Panic Attack at the Dentist: What to Do

The short answer: if you feel a panic attack starting in the dental chair, raise your hand to stop, sit up, take the instruments out of your mouth and tell the team what is happening. Then slow your breathing and let the wave pass, which usually takes minutes. Panic attacks feel frightening but pass on their own. Chest pain, trouble breathing or fainting should always be checked straight away, though, because those symptoms can also mean something else. If you know you are prone to panic, planning ahead, including talking about sedation options, can make the next visit very different.

What a panic attack is, and why the dental chair can trigger one

A panic attack is a sudden surge of intense fear with strong physical symptoms: a pounding or racing heart, shortness of breath, sweating or chills, trembling, dizziness, nausea and a feeling that something terrible is about to happen. Symptoms come on suddenly and usually peak within about ten minutes.

The dental chair combines several common triggers. You are lying back, your mouth is open and occupied, it can be hard to swallow or speak, and you may feel you cannot leave. For people who fear choking or losing control, that combination is especially hard. Past painful or embarrassing dental experiences add to it.

There is one more, very physical factor. Some dental anesthetics contain a small amount of epinephrine (adrenaline) to make the numbing last. Studies show it can cause a small, short rise in heart rate and blood pressure in some people. For someone already anxious, a racing heart can feel like the start of a panic attack and set one off. Knowing this in advance takes some of the fear out of it.

What to do in the moment

1. Signal and stop

Raise your hand, the usual stop signal. A good dental team will stop immediately, take everything out of your mouth and sit you up. You are always allowed to stop.

2. Say what is happening

“I think I’m having a panic attack” is enough. The team can then help you, rather than guessing. If you have had panic attacks before, tell them it is a familiar pattern.

3. Sit up and breathe slowly

Sit upright with your feet on the floor. Breathe in gently through your nose and out slowly through your mouth, making the out-breath longer than the in-breath. Over-breathing makes the dizzy, tingling feelings worse, so aim for slow and steady rather than deep and fast.

4. Ground yourself

Press your feet into the floor, hold something cool such as a cup of water, and name a few things you can see and hear around you. This pulls attention away from the body sensations that feed the panic.

5. Decide together what happens next

Once you feel steadier, you and the dentist can decide whether to carry on, do a shorter version of the treatment, or stop for the day. There is no failure in rescheduling. For urgent problems such as infection, the dentist may suggest a smaller step now to relieve pain and a planned, calmer visit soon after.

When it might not be panic

Panic attacks can feel like a heart attack, and the reverse is also true. Mayo Clinic notes that both can cause chest pain, a racing heart, shortness of breath and sweating. Do not assume it is anxiety if you have chest pain or pressure, pain spreading to the arm, jaw or back, severe breathlessness, or you faint, especially if you have heart disease or it has never happened before. Tell the team right away, and call 911 if symptoms are severe. It is always better to be checked and reassured.

How to prepare if you are prone to panic

• Tell the office when you book. A note on your chart means the team expects it and can plan breaks, a slower pace and a stop signal.
• Ask for a longer appointment slot so nothing feels rushed.
• Ask about anesthetic options if a racing heart is a trigger for you. The dentist can explain what they plan to use and why.
• Book a meet-and-talk visit first, with no treatment, to see the room and plan the steps.
• Bring support. Headphones, a companion in the waiting room, or a planned reward afterward all help.
• Keep up any treatment you already have for panic or anxiety, and tell the dentist what you take. Do not take extra sedatives on your own; our article on taking Xanax or Valium before the dentist explains why.

For broader, longer-term strategies, our guide to overcoming dental anxiety covers techniques such as gradual exposure. Reviews of dental fear management, such as one in the Australian Dental Journal, find acceptable evidence for several of these non-drug approaches. If the fear has become strong enough to keep you away, see dental phobia vs. dental anxiety.

When sedation is worth discussing

If panic attacks have stopped you getting care, or you need a longer procedure, sedation is a practical option:

• Nitrous oxide takes the edge off within minutes and wears off quickly. You stay awake and can still signal.
• Oral sedation leaves you deeply relaxed. You will need a companion to drive you home. See oral conscious sedation.
• IV sedation is the deepest level we offer, adjusted during the visit. See IV sedation: what to expect.

Sedation does not replace good communication, but it can make the physical cycle of panic less likely to start. If gagging or a feeling of choking is part of your panic, our article on sedation for a strong gag reflex may help.

Panic-aware care at Shield Dental Care

At Shield Dental Care in Burke, VA, you can tell us about panic attacks before you come in, and we will plan the visit with breaks and a clear stop signal. We offer nitrous oxide, oral sedation and IV sedation, and Dr. Pejman Ghorbani recommends the level after reviewing your medical history.

Call (703) 250-5072 or read about sedation dentistry at Shield Dental Care.