Dental Fear and Anxiety

Question 1

Define dental fear.

Answer 1

A normal emotional reaction to threatening stimuli in the dental environment.
E.g. Needles, drill sound.

Question 2

Define dental anxiety.

Answer 2

Sense of apprehension that something dreadful is going to happen in the dental environment. Coupled with sense of losing control.

Question 3

Define a dental phobia.

Answer 3

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.

Question 4

What actions would diagnose a dental phobia?

Answer 4

Complete avoidance of necessary dental treatment or endurance of treatment with dread and specialist intervention.

Question 5

What commonly causes dental fear in adults?

Answer 5

From a negative experience in childhood.

Question 6

What are the stages in the cycle of dental fear and anxiety?

Answer 6

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

Question 7

List possible causes of dental anxiety. (5)

Answer 7

Negative past dental/medical experiences. 
Family/peer influence
Media representations of dentistry
Expectation of pain and discomfort
Poor knowledge

Question 8

List the 3 ways children become dentally anxious.

Answer 8

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.

Question 9

What do you have to consider when treating a patient with anxious characteristcs?

Answer 9

Cani treat this patient or do they have to be referred to a specialist?

Question 10

What are provoking factors in fearfulness?

Answer 10

Bad experience
High neuroticism - anxiety, worry, fear, anger.
Depression and anxirty

Question 11

How is dental anxiety measured in adults?

Answer 11

Dental anxiety scales:
DAS-R
MDAS (modified dental anxiety scale)

Question 12

What is the diagnostic cut off (out of 25) for a dental phobic?

Answer 12

19

Question 13

How is dental anxiety measured in children?

Answer 13

Picture tests.
Venham Picture Test.
Facial Image Scale.
(Also helpful in those with limited cognative function)

Question 14

List some criticisms of the Venham picture test.

Answer 14

All the figures are male.

Some of the facial expressions in the picture are ambiguous.

Question 15

What are the treatment strategies for mild/moderate anxiety?

Answer 15

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.

Question 16

What are the ways in which you can reduce anxiety via treatment style?

Answer 16

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.

Question 17

What are way in which the patient feels in control?

Answer 17

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

Question 18

When is music distraction useful?

Answer 18

Adult patients - unsuccessful in children.

Question 19

In adults what activities can be used as a distraction?

Answer 19

Music 
Breathing exercises? 
Pleasant/relaxing thoughts
Puzzles
Things that make you happy.

Question 20

When should you refer an anxious patient?

Answer 20

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.