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

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3
Q

what is dental phobia?

A

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

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4
Q

what is required for a diagnosis of dental phobia?

A

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

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5
Q

what are the 3 biggest problems for dentists?

A

dentist-patient relationship, patient anxiety, prevention

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6
Q

in the UK which group of people have the highest dental anxiety?

A

18-39

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7
Q

what is the vicious model of dental anxiety and fear?

A

fear/anxiety - avoidance - deterioration in dental status - feelings of shame and inferiority

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8
Q

what is the aetiology of dental anxiety?

A

negative medical and dental experiences, influenced by family and peers, media representations of dentistry, expectation of pain and discomfort, poor knowledge of modern analgesia

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9
Q

what are the three pathways of which children become dentally anxious?

A

conditioning, modelling, information

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10
Q

what is conditioning?

A

arising from objective dental pathology and subjective dental experiences

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11
Q

what is modelling?

A

childrens imitation of mother’s behaviour

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12
Q

what is information pathway for dentally anxious children?

A

unwitting provision of frightening information (absorbing mothers attitudes to dentistry)

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13
Q

what are characteristics of dentally anxious patients?

A

high neuroticism and trait anxiety, pessimism and negative expectation, proneness to somatisation, low pain threshold, co-morbid anxiety disorders, co-morbid depressive disorders

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14
Q

what is anxious and neurotic thinking composed of?

A

fear of negative evaluation, pessimistic and vulnerable, catastrophic, over-inclusive negativity, worry as a habit

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15
Q

how are benign experiences recalled by avoidant and fearful patients?

A

negatively and hence are consistent with a pessimistic and fearful schema

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16
Q

what are the provoking factors for fearfulness and what maintaining factors do these lead to?

A

bad experience - selective memory and attention
high neuroticism - high neuroticism
depression and anxiety - biased judgement

17
Q

what do provoking and maintaining factors ultimately lead to?

A

fear avoidance, safety seeking and anticipating disaster

18
Q

what is the anxiety maintenance diagram?

A

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

19
Q

what is the diagnostic cut off for severe DFA on the MDAS questionnaire?

A

greater than 19/25

20
Q

what tests are used to assess dentally anxious adults?

A

DAS-R and MDAS

21
Q

what tests are used to assess dentally anxious children?

A

Venham picture test and Facial Image Scale, MCDASf (for children 8+), CEDAM (9-16)

22
Q

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

A

general anxiety reducing treatment, teach coping strategies (relaxation, distraction), specific pharmacological support

23
Q

what is included in general anxiety reducing treatment?

A

acknowledge patients feeling of anxiety, engender a trusting relationship, provide realistic information, provide high level of predictability, provide control

24
Q

what types of relaxation techniques can you use?

A

simple breathing awareness or progressive muscle relaxation

25
Q

what sort of distraction techniques can you use?

A

general discussion, visualisation and imagery

26
Q

what sort of pharmacological support can you prescribe to patients?

A

benzodiazepine prior to treatment/nitrous oxide sedation

27
Q

what type of signals are available to give to patients to increase their control?

A

stop signals, rest signals, proceed signals, providing options

28
Q

what are the behavioural treatment strategies for moderate/severe dental anxiety?

A

exposure-based treatment such as systematic desensitization after muscular relaxation

29
Q

what would be the step-by-step approach for desensitising a patient for needle phobia?

A

sitting in waiting room - seeing the needle - holding the needle - feeling needle on the gum - intra-oral injection

30
Q

what does simple desensitisation include?

A

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

31
Q

what type of fear are dentists well-placed to carry out exposure therapy for?

A

uncomplicated specific fears

32
Q

how should complex cases be treated?

A

by a clinical psychologist in close cooperation with the dentist

33
Q

what is exposure therapy often combined with?

A

teaching the patient cognitive coping strategies

34
Q

what does cognitive coping strategies include?

A

using pleasant and positive imagery, use of coping statements like “I can and I will, this is fine”

35
Q

what does cognitive treatment strategies work to do?

A

challenge and modify negative unhelpful thoughts and replace these with more positive and realistic thoughts

36
Q

what does challenging the evidence achieve?

A

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

37
Q

when is referral to a clinical psychologist/psychiatrist needed?

A

when the dental anxiety may be a manifestation of underlying emotional problems or more serious mental difficulties

38
Q

when is pharmacological approach needed?

A

when there is high treatment need but the psychological consequences would be too overwhelming and or demanding

39
Q

what is the most effective approach to dental anxiety?

A

combining sensory and procedural information