“Helping people regain control in the dental chair can ripple out into daily life”

Iveta Ramonaite, Dental Tribune International

Mon. 27 October 2025

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Few experiences evoke as much fear as sitting in the dental chair—especially for those whose trust was broken early in life. Bridging the fields of psychology and dentistry, a recent study led by Lena Myran, psychologist and PhD student at the Norwegian University of Science and Technology, has shed new light on how adverse childhood experiences (ACEs)—including bullying, parental divorce, abuse and parental alcohol misuse—may contribute to dental fear among young people. In this interview with Dental Tribune International, Myran discusses how early adversity can shape lifelong relationships with dentistry and suggests how dental professionals can help young patients rebuild trust.

Lead author of a recent study on adverse childhood experiences and dental anxiety, Lena Myran believes that combining procedural expertise with psychological care is key to patient-centred dentistry.

Ms Myran, what inspired you and your team to investigate dental anxiety in adolescents?
I’ve been working with patients who have severe dental anxiety since 2015 and have seen how profoundly it can affect their lives—not only their oral health. Many struggle with shame about their teeth, avoid treatment for years, endure pain or even attempt to extract teeth themselves rather than see a dentist. Some rely on painkillers and have difficulty eating. Helping people regain control in the dental chair can ripple out into daily life—improving confidence, social participation and quality of life. That’s deeply motivating.

When we got the opportunity to scientifically explore associations between ACEs, oral health and dental fear in adolescents, it felt like a natural extension of my work. It allowed me to further test what I was seeing in the clinic, contribute to a stronger evidence base, and ultimately help clinicians tailor care and reduce inequalities in oral health.

What did your study reveal about the relationship between ACEs and dental fear among adolescents?
We found that ACEs were associated with dental fear in adolescents. Adolescents with at least one ACE had higher odds of reporting dental fear, and each additional ACE further increased those odds. Specific ACEs such as bullying, witnessing violence, sexual abuse by peers and parental divorce were linked to 35%–93% higher odds of reporting dental fear. We also observed sex differences: dental fear was more common among girls than boys, and the association between ACEs and dental fear was stronger in girls.

Your research indicates that for individuals who have experienced bullying or abuse, the dental setting can evoke feelings of vulnerability and loss of control. What factors in the dental environment contribute to this, and why might the link between childhood adversity and dental fear be particularly strong among girls?
Several factors may contribute. First, the dental setting is intimate and can feel exposing: you’re lying back, someone is close to your face and working inside your mouth, you can’t fully see what’s happening and you can’t control the sequence of events. For individuals with histories of insecurity, humiliation or abuse, this can trigger feelings of vulnerability and loss of control.

Girls are, on average, more likely to experience certain forms of interpersonal violence and coercion, which may intensify their sense of vulnerability and loss of control. We also know that girls are vulnerable to experiencing unequal gender power relationships. Complying and placing yourself in a subordinate role may feel safer than expressing your needs or boundaries during dental treatment. This can make it more difficult to speak up when you are afraid, to ask for a break or to ask questions, and this in turn reinforces the experience of dental treatment as being threatening.

There are also social and developmental factors. During adolescence, girls tend to report higher levels of anxiety than boys, as reported in the Norwegian Young-HUNT study. Social norms can also make it more acceptable for girls to express distress, and girls may be socialised to be compliant—characteristics that can manifest in the dental chair. These are hypotheses that warrant further research.

Did you find any indication that early dental experiences might contribute to or reinforce dental fear later in life?
Our dataset did not include early dental experiences, so we could not test that directly. However, the literature consistently shows that painful or frightening experiences at the dental clinic and extensive early dental treatment are important risk factors for later dental anxiety. What has been less explored is how different types of adversity beyond the dental context contribute to dental fear, and that is why we focused on several specific ACEs.

What practical advice would you give to dental professionals who treat adolescents showing signs of dental fear or avoidance?
Dental fear is common in children and adolescents. Between 10% and 20% meet the criteria. Many children grow out of their dental fear as their brains mature, and they understand more about what is happening during the treatment. Dental professionals play a key role in how these experiences are shaped. During treatment, dental professionals should explain the procedure in terms children can understand, establish stop signals and provide a sense of control. This strengthens normal development. As our findings indicate, this is especially important for adolescents who have experienced trauma. Many have experienced insecurity, humiliation and betrayal. This can have emotional after-effects in the form of mistrust and fear.

“Combining dental expertise with psychological care allows us to offer genuinely patient-centred dentistry.”

Dental professionals should approach patients with openness and empathy and be aware of the unequal power relationship. Something as simple as asking an anxious patient about his or her experiences and being genuine, even when you make a mistake, can be crucial. Acknowledging mistakes can actually help rebalance power and strengthen safety. Children also need safe and predictable dental teams who talk about what is happening during visits, address their assumptions and follow up with short, regular appointments. This builds trust, which is the most important tool for preventing dental fear in the most vulnerable adolescents.

Finally, how can interdisciplinary collaboration between psychologists and dental professionals improve care for young patients with a history of adversity?
Oral health is about more than teeth; it’s about people and their experiences. Many adolescents arrive at a dental appointment with both physical and psychological needs, and closer collaboration with psychologists, general practitioners or school health services helps dental teams recognise trauma, choose attuned language and pace procedures so that care feels safe and predictable. For most young people, this level of trauma-informed practice is sufficient.

However, some adolescents have pervasive dental anxiety with long-standing avoidance and often won’t attend routine dental check-ups and will need structured anxiety treatment programmes. In these cases, the dental team and the psychologist can work side by side, planning graded exposure to dental treatment to rebuild trust and restore a sense of control. Such specialised treatment services exist in several European countries and are available in Norway specifically for both children and adults. Ultimately, combining dental expertise with psychological care allows us to offer genuinely patient-centred dentistry; we need each other’s skills to deliver the best service.

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