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BDS2 Paediatric Dentistry > Dental Anxiety > Flashcards

Dental Anxiety Flashcards

1
Q

What is meant by dental fear?

A
  • A normal emotional reaction to one or more specific threatening stimuli in the dental environment e.g. fear of the needle
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2
Q

What is meant by dental anxiety?

A

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

  • General dread - it is a loss of control
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3
Q

What is meant by dental phobia?

A
  • 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 a drill) or to the dental situation in general
  • When it is affecting their life - they can’t even walk past a dental surgery - will avoid it at all costs
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4
Q

What is required for a diagnosis of dental phobia?

A
  • There must be either a complete avoidance of necessary dental treatment or endurance of treatment only with dread and in a specialist treatment situation
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5
Q

Statistically how many out of 10 people really fear the dentist?

A
  • 1 in 10 people really fear the dentist
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6
Q

What are the top 5 stressors in dentistry for dentists?

A
  • Running behind schedule
  • Causing pain
  • Heavy workload
  • Late patients
  • Anxious patients
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7
Q

What is the cycle of dental fear and anxiety?

A
  1. Fear/anxiety
  2. Avoidance
  3. Deterioration in dental status
  4. Feeling of shame and inferiority (they are embarrassed and think that when they go to the dentist they will be laughed at)
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8
Q

What is meant by ‘conditioning’ of children to become dentally anxious?

A
  • Arising from an objecting dental pathology and subjective dental and medical experiences. The dentist’s personal sensitivity to children’s fears appears is also crucial
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9
Q

What are 5 of the main causes (aetiology) of dental anxiety?

A
  • Negative medical and dental experiences e.g. painful, frightening or embarrassing
  • ‘Influenced’ by family and peers
  • Medial representations of dentistry
  • Expectation of pain and discomfort
  • Poor knowledge of modern analgesia
  • BUT some patients are more vulnerable than others
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10
Q

What are the 3 pathways that were identified for how children become dentally anxious?

A
  • Conditioning
  • Modelling
  • Information
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11
Q

What is meant by ‘modelling’ of children to become dentally anxious?

A
  • Children’s imitation of parent’s behaviour. Parents of anxious children, higher in state anxiety and behave more variably during consultation than those of non-anxious children
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12
Q

What is meant by ‘information’ of children to become dentally anxious?

A
  • Possibly through unwitting provision of frightening information, but more likely through absorbing mother’s attitudes to dentistry
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13
Q

What are some common characteristics of anxious people? (6 points)

A
  • High neuroticism and trait anxiety
  • Pessimism & negative expectation
  • Proneness to somatisation (the manifestation of psychological distress by the presentation of physical symptoms)
  • Low pain threshold (because they are expecting pain)
  • Co-morbid anxiety disorders
  • Co-morbid depressive disorders
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14
Q

What are common characteristics of anxious and neurotic thinking people? (5 points)

A
  • Fear of negative evaluation
  • Pessimistic and vulnerable
  • Catastrophic
  • Over-inclusive negativity - ‘life is a disaster’/risky/failure/pointless
  • Worry as a habit
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15
Q

What are 3 provoking patterns in the pathway to fearfulness?

A
  • Bad experience
  • High neuroticism
  • Depression and anxiety
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16
Q

How may dental anxiety and fear be assessed? (4 points)

A
  • Listen to what the patient is saying to you
  • Ask the right questions:
  • What is their goal? (make sure they phrase it in the positive and not the negative)
  • What do they want to achieve?
17
Q

The dental anxiety scale and its derivatives, the DAS-R and the MDAS are widely used for assessment of dental anxiety in adults. What form do these take?

A
  • Take the form of 4 or 5 item questionnaires which can be given to patients to complete. Scoring instructions are also provided
  • Diagnostic cut offs are provided 19>/25 means dental anxiety
  • Both the DAS-R and the MDAS are available freely online
18
Q

How would you assess dental anxiety in children?

A
  • Picture tests have an advantage for younger children and have been found to help with understanding especially if there is limited cognitive functioning
  • The measure should assess specific triggers of dental anxiety or unhelpful thoughts
19
Q

What is the Venham picture scale?

A
  • Shows 8 pairs of boys, one with an anxious and one with a non-anxious facial expression and the child is asked to point to the figure they feel most like
  • This is used for children from the ages of 4-11
20
Q

What is the criticism of the Venham picture scale?

A
  • All figures are male

- Some of the facial expressions are ambiguous

21
Q

What is the Facial Image Scale?

A
  • Children asked to point at the face they most feel like
  • Measure of ‘state’ anxiety or may even be measuring the childs mood that day
  • Significantly correlates with the Venham Picture scale
22
Q

One treatment strategy for mild/moderate anxiety is ‘general attitude and the application of a general anxiety reducing treatment style’. Explain how you can do this? (6 points)

A

Explain the ‘fight and flight’ system to them and let them know they can take control

  • Acknowledge the patients feelings of anxiety
  • Engender a trusting relationship
  • Provide realistic information
  • Provide control
  • Provide a high level of predictability (agree the appointment goals at the start)
23
Q

One treatment strategy for mild/moderate anxiety is ‘ pharmacological support ‘. Explain how you can do this?

A
  • If necessary liaise with GMP regarding prescribing oral sedation prior to treatment (adults), use nitrous oxide sedation
24
Q

One treatment strategy for mild/moderate anxiety is ‘ Teach coping strategies ‘. Explain how you can do this? (6 points)

A
  • Relaxation and Distraction

- These are only 2 examples

25
Q

What is a stop signal used for?

A
  • gives control over the pace of the procedure - helps coping
  • ‘place your left hand straight in the air if you want me to stop’
26
Q

What is a rest signal used for?

A
  • Allows the patient to stop with the understanding that the treatment is not finished yet
27
Q

What is a proceed signal used for?

A
  • Signal used for patient to let dentist know that they are comfortable with treatment starting again
  • ‘Open your mouth when you are ready to start’
28
Q

One way in which you can make the patient feel they are in control is by giving them options. What are 2 examples of these?

A
  • ‘What do you want to happen’?

- ‘Which tooth will we resolve first?’

29
Q

What can you use as distraction mechanisms for a pa tient? (3 points)

A
  • Thinking pleasant and relaxing thoughts
  • Imagining somewhere real or imaginary where you can relax and out aside the cares of the world
  • Do puzzles in your head (word, number games)
  • What makes you happy? think of 5 things
30
Q

What if the behavioural treatment strategy for moderate/sever dental anxiety/phobia?

A
  • Consensus is to opt for exposure based treatment programme, such as systematic desensitisation
  • Patient first trained in relaxation
  • After this they are encouraged to expose them selves to a hierarchy of fearful situations
  • This procedure can be carried out individually or in a group setting using imagined, video, computer-based or real-life confrontation
31
Q

How do you carry out simple desensitisation?

A
  • Relaxation training
  • Give control in a calm manner
  • Fear hierarchy
  • Successive approximations
32
Q

In practice, exposure therapy is often combined with teaching the patient cognitive coping strategies. What are examples of these? (3 points )

A
  • Using pleasant and positive imagery
  • Identifying challenging and modifying negative and unhelpful thoughts and replacing these with more positive and realistic thoughts
  • Use of coping statements. ‘I can and I will’
33
Q

When should you as a dentist refer on a patient with dental anxiety?

A
  • Where the dental anxiety may be a manifestation of underlying emotional problems or more serious mental difficulties, referral to a clinical psychologist, psychiatrist or specialist dental clinic may be needed
  • Where there is high treatment need, but the psychological consequences would be too overwhelming of demanding for the patient, such that the patient is unwilling to have the treatment then a pharmacological approach in the form of GA or IV sedation may be appropriate

BDS2 Paediatric Dentistry (7 decks)

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