Dental anxiety Flashcards
What is the definition of dental fear
a normal emotional reaction to one or more specific threatening stimuli in the dental environment
What is the definition of dental anxiety
a sense of apprehension that something dreadful is going to happen in relation to dental treatment, coupled with a sense of losing control
What is dental phobia
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.
What must be occuring for dental phobia do be diagnosed
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.
What percentage of adult patients have dental anxiety
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
How many children have dental anxiety
Dental anxiety prevalence - 23.9%
Preschoolers - 36.5%
Schoolchildren - 25.8%
Adolescents - 13.3%
What treatment factors do anxious patients possess
Less likely to have visited a dentist within the previous 12 months
Greater oral disease experience
Poorer oral health-related quality of life
What is the cycle model of dental axiety and fear
Fear/anxiety
Avoidance
Deteriotation in dental status
Feelings of shame and inferiority
What is the definition of stress
“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.”
What causes dental anxiety
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
What characteristics do anxious patients have
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
What are the twomain areas of anxious thinking
1) Fear of negative health outcomes
2) Fear of negative social outcomes
Why is anxiety maintained
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
How can you relieve patient anxiety
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
What guidlines are used to assess dental anxiety
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)
How are the assessment of dental anxiety guidelines used
They take the form of 4 or 5 item questionnaires which can be given to patients to complete. Scoring instructions are also provided.
What score indicates severe dental fear and anxiety
19> out of 25
What can be used to assess young children
Picture tests
The Facial Image Scale (FIS) ( Buchanan & Niven, 2002) Children are asked to point at the face they most feel like.
What is a disadvantage of using the Venham picture test for assessment of dental anxiety
all figures are male and some of the facial expressions are ambiguous.
What is used to assess children aged 8+ for DFA
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)
What are the treatment strategies for patients with mild/moderate anxiety
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
What are some coping strategies for dental anxiety
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)
What drugs can be used when treating anxious patients
If necessary prescribe a benzodiazepine (adults) prior to treatment nitrous oxide sedation
What is the difference between stop and rest signals
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.
What signals can you discuss with an axious patient before treatment
Stop
Rest
Proceed
What is the most successful treatment method for dental anxiety
Exposure therapy
What is the most important thing to ensure during exposure therapy
It must be voluntary
Involuntary exposure could lead to worsened anxiety or trauma
What is psycho education
Exposure therapy combined with teaching the patient cognitive coping strategies
