you establish that line of communication, that alone will help your dentist understand what your needs are and give you confidence that your needs are going to be addressed.” You should confide in your dentist and their staff about your specific concerns, and share what Randall calls “the nuances of your own dental fear.” How severe is it? Are you able to isolate the things that make you feel anxious? Is it that you’re afraid of injections, or do you have more generalized worries? Do you have a memory of a terrible dental experience that’s kept you from seeking treatment? You might not be able to pinpoint a single event, “but it can be helpful for the dentist to know,” Randall said. From there, they’ll be able to make a tailored plan that works for you and even pace treatments in a way that’s comfortable for you, and their staff can help minimize exposure to the things that cause you anxiety. This is a conversation you can have over the phone or by email before your visit, whether it’s a new dentist or one you haven’t seen in a while. Tell the receptionist, or ask if you can speak with a dental assistant (or even the dentist) before your appointment to talk about the fact that you’re an anxious patient. More and more oral experts are including questions about anxiety on new patient intake forms, where you can note your fears and then have a more in-depth conversation when you’re in the chair. This can be the time to bring up any financial anxiety you might have about surprise exorbitant costs. Some dentists—but not all—offer payment plans, and these policies vary widely from practice to practice. Payments might be expected weekly or monthly, a down payment might be required or not, plans might be interest free for a certain length of time but aren’t always. It helps to know the specifics before you’re in the chair. It can also help to do some research about dental anxiety before you go—and yes, reading this article counts. “For many people, I think understanding more about dental anxiety is helpful,” Randall said. Don’t go spiraling into the darkest corners of dental treatment WebMD, but think about how you’ll communicate to the dentist/hygienist in advance that you're feeling stressed/ashamed about your teeth, or ask your dentist to walk you through the details of the procedure you have coming up, so you know what to expect. “Sometimes just knowing what’s going to happen, in and of itself, alleviates the anxiety or fear of the unknown,” Cooper said. Practice relaxation exercises (and distraction exercises). Some people experience dread and worry about the dentist before they visit—they ruminate on the guilt about a delayed appointment, or stress about the recent falloff in flossing habits. For others, the reaction is both physical and mental, and it can happen when they’re in the middle of the visit. “If you’re feeling anxious, one of the things that happens is you have this physiological response,” Randall said. You might experience the “fight or flight” response: increased heart rate, faster breathing, sweaty palms, feeling fidgety or even nauseous. In these cases—if you’re in the chair, in the middle of a visit, with a set of fingers prodding your mouth—relaxation and distraction exercises can be really helpful. “Sometimes deep breathing can help,” Cooper said. “Breathing deeply while slowly counting to five, holding your breath for a second, then slowly exhaling.” This can “slow down your emotional needle” and keep that fight or flight response at bay. In addition to breathing exercises, she said her patients often wear air pods or headphones and listen to music over the course of the appointment. Others squeeze a stress ball or hold her assistant’s hand. She encourages people to visualize being anywhere else but the chair—a beach, a garden, a hiking trail. Randall noted that some practices now have TVs so you can watch a show or movie during your visit, and others have even started to use virtual reality as a distraction measure. He recommends positive coping statements, like, “This will last only two minutes, I can do anything for two minutes,” or, “I’ve had other dental visits in the past, and things have gone well.” Repeating this like a mantra can mentally fortify you in a thought-based way. Consider finding a new dentist. Cooper says patients should look for “a dental home,” or in other words: “A dentist you feel comfortable with, a dentist who you trust. A dentist whose style and manner and rapport with you make you feel comfortable being there, and who makes you feel as if whatever concerns you may have will be taken seriously.” If you’ve tried talking it out with your current provider and don’t feel like your concerns are being met with sincerity, it might be time to start looking for a new one. Up-front communication is key here, too: Finding a person who will take you seriously over an extended period of time begins with that first call or email to a new office, where you express your anxieties and communicate your concerns. Over the course of your search, you might be able to find a dentist who specializes in working with anxious patients, who has familiarity with working in time for breaks, or who’s comfortable responding to hand signals. “Before I do anything, before I pull the chair back, I say, ‘This is what I’m going to do. I’m going to pull the chair back now,” Cooper said. “And I always ask patients to give me a signal—raise your hand if you want me to stop for any reason, and I will stop.” Whoever your dentist is, it’s important for you, the patient, to feel in control of what happens during your appointment. Cooper said that the relationship between doctor and patient has changed over time, and there shouldn’t be a power dynamic where you feel helpless and unheard. When you find a dentist who makes it clear that you’re in charge—that nothing is going to happen without your awareness and permission—it can really help change your feelings about oral care. Give additional therapy a try. Sometimes, Randall told VICE, it can help to talk to someone besides your dentist. “If you’ve got very severe, very intense fears about the dentist—maybe even dental phobia, which is where your fears are so significant that you avoid going to dentist for long periods of time—you might consider talking to a psychologist, counselor, or psychotherapist about those fears.” Cognitive behavioral therapy (CBT) can be effective in working through teeth-related anxiety. For some people, exposure therapy is helpful: it can desensitize you to the things that cause you fear by facing your fears, systematically moving up what’s called a “fear hierarchy,” with a lot of support and training along the way. “You learn to cope with the things that cause you fear while also learning that some of those things aren't actually all that threatening, so it’s very effective for anxieties and fears and phobias—in fact, it’s one of the most effective treatments for anxiety and fear,” Randall said. A psychologist or therapist will also be able to point you to other treatment options. For example, there might be pharmacological options, including additional sedation, available to you. At the end of the day, whatever approach gets you into the dental chair to get the care you need is great. And remember: Your dentist should be on your team. Don’t let fear or shame get in the way of your oral health. “If you have had a bad experience in the past, that’s not going to determine what your experience is going to be in the future,” Cooper said. “Most of us have been in this business for many many many years. Whatever it is that you’re ashamed about, we’ve seen it, and we’ve seen more.” Follow Em Cassel on Twitter.