Impact of high-speed handpiece noise-induced dental anxiety on heart rate: analyzing experienced and non-experienced patients - a comparative study.

BACKGROUND: Dental anxiety is very much common among the patients and could be due to different factors like the behavior of the dentist, past experiences, Needle phobia, or word of mouth from other patients. According to recent studies, a strong association between sound and anxiety has been found, so this observational study has been conducted to find out the link between the activation of anxiety with the sound of a handpiece between experienced patients, who have already gone through the dental treatments and non-experienced patients. METHODS: Total of 297 participants were part of this study. These participants were divided into 2 groups according to the experienced and non-experienced dental patients. The researcher first filled out the CORAH Dental Anxiety Scale (DAS) form to mark the anxiety level of the patients, and then noted the readings of the heart rate in 3 intervals which were before during, and after the treatment with the pulse oximeter. Later the data was analysed using the SPSS independent t-test. RESULTS: Results show that patients in group 1 who have gone through the dental treatment before were less anxious and had a lesser effect on their heart rate than the patient who were having the treatment for the first time who were in group 2. Another interesting factor was noticed that in both the groups female were found to be more anxious than male participants. Participants with younger age were found to be more anxious than older age patient in both groups CONCLUSIONS: The sound of the handpiece can provoke anxiety in the patient, affecting the heart and increasing the heart rate. Participants who were experienced were found to be less anxious than the participants who were inexperienced.

Biased emotional attention in patients with dental phobia.

Biased motivated attention towards phobia-relevant pictures is a typical finding in specific phobia. In the visual system, the allocation of motivated attention is indexed by two event-related potential components - the Early Posterior Negativity and the Late Positive Potential. Enhanced Early Posterior Negativity and Late Positive Potential amplitudes are reliably observed in specific phobia such as, for instance, snake, spider, or blood-injection-injury phobia and to some extent also in dental phobia. However, regarding dental phobia results are sparse and its theoretical concept is not undisputed. To further elucidate the electrophysiological characteristics of dental phobia, we investigated visual emotional processing in dental phobia patients and controls. Subjects viewed neutral, phobia-irrelevant and phobia-relevant pictures while magnetoencephalographic and behavioural measures were recorded. All patients reported a history of traumatic experiences and depressive and anxiety symptoms, as well as dissociative and posttraumatic symptoms. In the magnetoencephalography, patients showed generally less evoked neural activation at parietal and temporal regions and a reduced differentiation between picture categories compared to controls. At the behavioural level, patients rated phobia-relevant pictures as clearly more negative as did controls. In contrast to previous reports, our results suggest that dental phobia cannot be associated with the typical effects of biased motivated attention seen in other specific phobias. Instead, results indicate that dental phobia shares typical characteristics with mild forms of posttraumatic stress disorder.

Progressive muscle relaxation therapy to relieve dental anxiety: a randomized controlled trial.

Dental anxiety causes patients to refuse or delay treatment, which may exacerbate oral diseases. The aim of the current randomized controlled trial was to determine whether progressive muscle relaxation therapy could relieve dental anxiety. The trial included 68 periodontal patients with dental anxiety scores of ≥13 who were randomly assigned to either an intervention group or a control group (n = 34 per group). The intervention group was administered progressive muscle relaxation therapy for 20 min and oral health education for 15 min before periodontal treatment once per week for 4 wk. The control group was provided with oral health education only, for the same duration. Changes in dental anxiety, depression symptoms, blood pressure, heart rate, and salivary cortisol were evaluated 4 wk and 3 months after the intervention. The intervention group exhibited statistically significantly greater reductions in dental anxiety scores than did the control group at the 4-wk (-3.82 vs. -0.89) and 3-month (-4.22 vs. -0.28) assessments. They also exhibited significantly greater reductions in depression symptoms, systolic and diastolic blood pressure, pulse rate, and salivary cortisol levels at both time-points. Progressive muscle relaxation therapy relieves tension and anxiety in dental patients.

Control of Anxiety in Pediatric Patients using "Tell Show Do" Method and Audiovisual Distraction.

INTRODUCTION: Visiting a dentist can easily evoke strong fear reactions and acute anxiety in children. It is one of the most basic reasons for avoidance and neglect of dental care. It may obstruct delivery of dental care, as the child may be unwilling to accept the treatment being provided by the dentist. AIM: To evaluate and compare reduction in anxiety level in patients undergoing dental treatment at first dental visit. TECHNIQUE: The study was conducted on 400 patients coming to the Department of Pedodontics and Preventive Dentistry, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, for their first dental visit. Anxiety was recorded using facial image scale (FIS), Venham's picture test (VPT), blood pressure, pulse rate (PR), and oxygen saturation (SpO2) at different stages of the visit. Patients coming for the first dental visit were subjected to restorative treatment under Tell show do (TSD) method and audiovisual distraction (AVD). The data collected were tabulated and subjected to statistical analysis. CONCLUSION: The AVD was found to be more capable in reducing anxiety than TSD. Combination of TSD and AVD had an additive effect in reduction of anxiety level and it proved to be more beneficiary. CLINICAL SIGNIFICANCE: If a child's behavior in the dental office cannot be managed, then it is difficult to hold out any dental treatment that is needed. Bringing positivity in the child's behavior would not only increase efficiency of work but would also make the experience for child undergoing treatment more pleasant.

Influence of Er:YAG Laser on Objective and Subjective Parameters of Stress during Sealant Application in Children.

BACKGROUND: Acceptance of lasers as alternatives and accessory tools to traditional methods in dental medicine has created an explosion of interest. Er:YAG laser is recommended for enamel conditioning. There is no study evaluating the anxiety in children during fissure sealing procedures when using Er:YAG laser compared to the routine application technique. AIM: To evaluate the objective and subjective stress parameters in children during a preventive procedure when using Er:YAG laser for additional enamel conditioning before pit and fissure sealant application compared to the routine clinical application technique. MATERIALS AND METHODS: The study included sixty-four 6-12-year-old children, divided into two equal treatment groups. A standardized fissure sealant application was performed, as in the intervention group before acid etching, the occlusal surfaces of teeth were conditioned with Er:YAG laser (2940 nm). During the procedure, objective and subjective stress parameters were recorded. RESULTS: Significantly lower degree of dental anxiety was found at the end of the dental visit of the study group (p<0.001). During the professional cleaning of the tooth surface, the mean heart rate was low (95.55±14.29 bpm) within the physiological normal range. The objective and subjective stress parameters show no significant differences between the two subgroups during sealing procedure (p>0.05). CONCLUSIONS: Application of Er:YAG laser during sealant application does not provoke anxiety and is well accepted by children in dental environment. Preventive procedures at the beginning of a dental visit decrease the initial levels of dental anxiety and contribute to an effective treatment process.

Transdiagnostic brain responses to disorder-related threat across four psychiatric disorders.

BACKGROUND: There is an ongoing debate whether transdiagnostic neural mechanisms are shared by different anxiety-related disorders or whether different disorders show distinct neural correlates. To investigate this issue, studies controlling for design and stimuli across multiple anxiety-related disorders are needed. METHOD: The present functional magnetic resonance imaging study investigated neural correlates of visual disorder-related threat processing across unmedicated patients suffering from panic disorder (n = 20), social anxiety disorder (n = 20), dental phobia (n = 16) and post-traumatic stress disorder (n = 11) relative to healthy controls (HC; n = 67). Each patient group and the corresponding HC group saw a tailor-made picture set with 50 disorder-related and 50 neutral scenes. RESULTS: Across all patients, increased activation to disorder-related v. neutral scenes was found in subregions of the bilateral amygdala. In addition, activation of the lateral amygdala to disorder-related v. neutral scenes correlated positively with subjective anxiety ratings of scenes across patients. Furthermore, whole-brain analysis revealed increased responses to disorder-related threat across the four disorders in middle, medial and superior frontal regions, (para-)limbic regions, such as the insula and thalamus, as well as in the brainstem and occipital lobe. We found no disorder-specific brain responses. CONCLUSIONS: The results suggest that pathologically heightened lateral amygdala activation is linked to experienced anxiety across anxiety disorders and trauma- and stressor-related disorders. Furthermore, the transdiagnostically shared activation network points to a common neural basis of abnormal responses to disorder-related threat stimuli across the four investigated disorders.

Clinical and neurobiological effects of aerobic exercise in dental phobia: A randomized controlled trial.

BACKGROUND: Physical activity has shown to be effective in anxiety disorders. For specific phobia, no studies are available that systematically examined the effects of an aerobic exercise intervention on phobic fear within a randomized-controlled design. Therefore, we investigated the acute effect of a standardized aerobic training on clinical symptoms of dental phobia as well as on stress-related neurobiological markers. METHODS: Within a crossover design, 30 patients with dental phobia (mean age: 34.1 years; mean score of the Dental Anxiety Scale: 18.8) underwent two minor dental interventions separated by 7 days. Dental treatment was performed after 30 min of physical activity at either 20% VO2 max (control) or 70% VO2 max (intervention), respectively. To control for habituation, patients were randomly assigned to one of the two conditions prior to the first intervention. Moreover, saliva samples were collected at five times in order to determine changes in salivary cortisol (sC) and alpha-amylase (sAA) due to treatment. RESULTS: In comparison to baseline, aerobic exercise within 70% VO2 max significantly reduced clinical anxiety and sC concentrations before, during, and after the dental treatment. In contrast, the control condition led to decreased sAA levels at different time points of measurement. Habituation occurred at the second study day, independent of the order. CONCLUSIONS: Our study provides evidence for an effect of moderate-intense exercise on clinical symptoms and sC in patients with dental phobia. Therefore, acute aerobic exercise might be a simple and low-cost intervention to reduce disorder-specific phobic fear.

The interaction between parenting and children's cortisol reactivity at age 3 predicts increases in children's internalizing and externalizing symptoms at age 6.

Little is known about the role of stress reactivity in the emergence of psychopathology across early childhood. In this longitudinal study, we tested the hypothesis that child cortisol reactivity at age 3 moderates associations between early parenting and children's internalizing and externalizing symptoms from age 3 to age 6. One hundred and sixty children were assessed at age 3, and 135 children were reassessed at age 6. At age 3, we exposed children to stress-inducing laboratory tasks, during which we obtained four salivary cortisol samples, and parental hostility was assessed using an observational parent-child interaction task. At ages 3 and 6, child psychiatric symptoms were assessed using a clinical interview with parents. The results indicated that the combination of high child cortisol reactivity and high observed parental hostility at age 3 was associated with greater concurrent externalizing symptoms at age 3 and predicted increases in internalizing and externalizing symptoms from age 3 to age 6. Findings highlight that increased stress reactivity, within the context of hostile parenting, plays a role in the emergence of psychopathology from preschool to school entry.

The anterior insula and anterior cingulate cortex are associated with avoidance of dental treatment based on prior experience of treatment in healthy adults.

BACKGROUND: Fear concerning stressful medical or dental procedures is one of the major factors that distance patients from health care. Fear and avoidance of dental treatments can be shaped by a patient's prior experience with receiving dental procedures or by imagining the procedures. METHODS: We performed two functional magnetic resonance imaging (fMRI) experiments to investigate the role of the anterior insula (aINS) and dorsal anterior cingulate cortex (dACC), which are both critical to threat perception, in dental avoidance. Dental avoidance based on both prior treatment experience and imagination was assessed using a customized questionnaire. In an fMRI task-based study, we investigated brain activation in 17 healthy participants when they viewed images depicting dental procedures that evoked a moderate degree of fear. Region-of-interest analysis was performed to assess the association between dental avoidance and aINS as well as dACC activation. In a resting state fMRI study, we investigated 18 healthy participants for the association between the intrinsic functional connectivity of the aINS and dACC and dental avoidance. RESULTS: We found that (1) the participants showed a higher activation of the right aINS and bilateral dACC when they viewed images of dental procedures compared with the brain activation observed when they viewed scrambled images (p < 0.05 corrected for small volume and family-wise error). (2) The avoidance ratings based on prior experience of dental treatment were significantly positively correlated with the activation in the right aINS (r = 0.67, p = 0.003), right dACC (r = 0.65, p = 0.005) and left dACC (r = 0.63, p = 0.007). (3) The intrinsic functional connectivity between the aINS and the orbitofrontal cortex was positively correlated with the avoidance ratings based on experience (uncorrected p < 0.001). CONCLUSIONS: The findings highlight prior experience of dental treatment as a predominant factor in shaping patients' avoidance behavior. Individual differences in threat perception may play a key role in the development of dental avoidance.

Efficiency and Reliability of Thermal and Electrical Tests to Evaluate Pulp Status in Primary Teeth with Assessment of Anxiety Levels in Children.

OBJECTIVE: Assessing the pulp status plays a vital role in diagnosis and treatment planning in dentistry especially in children, who may not be able to verbalize their dental symptoms. Pulp sensibility test is used as a valuable investigation to evaluate the state of pulp. The aim of this study is to assess the efficiency and reliability of thermal and electrical pulp tests in primary teeth and to rule out the anxiety level involved in each tests. STUDY DESIGN: 30 children aged between 6 to 8 years with carious primary molar teeth in need of conservative pulp therapy were included in this study. 3 tests at random were employed on each tooth which includes cold, heat, electrical pulp test. The sensitivity, specificity, positive predictive value and negative predictive value were evaluated based on the clinical visual examination on access opening and the accuracy for each test was calculated. The Facial Image Scale (FIS) was used to assess the state of dental anxiety in children due to these pulp sensibility tests. RESULTS: The highest accuracy rate was calculated for EPT (0.814) followed by cold test (0.777) and heat test (0.759). CONCLUSION: No significant association was found between the accuracy of all the three tests. (P value > 0.05). Cold test is the most reliable test due to its simplicity and ease to perform. (FIS -1.53).

[DETERMINATION OF THE STATE OF MICROCIRCULATION BY MEANS OF COMPUTER CAPILLAROSCOPY IN CHILDREN SEDATED WITH RETENTION OF CONSCIOUSNESS IN OUTPATIENT PEDIATRIC DENTAL TREATMENT].

UNLABELLED: Dental treatment of infants and pre-school children is challenging because of high rate of dental fear General anesthesia is the only option for behavioral control in this age group. In case of minor medical procedure physical restrain is also used often enough aggravating the fear An alternate method for comfortable treatment is monitored conscious sedation (MCS). Standard techniques of monitoring do not always provide accurate determination of stress level in children since the external stress manifestations may appear non-significant and unobtrusive. Computer capillaroscopy (CC) allows real time evaluation of early functional disorders at the microlevel and of anesthesia efficiency in vivo. OBJECTIVE AND METHODS: The research involved 298 children. 256 of them were treated under MCS and 42 constituted reference group treated without MCS. The groups were also divided into subgroups according to age: 0-3 and 3-6 year olds. Therapeutic and surgical treatment features were analyzed separately. MCS was conducted by means of intramuscular injection of midazolam in dosages of 0.1, 0.15, and 0.2 mg per kg. BIS, arterial blood pressure, heart rate, respiratory rate, and SpO2 were monitored at 4 stages while the following microcirculation parameters were recorded by CC: density of capillary net, the size of arterial, venous and transitional microcirculation links (ML), linear and volume bloodflow velocity, perfusion balance. The obtained data were statistically processed and analyzed with the use of Statistica Stat Soft 8.0 software. CONCLUSIONS: Children undergoing dental treatment without MCS are affected by stress. The degree of stress in surgical patients was noted to be significantly higher The absence of physiological parameters changes in children treated without MSC is not a proof of the absence of stress. The dose of 0.15 mg per kg is optimal for the comfortable level of MSC. The increase of midazolam-dose over 0.15 mg per kg is not associated with further reduction of stress. The obtained data is true for both age categories.

Is dental phobia a blood-injection-injury phobia?

BACKGROUND: Dental phobia is part of the Blood-Injection-Injury (B-I-I) phobia subtype of specific phobia within DSM-IV-TR. To investigate the conceptual validity of this classification, the purpose of the present study was to determine the co-occurrence of dental phobia, typical dental (and B-I-I related) fears, vasovagal fainting, and avoidance of dental care. METHOD: Data were collected by an online survey in Dutch twin families (n = 11,213). RESULTS: Individuals with a positive screen of dental phobia (0.4% of the sample) rated typical B-I-I-related stimuli as relatively little anxiety provoking (e.g. of all 28 fears the stimulus "the sight of blood" was ranked lowest). Presence of dental phobia was significantly associated with a history of dizziness or fainting during dental treatment (OR = 3.4; 95% CI: 1.5-8.1), but of the dental phobic individuals only 13.0% reported a history of dizziness or fainting during dental treatment. Presence of dental phobia (OR = 5.0; 95% CI: 2.8-8.8) was found to be associated with avoidance of dental care, but a history of dizziness or fainting during dental treatment was not (OR = 1.0; 95% CI: 0.8-1.2). CONCLUSIONS: The present findings converge to the conclusion that dental phobia should be considered a specific phobia subtype independent of the B-I-I cluster within the DSM classification system.

[Evaluation of psychological methods for determining the degree of psychological stress in children in dentistry].

The article deals with results of comparative evaluation of system of assessment of children's fear and anxiety in dentistry (SDS test) and other objective and subjective methods for assessing anxiety in pediatric patients. We studied 381 pediatric patients aged from 3 to 7 years. The aim of the study was to prove validity mathematical derived FCD test as a technique of anxiety detection in dentistry. During the study following subjective test were used: MAS, DAS, mYPAS, VAS, STAI, STAIC, EASI, PHBQ, and some history data and stress factors were also considered. Objective data used were vital signs (hemodynamics and respiratory rate). Test SDS has strong correlation with YALE, MAS, DAS, STAIlich, VAS and other parameters such as age, sex, person which is responsible for bringing up a child and so on.

On the dynamics of dental fear: dental or mental?

This study explored possible predictors of change over time in dental fear. In a population-based sample of 664 women, 38-54 yr of age at first assessment, a self-rating of dental fear was recorded on two occasions, 6 yr apart. Whilst the majority of the women maintained their level of fear, two subgroups reported changes at follow up. Of the 99 subjects indicating high fear at baseline, 54 recorded no or minimal fear at follow up and, among the 565 recording minimal fear at baseline, 27 reported increased fear at follow up. We used psychological and odontological findings at baseline to compare the four subgroups with altered or maintained fear ratings at follow up. The women reporting reduced fear at follow up differed significantly in the psychological variables from those reporting unchanged fear; there were no significant differences between these groups in any of the odontological variables. The group indicating increased fear at follow up did not differ from those with a maintained fearlessness in any of the baseline measurements. The results are discussed in terms of a systems-oriented understanding of the development of dental fear.

Can you read my pokerface? A study on sex differences in dentophobia.

Men and women with dentophobia differ in specific fear contents and underlying brain activity during symptom provocation. Possible sex differences concerning other basic emotions, such as disgust, have undergone minimal investigation. Therefore, we recorded the facial electromyogram from the musculus levator labii (as a specific disgust indicator) and the heart rate of 36 individuals with dentophobia (18 women and 18 men with comparable disorder severity) and of 36 non-phobic controls (18 women and 18 men). The participants were asked to look at pictures showing dental treatment scenes, generally fear- and disgust-inducing, as well as pictures with neutral contents. Subsequently they performed an affective picture rating. Independently of sex, phobic subjects relative to controls showed heart-rate acceleration when watching pictures of dental treatment scenes, reflecting a fear reaction. Male and female phobic subjects did not differ in their verbal reports of fear and disgust experienced. However, phobic women showed enhanced disgust-related facial electromyographic activity to dental treatment scenes relative to men. This sex-specific response pattern points to the greater relevance of disgust for the female symptomatology of dentophobia, or it might also be possible that male patients more successfully inhibit disgust reactions during confrontation.

Influence of gag reflex on dental attendance, dental anxiety, self-reported temporomandibular disorders and prosthetic restorations.

To assess the influence of gag reflex severity, assessed according to the short form of the patient part of Gagging Problem Assessment Questionnaire (GPA-pa SF), on the dental attendance, dental anxiety, self-reported temporomandibular disorder (TMD) symptoms and presence of prosthetic restorations among patients requiring prosthodontic treatment in Turkey. A total of 505 patients (305 women; mean age: 46·35 years, SD: 28·2 years) undergoing dental examination were administered a questionnaire containing questions regarding their age, gender, education level, dental attendance, TMD symptoms (limitation in jaw opening, muscle pain, pain/sounds in the temporomandibular jaw), the Turkish version of the Modified Dental Anxiety Scale (MDAS) and the GPA-pa SF. Subsequently, any prosthetic restoration was recorded by a dentist. Descriptive statistics, one-way analysis of variance (anova) and the chi-square test were used for statistical analysis. Differences were found between GPA-pa SF scores 0, 1 and 2 for education level (P = 0·001), MDAS scores (P = 0·003), self-reported TMD (P = 0·000) and prosthesis wear (P = 0·000), but not for attendance patterns (P = 0·826). Patients with gag reflex had lower education levels, higher levels of dental anxiety, more self-reported TMD symptoms and fewer fixed or removable prosthetic restorations than patients without gag reflex. Gag reflex has impacts on dental anxiety, self-reported TMD and prosthetic restorations, but not on dental attendance patterns, according to the results of the GPA-pa SF.

Relationship between gagging severity and its management in dentistry.

The purpose of this study was to investigate how grading according to our new gagging reflex index correlated with patient background and subsequent management. After obtaining institutional approval and informed consent, 110 patients with a gagging problem were enrolled. The patients completed the State-Trait Anxiety Inventory (STAI), the Dental Anxiety Scale (DAS), and a health questionnaire at initial consultation. On the second visit, an intra-oral examination was carried out and the severity of gag reflex determined according to our new, 5-level Classification of Gagging Problem (CGP) index: normal gagging but not desensitised (G1 = score 1); mild gagging (G2 = score 2); moderate gagging (G3 = score 3); severe gagging (G4 = score 4); and very severe gagging (G5 = score 5). No difference was found in grade based on age or STAI or DAS scores. The CGP score in male patients was significantly higher than that in female. The management classification method and degree of desensitisation were investigated retrospectively in each patient at 3 months and 1 year after initial consultation. The higher the CGP grade, the more often intravenous sedation or general anaesthesia was required due to difficultly in desensitisation. The present results suggest that determining whether it is possible to examine the molar area without inducing the gag reflex offers the key to deciding the treatment strategy.

Salivary biomarkers, vital signs and behaviour of pre-school children during their first dental visit.

AIM: Anxiety may influence dental treatment unfavourably, thus evaluation of the psychophysiological reactions of the child may reduce its negative effects. This study aimed to evaluate and correlate the levels of cortisol and alpha-amylase, vital signs and behaviour of children during their first dental visit. METHODS: Study sample consisted of 32 children (11 male and 21 female patients) aged between 4 and 6 years, who would go to the dentist for the first time, with no pain or chronic illness, and without the use of medication. Three saliva samples were collected: before, immediately after and 20 minutes after the dental procedure (dental prophylaxis). STATISTICS: Data were analysed using Student's t test and Pearson's correlation test (p = 0.05). RESULTS: In the comparison of the levels of alpha-amylase, the heart rate and blood pressure were higher after the dental visit and the levels of salivary cortisol were significantly higher before. There was no statistically significant difference in the correlation between the Frankl Behaviour Rating Scale and the levels of cortisol and alpha-amylase, but the results showed that the levels of these two salivary biomarkers increased gradually as the child had a less cooperative behaviour. CONCLUSION The sample revealed that the first dental visit generated anxiety, which was manifested through physiological and behavioural alterations.

Objective assessment of internal stress in children during dental treatment by analysis of autonomic nervous activity.

AIMS: The aim of this study was to assess the internal stress of children during dental treatment based on autonomic nerve activity and facial muscle activity. METHODS: We recorded the electrocardiogram of children during the treatment of composite resin restoration and analysed autonomic nerve activity by means of power spectral analysis of heart rate variability. Simultaneously, electromyography (EMG) activity of the corrugator muscle was recorded in children during dental treatment, and the relationship between sympathetic nerve activity and corrugator EMG activity was analysed. RESULTS: In all subjects, the mean sympathetic nerve activity was significantly higher during oral examination and after treatment compared with pre-treatment. Depending on the sympathetic nerve responses to the other treatment procedures, the subjects could be classified into two groups: the stress group and the nonstress group. Sympathetic nerve activity was significantly higher during infiltration anaesthesia and cavity preparation compared with pre-treatment activity in the stress group, whereas it was consistently lower than the pre-treatment levels during most treatment procedures in the nonstress group. The mean amplitudes of the averaged corrugator muscle EMG during dental treatment did not differ between the stress and nonstress groups. CONCLUSION: The present results suggest that the measurement of autonomic nervous activity, especially sympathetic nervous activity, is quite useful in assessing the internal stress of children, even when no expressed sign of unease are present during dental treatment.

How specific is specific phobia? Different neural response patterns in two subtypes of specific phobia.

Specific phobia of the animal subtype has been employed as a model disorder exploring the neurocircuitry of anxiety disorders, but evidence is lacking whether the detected neural response pattern accounts for all animal subtypes, nor across other phobia subtypes. The present study aimed at directly comparing two subtypes of specific phobia: snake phobia (SP) representing the animal, and dental phobia (DP) representing the blood-injection-injury subtype. Using functional magnetic resonance imaging (fMRI), brain activation and skin conductance was measured during phobogenic video stimulation in 12 DP, 12 SP, and 17 healthy controls. For SP, the previously described activation of fear circuitry structures encompassing the insula, anterior cingulate cortex and thalamus could be replicated and was furthermore associated with autonomic arousal. In contrast, DP showed circumscribed activation of the prefrontal and orbitofrontal cortex (PFC/OFC) when directly compared to SP, being dissociated from autonomic arousal. Results provide preliminary evidence for the idea that snake and dental phobia are characterized by distinct underlying neural systems during sustained emotional processing with evaluation processes in DP being controlled by orbitofrontal areas, whereas phobogenic reactions in SP are primarily guided by limbic and paralimbic structures. Findings support the current diagnostic classification conventions, separating distinct subtypes in DSM-IV-TR. They highlight that caution might be warranted though for generalizing findings derived from animal phobia to other phobic and anxiety disorders. If replicated, results could contribute to a better understanding of underlying neurobiological mechanisms of specific phobia and their respective classification.