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BDS2 - PMHP > dental fear and anxiety > Flashcards

dental fear and anxiety Flashcards

1
Q

what is dental fear

A

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

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2
Q

what is 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/ loss of control
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3
Q

what is dental phobia

A
  • a sever type of dental anxiety manifested as a marked and persistent anxiety in relation to clearly discernible situations or objects or to the dental situation in general
  • for a diagnosis of dental phobia, there must be either complete avoidance of necessary dental treatment of endurance treatment only with a dread and in a specialist treatment situation
  • affects their life
  • for adults this means they can just not go to the dentist but for children they are brought by parents so they may close their mouths etc to prevent treatment
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4
Q

what are the levels fo dental anxiety globally

A
  • in UK = 11.6% adults (4x higher in 18-39 y/o than 60+)
  • in Sweden = 9% children
  • australia = 6.1%
  • hong kong = 10.5%
  • france = 7.3%
  • india = 7.8% women, 7.1% men
  • Japan = 42% (children have been seen to be dragged to dentists)
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5
Q

what is a common reason for dental phobia

A

people have had a traumatic experience at the dentist in the past = as a child for example

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6
Q

who is more likely to be dentate and have more missing teeth

A

people with higher fear as they avoid the dentist

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7
Q

what are the 5 top stressors in dentistry for dentists

A
  • running behind schedule
  • causing pain
  • heavy workload
  • late patient s
  • anxious patients- some dentists find it really challenging
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8
Q

what is the best way to help an anxious patient

A
  • acknowledge that they are scared
  • don’t belittle them
  • tell them that you are going to take it ‘step by step’
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9
Q

what is the cycle of dental fear and anxiety

A

fear/anxiety –> avoidance –> deterioration in dental status –> feel shamed and inferior –> back to beginning

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10
Q

what is the aetiology of dental anxiety

A
  • negative medical and dental experience
  • influenced by family and peers
  • media representation of dentistry
  • expectation of pain and discomfort
  • poor knowledge of modern analgesia
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11
Q

what must you do if someone expects pain

A

use local anaesthetic

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12
Q

how do children become dentally anxious

A
  • 3 pathways identified
  • conditioning = arising from objective dental pathology and subjective dental and medical experiences, dentists sensitivity to fears has big impact
  • modelling = imitation of mothers behaviour, if mothers acts anxious then child may too
  • information = possibly through unwitting provision of frightening information more likely through absorbing mothers attitudes to dentistry, need to be careful what you say
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13
Q

what can you say instead of pain

A

can say that you may feel a little bit of pressure, instead of pain

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14
Q

what are the characteristics of the anxious patents

A
  • high neuroticism and trait anxiety
  • pessimism and negative expectation
  • process to somatisation (the manifestation of psychological distress)
  • low pain threshold
  • co-morbid anxiety disorders/depressive disorders
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15
Q

what is anxious and neurotic thinking

A
  • fear of negative evaluation
  • pessimistic and vulnerable
  • catastrophic
  • worry as a habit
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16
Q

what can neuroticism and clinical depression often do

A
  • ten dot negatively bias recall about personal information and events
  • so avoidant and fearful dental patents have inaccurate memories for treatment experiences and also benign experiences are recalled negatively, increasing the fear and anxiety
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17
Q

what is the pathway to fearfulness

A
  • bad experiences cause selective memory and depression and anxiety cause biased judgement
  • these both lead to high neuroticism
  • high neuroticism leads to fear, avoidance, safety seeking and anticipating disaster
18
Q

how can you treat an anxious patient

A
  • listen to what your patient is saying to you
  • ask the right questions
  • what is their goal
  • what do they want to achieve
19
Q

how is dental anxiety assessed in adults

A
  • Dental Anxiety Scale (DAS) and its derivatives DAS-R and MDAS
  • take the form of 4 or 5 item questionnaires given to patients
20
Q

what is the MDAS

A
  • modified dental anxiety scale
  • can score up to 25 (5 questions with max score of 5)
  • above 19 overall is deemed phobic
  • any question answered as 5 is deemed phobic
21
Q

how is dental anxiety measured in children

A
  • picture tests
  • Venham picture scale
  • facial image scale
  • modified child dental anxiety scale (MCDASf)
  • child experience and anxiety measure (CEDAM)
22
Q

why are picture tests good

A
  • have advantage for younger children and have been found to help with understanding especially if there is limited cognitive functioning
23
Q

what is the Venham picture scale

A
  • shows 8 Paris of boys, one with an anxious and one with a non-anxious face
  • child is asked to point to one they feel like more
24
Q

what are negatives of the Venham picture scale

A
  • used more in research than reality
  • only males show
  • ambiguity on whether faces are happy or not
25
Q

what is the facial image scale

A
  • 5 unhappy to 1 happy
  • children asked to point at face they feel most like
  • measures ‘state anxiety’ or may only measure the Childs mood that day
  • significantly correlates with the Venham picture scale
26
Q

what ages use the MCDASf

A

ages 8-16

- it’s the same as MDAS but has faces on it

27
Q

what is the CEDAM

A
  • for ages 9-16
  • has behavioural, thoughts and physiological sections to it
  • boys particularly won’t say how they feel and instead will just say ‘they’re not bothered’ however
28
Q

what are some treatment strategies for mild/moderate dental anxiety

A
  • explain the ‘fight or flight’ system to them, let them know they can take control (acknowledge anxiety, form trusting relationship, provide realistic information, provide control)
  • talk them through what’s going to happen during this visit
29
Q

what pharmacological support can be given

A

if necessary lease with the GP regarding prescribing oral sedation prior to the treatment, for adults use nitrous oxide sedation

30
Q

what coping mechanisms can be used

A
  • relaxation and distraction
  • relation and hypnosis (best)
  • music distraction (tends not to work for children though)
31
Q

how can you give the patient control

A
  • give them stop signals, rest signals, proceed signals
  • stop = raise your hand if you want me to stop
  • rest = allows patient to stop procedure with understanding that it is not finished yet
  • proceed signals = open your mouth when you are ready to start (just as important as stop)
  • provide options to patient = what do you want to happen, which tooth will you like me to start on
32
Q

how good is relaxation training

A
  • when done correctly is a very good method to use
  • but patient and dentist experience should be considered
  • need to practise regularly to make it work
33
Q

what is distraction methods

A
  • thinking pleasant and relaxing thoughts
  • do puzzles in your head
  • count back from hundred in 2’s
  • what makes you happy = list 5 things
34
Q

what are behavioural treatment strategies for severe/moderate dental anxiety

A
  • consensus is to opt for exposure based treatment programme such as systemic desensitisation.
  • patient first trained in relaxation
  • after this they are encourages to expose themselves to a hierarchy of fearful situations ( they’re anxiety ladder)
  • can be carried out individually or in a group setting
35
Q

what is an example of fear hierarchy

A
  • sitting in waiting room (least)
  • seeing needle
  • hold needle
  • feel needle on gum
  • intro-oral injection (most)
36
Q

what is simple desensitisations

A
  • relaxation training
  • give control in a calm manner
  • fear hierarchy
  • successive approximations
37
Q

what produces the greatest effect to reduce fear

A

real life dental situations or video games

38
Q

when must a clinical psychologist be introduced

A

for more complex cases

- psychologist works close cooperation with the dentist

39
Q

what is cognitive treatment strategies

A
  • exposure therapy is often combined with teaching patient cognitive coping strategies
  • using pleasant and positive imagery
  • identifying challenging and modifying negative and unhelpful thoughts and replacing with positive thoughts
  • use of coping statements = ‘I can and I will’
40
Q

how can you challenge patients belief

A
  • e.g. ‘ I have never coped well with pain and am prone to fail’
  • challenge = ‘ what about when you’re child was born’
  • when highly anxious patients have to come up with facts that do not confirm their hears, there is a subsequent decline in their perception of risk
41
Q

when do you need to refer on an anxious patient

A
  • where dental anxiety may be a manifestation of underlying emotional problems of more serious medical difficulties, referral to clinical psychologist, psychiatrist or specialist clinical may be needed
  • if patient adamantly not wanting the treatment a pharmacological treatment may be needed such as GA
  • however referring on and getting rejected can make anxiety worse
42
Q

what are some optimal interventions

A
  • information giving improves knowledge and dispels fears
  • inappropriate beliefs can be challenged and reconstructed
  • sedation may be beneficial for highly anxious patients

BDS2 - PMHP (11 decks)

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