Dental Fear and Anxiety Flashcards
what is dental fear?
a normal emotional reaction to one or more specific threatening stimuli in the dental environment
what is dental anxiety?
a sense of apprehension that something dreadful is going to happen in relation to dental treatment, coupled with a sense of losing control
what is dental phobia?
a severe 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
what is required for a diagnosis of dental phobia?
complete avoidance of necessary dental treatment or endurance of treatment only with dread and in a specialist treatment situation
what are the 3 biggest problems for dentists?
dentist-patient relationship, patient anxiety, prevention
in the UK which group of people have the highest dental anxiety?
18-39
what is the vicious model of dental anxiety and fear?
fear/anxiety - avoidance - deterioration in dental status - feelings of shame and inferiority
what is the aetiology of dental anxiety?
negative medical and dental experiences, influenced by family and peers, media representations of dentistry, expectation of pain and discomfort, poor knowledge of modern analgesia
what are the three pathways of which children become dentally anxious?
conditioning, modelling, information
what is conditioning?
arising from objective dental pathology and subjective dental experiences
what is modelling?
childrens imitation of mother’s behaviour
what is information pathway for dentally anxious children?
unwitting provision of frightening information (absorbing mothers attitudes to dentistry)
what are characteristics of dentally anxious patients?
high neuroticism and trait anxiety, pessimism and negative expectation, proneness to somatisation, low pain threshold, co-morbid anxiety disorders, co-morbid depressive disorders
what is anxious and neurotic thinking composed of?
fear of negative evaluation, pessimistic and vulnerable, catastrophic, over-inclusive negativity, worry as a habit
how are benign experiences recalled by avoidant and fearful patients?
negatively and hence are consistent with a pessimistic and fearful schema
what are the provoking factors for fearfulness and what maintaining factors do these lead to?
bad experience - selective memory and attention
high neuroticism - high neuroticism
depression and anxiety - biased judgement
what do provoking and maintaining factors ultimately lead to?
fear avoidance, safety seeking and anticipating disaster
what is the anxiety maintenance diagram?
internal/external event - perceived exaggerated threat - best attempt to protect yourself from threat - short term relief but no challenge to anxiety-related belief - fear remains intact and alarming belief unchanged
what is the diagnostic cut off for severe DFA on the MDAS questionnaire?
greater than 19/25
what tests are used to assess dentally anxious adults?
DAS-R and MDAS
what tests are used to assess dentally anxious children?
Venham picture test and Facial Image Scale, MCDASf (for children 8+), CEDAM (9-16)
what are the treatment strategies for mild/moderate dental anxiety?
general anxiety reducing treatment, teach coping strategies (relaxation, distraction), specific pharmacological support
what is included in general anxiety reducing treatment?
acknowledge patients feeling of anxiety, engender a trusting relationship, provide realistic information, provide high level of predictability, provide control
what types of relaxation techniques can you use?
simple breathing awareness or progressive muscle relaxation
what sort of distraction techniques can you use?
general discussion, visualisation and imagery
what sort of pharmacological support can you prescribe to patients?
benzodiazepine prior to treatment/nitrous oxide sedation
what type of signals are available to give to patients to increase their control?
stop signals, rest signals, proceed signals, providing options
what are the behavioural treatment strategies for moderate/severe dental anxiety?
exposure-based treatment such as systematic desensitization after muscular relaxation
what would be the step-by-step approach for desensitising a patient for needle phobia?
sitting in waiting room - seeing the needle - holding the needle - feeling needle on the gum - intra-oral injection
what does simple desensitisation include?
relaxation training, give control in a calm manner, fear hierarchy, successive approximations
what type of fear are dentists well-placed to carry out exposure therapy for?
uncomplicated specific fears
how should complex cases be treated?
by a clinical psychologist in close cooperation with the dentist
what is exposure therapy often combined with?
teaching the patient cognitive coping strategies
what does cognitive coping strategies include?
using pleasant and positive imagery, use of coping statements like “I can and I will, this is fine”
what does cognitive treatment strategies work to do?
challenge and modify negative unhelpful thoughts and replace these with more positive and realistic thoughts
what does challenging the evidence achieve?
when highly anxious patients have to come up with facts that do NOT confirm their fears there is a subsequent decline in their perception of risk
when is referral to a clinical psychologist/psychiatrist needed?
when the dental anxiety may be a manifestation of underlying emotional problems or more serious mental difficulties
when is pharmacological approach needed?
when there is high treatment need but the psychological consequences would be too overwhelming and or demanding
what is the most effective approach to dental anxiety?
combining sensory and procedural information
