Dental anxiety

Question 1

What is the definition of dental fear

Answer 1

a normal emotional reaction to one or more specific threatening stimuli in the dental environment

Question 2

What is the definition of dental anxiety

Answer 2

a sense of apprehension that something dreadful is going to happen in relation to dental treatment, coupled with a sense of losing control

Question 3

What is dental phobia

Answer 3

a severe type of dental anxiety manifested as a marked and persistent anxiety in relation to clearly discernible situations or objects (e.g. use of drill) or to the dental situation in general.

Question 4

What must be occuring for dental phobia do be diagnosed

Answer 4

For a diagnosis of dental phobia, there must be either complete avoidance of necessary dental treatment or endurance of treatment only with dread and in a specialist treatment situation.

Question 5

What percentage of adult patients have dental anxiety

Answer 5

Dental anxiety prevalence - 13.3% - 19%​

Dental anxiety higher by 14% among females​

lower among those aged 55+​

higher by 10% among those in the most deprived neighbourhoods

Question 6

How many children have dental anxiety

Answer 6

Dental anxiety prevalence - 23.9% ​

Preschoolers - 36.5% ​

Schoolchildren - 25.8%​

Adolescents - 13.3%

Question 7

What treatment factors do anxious patients possess

Answer 7

Less likely to have visited a dentist within the previous 12 months​

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Greater oral disease experience​

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Poorer oral health-related quality of life

Question 8

What is the cycle model of dental axiety and fear

Answer 8

Fear/anxiety
Avoidance
Deteriotation in dental status
Feelings of shame and inferiority

Question 9

What is the definition of stress

Answer 9

“A negative emotional experience accompanied by predictable biochemical, physiological, cognitive & behavioural changes that are directed either toward altering the stressful event or accommodating to its effects.”

Question 10

What causes dental anxiety

Answer 10

Negative medical and dental experiences …
-Painful
-Frightening​
-Humiliating

Poor knowledge of modern dentistry and treatments

Expectations of pain and discomfort

Social influences
-family and peers
-Media representation

History of trauma

Question 11

What characteristics do anxious patients have

Answer 11

High trait neuroticism and anxiety
Pessimism & negative expectation
Proneness to somatisation (the manifestation of psychological distress by the presentation of physical symptoms)
Low pain threshold
Co-morbid anxiety disorders
Co-morbid depressive disorders

Question 12

What are the twomain areas of anxious thinking

Answer 12

1) Fear of negative health outcomes​

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2) Fear of negative social outcomes

Question 13

Why is anxiety maintained

Answer 13

Internal or external event
Perceived exaggerated/inappropriate threat
Best attempt as self defence/protection
Strategy gives short term releif but fails to challenge anxiety related belief
Fear remains intact and beliefs unchanged

Question 14

How can you relieve patient anxiety

Answer 14

Constant reassurance
Tell them before carrying out actions
Ask before doing
Use simple and easy to understand language
Build rapor and be wary of impersonalising patient interactions

Question 15

What guidlines are used to assess dental anxiety

Answer 15

The Dental Anxiety Scale (DAS) (Corah, 1969) and its derivatives: ​

DAS-R (Ronis, Hansen & Antonakos, 1995)​

Modified Dental Anxiety Scale (MDAS) (Humphris, Dyer & Robinson, 2009) ​

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Question 16

How are the assessment of dental anxiety guidelines used

Answer 16

They take the form of 4 or 5 item questionnaires which can be given to patients to complete. Scoring instructions are also provided.

Question 17

What score indicates severe dental fear and anxiety

Answer 17

19> out of 25

Question 18

What can be used to assess young children

Answer 18

Picture tests
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The Facial Image Scale (FIS) ( Buchanan & Niven, 2002) Children are asked to point at the face they most feel like.

Question 19

What is a disadvantage of using the Venham picture test for assessment of dental anxiety

Answer 19

all figures are male and some of the facial expressions are ambiguous.

Question 20

What is used to assess children aged 8+ for DFA

Answer 20

The Modified Child Dental Anxiety Scale (faces version) MCDASf​(age 8 to 16)

Child Dental Experience of Dental Anxiety Measure (CEDAM; age 9 to 16)

Question 21

What are the treatment strategies for patients with mild/moderate anxiety

Answer 21

Acknowledge patient’s feeling of anxiety​

Foster a trusting relationship​

Provide realistic information​

Provide a high level of predictability (explain the appointment goals at the start)​

Provide Control​

Question 22

What are some coping strategies for dental anxiety

Answer 22

Relaxation – simple breathing awareness, to techniques like progressive muscle relaxation (lots of apps out there to help)​

Distraction – General friendly discussion, visualisation and imagery, (children – teaching a magic tricks, sums in head, a squeeze ball)

Question 23

What drugs can be used when treating anxious patients

Answer 23

If necessary prescribe a benzodiazepine (adults) prior to treatment nitrous oxide sedation

Question 24

What is the difference between stop and rest signals

Answer 24

Stop signals – give control over the pace of the procedure – helps coping: “Place your left hand in the air if you want me to stop”

Rest signals – allows the patient to stop with the understanding that the treatment is not finished yet.​

Question 25

What signals can you discuss with an axious patient before treatment

Answer 25

Stop
Rest
Proceed

Question 26

What is the most successful treatment method for dental anxiety

Answer 26

Exposure therapy

Question 27

What is the most important thing to ensure during exposure therapy

Answer 27

It must be voluntary
Involuntary exposure could lead to worsened anxiety or trauma

Question 28

What is psycho education

Answer 28

Exposure therapy combined with teaching the patient cognitive coping strategies