It Might Not Be Dental Anxiety. It Might Be the Shot.

It is CRAZY that no one tells you this about dentist appointments.

I have never had a problem with dental procedures. I didn’t LOVE going to the dentist, but after having my baby I saw the benefit of an hour of just lying in a supportive chair with my feet up while someone else did all the fussing. Then one random visit for a filling, my heart started RACING after getting my painkiller injection. I knew it made no sense that this was anxiety, but it sure felt like it. I asked my dentist what was going on, and she begrudgingly told me that yes, there are steroids in that shot, and they might make my heart speed up.

(Dear Reader, I have since changed dentists.)

WTF?! So all my clients, all this time — maybe they were never that anxious, but they only thought they were because of shot-induced physical symptoms.

The science:

Most dental local anesthetics contain epinephrine (adrenaline) as a vasoconstrictor — it keeps the anesthetic from dispersing too quickly and controls bleeding. Epinephrine’s effects raise heart rate and blood pressure. Research shows that tachycardia or increased heart rate was observed in 53.3% of patients receiving local anesthetic with a vasoconstrictor, compared with only 7.1% of patients who received anesthetic without one. More science about this here: MDPI + 2

In other words: more than half of people getting a standard dental shot experience a racing heart. And almost nobody tells them this is coming.

Here’s what that does to your brain:

That is the very nature of panic attacks — a spiral of trigger, physical response, and catastrophic misinterpretation. Clark’s cognitive model of panic proposes that panic attacks result from the catastrophic misinterpretation of certain bodily sensations — mainly those involved in normal anxiety responses, such as palpitations — which are perceived as much more dangerous than they really are. Then, once your brain starts freaking out about what your body is doing, your body in turn ratchets up the danger response, which makes your brain think “oh now we’re really in trouble” and your panic attack is off to the spiraling races. (ScienceDirectPLOS)

So in the dentist’s chair: you may not be thrilled to be there, and you may be feeling uneasy, then they give you the shot → your heart races → you think “I’m panicking!” → your heart races more → now you’re definitely panicking → repeat.

None of this had to happen.

Try this instead:

First, recline and appreciate that you don’t have to do anything. Catch up on your favorite Substack or podcast. Then, when they give you the shot, put on your Sherlock Holmes detective deerstalker hat and OBSERVE with DETACHED CURIOSITY (this is a mindfulness practice): “Ooh, thank you for the painkilling, shot! Let’s get to work! Now let’s see if I get that epinephrine response with a faster pulse.” Maybe even track your heart rate on your Fitbit — out of curiosity, not alarm. “Oh, isn’t that interesting, that’s a big/little/no jump. I can/can’t notice it. I also do/don’t notice breath/flush/sweat response as well. I am going to interpret that as a painkiller that is really working! No placebo there! Phew!”

Add some physical coping skills to the mindful observations: take deep breaths in with longer exhales. Distract and tire yourself out by seeing how long you can hover one heel off the chair.

That’s it. That interrupts the panic spiral before it starts. And then you get to label yourself as Someone Who Does Not Panic At The Dentist’s Office.

Just think of the podcasts you’ll enjoy.

One more thing: If you find the epinephrine response unpleasant, you can simply ask your dentist for an anesthetic without a vasoconstrictor. They exist. You’re allowed to ask.

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I love working with anxiety, and offer a 6-session course, Unanxious.

Schedule a free discover call with me if you want to manage your anxiety!