Dental Fear and Anxiety Flashcards
Define dental fear.
A normal emotional reaction to threatening stimuli in the dental environment.
E.g. Needles, drill sound.
Define dental anxiety.
Sense of apprehension that something dreadful is going to happen in the dental environment. Coupled with sense of losing control.
Define a dental phobia.
Severe type of dental anxiety that is manifested as marked and persistent anxiety in relation to clearly discernible situations and objects or to the dental situation in general.
What actions would diagnose a dental phobia?
Complete avoidance of necessary dental treatment or endurance of treatment with dread and specialist intervention.
What commonly causes dental fear in adults?
From a negative experience in childhood.
What are the stages in the cycle of dental fear and anxiety?
Fear/anxiety
Avoidance
Deterioration in dental status
Feelings of shame and inferiority.
List possible causes of dental anxiety. (5)
Negative past dental/medical experiences. Family/peer influence Media representations of dentistry Expectation of pain and discomfort Poor knowledge
List the 3 ways children become dentally anxious.
Conditioning: Objective dental pathology and subject dental and medical experiences. Dentists sensitivity to childrens fears is crucial.
Modelling: Imitation of mother’s behaviour. Mothers of anxious children are in a higher state of anxiety and behave more variably during consultation compared to those with non-anxious.
Information: Frightening information. More likely through absorbing mother’s attitudes to dentistry.
What do you have to consider when treating a patient with anxious characteristcs?
Cani treat this patient or do they have to be referred to a specialist?
What are provoking factors in fearfulness?
Bad experience
High neuroticism - anxiety, worry, fear, anger.
Depression and anxirty
How is dental anxiety measured in adults?
Dental anxiety scales:
DAS-R
MDAS (modified dental anxiety scale)
What is the diagnostic cut off (out of 25) for a dental phobic?
19
How is dental anxiety measured in children?
Picture tests.
Venham Picture Test.
Facial Image Scale.
(Also helpful in those with limited cognative function)
List some criticisms of the Venham picture test.
All the figures are male.
Some of the facial expressions in the picture are ambiguous.
What are the treatment strategies for mild/moderate anxiety?
Trying to alter their general attitude and apply an anxiety reduced treatment style i.e. give patient control
Pharmacological support: Confer with GMP and prescribe oral sedation before the treatment.
Teaching coping strategies, i.e. muscle relaxation and distraction techniques.
What are the ways in which you can reduce anxiety via treatment style?
Explain the fight or flight response of anxiety - let them know they are in control.
Acknowledge patients anxiety
Establish trust
Provide relistic information
Provide control
Provide predicatability by telling them at the start of the visit what the plan is for the appoinment.
What are way in which the patient feels in control?
Stop signals: Gives control of the pace.
Rest signals: Allows patient to have a break whilst understanding that the treatment is not over.
Proceed signals.
Provide options
When is music distraction useful?
Adult patients - unsuccessful in children.
In adults what activities can be used as a distraction?
Music Breathing exercises? Pleasant/relaxing thoughts Puzzles Things that make you happy.
When should you refer an anxious patient?
Where the dental anxiety may be a mannifestation of underlying emotional problems or serious mental difiiculties.
Where there is a high treatment need but the psychological consequences would be too overwhelming for the patient. GA or IV sedation required.
