Dental anxiety causes and treatment

Question 1

what is dental fear?

Answer 1

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

Question 2

what is 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 leaving control

Question 3

what is dental phobia?

Answer 3

a severe type of dental anxiety in relation to clearly discernible situations or objects or the dental situation in general

Question 4

what is required when diagnosing dental phobia?

Answer 4

either complete avoidance of necessary dental treatment or **endurance of treatment only with dread and in a specialist treatment situation **

Question 5

what is stress?

Answer 5

a negative emotional experience accompanied by predictable biochemical, physiological, cognitive and behavioural changes that are directed either toward altering the stressful event or accompanying to its effects

Question 6

how does dental anxiety lead to poorer oral health?

Answer 6

• dental anxiety leads to avoidance of going to the dentist
• leads to deterioration of oral health
• leads to feelings of shame and inferiority
• can increase levels of dental anxiety and leads to poorer oral health and quality of life

Question 7

what is the aetiology of dental anxiety?

10

Answer 7

• negative medical/dental experiences
• painful
• frightening
• humiliating
• poor knowledge of modern analgesia
• social influences
• family and peers
• media representation
• history of trauma
• expectations of pain and discomfort

Question 8

what are characteristics of anxious people?

6

Answer 8

• high trait neuroticism and anxiety
• pessimism and negative expectation
• prone to somatisation (manifestation of psychological distress by the presentation of physical symptoms)
• low pain threshold
• co-morbid anxiety disorders
• co-morbid depression disorders

Question 9

what are the two main areas of anxious thinking?

Answer 9

1. fear of negative health outcomes
2. fear of negative social outcomes

Question 10

what are the treatment strategies for mild/moderate dental anxiety?

3

Answer 10

1. general attitude and the application of a general anxiety reducing treatment style (acknowledge patient’s feelings, create trusting relationship, provide high leel of predictability, provide control)
2. teach coping strategies (relaxation and distraction)
3. specific pharmacological support (benzodiazapine prior to treatment)

Question 11

what are examples of relaxation strategies?

Answer 11

• simple breathing awareness
• progressive muscle relaxation

Question 12

what are examples of distraction techniques?

Answer 12

• general friendly discussion
• visualisation
• imagery
• children - teach a magic trick, sums in head, squeeze ball

Question 13

how can you give a degree of control during dental treatment?

Answer 13

• stop signals - give control over pace of procedure
• rest signals - allows patient to stop with the understanding that the treatment is not finished yet
• proceed signals
• provide options - what do you want to happen? which tooth do you want to start with?

Question 14

what are behavioural treatments for moderate/severe dental anxiety?

Answer 14

• patient can be trained first in relaxation
• patient encouraged to expose themselves to a hierarchy of fearful situations
• using imagined, video, computer-based or real life confrontation
• carried out by clinical or health psychologist, or a CBT therapist in cooperation with a dentist

Question 15

describe what a fear hierarchy (step-by-step approach) is?

Answer 15

• list of things patient is scared about and is ranked from least to most anxious
• patient is gradually exposed to each item on the list
• exposure must be voluntary

Question 16

what are examples of simple desensitisation strategies?

4

Answer 16

• relaxation training
• give control in a calm manner
• fear hierarchy
• successive approximations

Question 17

what are examples of cognitive treatment strategies?

Answer 17

• exposure therapy often combines with teaching the patient
• using pleasant and positive imagery
• use of coping statemtents (I can, I will…)
• challenging and modifying negative and unhelpful thoughts and replacing these with more positive and realistic thoughts

Question 18

how does a dentist explore and not challenge a patient’s anxious thoughts?

Answer 18

• patient needs to challenge the evidence not the dentist
• need to ask questions to make them look past the feared outcome
• need to reduce the underlying fear and anxiety
• e.g. have you ever experienced a lot of pain before?

Question 19

how is sedation both a positive and negative for dental anxiety?

Answer 19

• good in extreme cases when patient needs to have treatment but is too fearful
• does not alter the underlying problem of dental anxiety and fear