Fear, Dental anxiety and pain

Question 1

What is the medical model of care?

2) What are the issues with it?
3) What model should be used instead and why?
4) what do patient reviews focus on?

Answer 1

1) focuses on treating identified pathology and appropriate for straigh forward patients
2) not useful with complex patients as doesn’t include social and psychological factors, hierarchy system (dentist dictates),
3) biopsychosocial model, social and psychological factors in treatment planning. Helps you to understand patient satisfaction, attendance, compliance and barriers to treatment.
4) psychological and social aspects of treatment

Question 2

1) In the medical Model of Care, what is meant to resolve symptoms? and what is though to be the cause of unresolved symptoms?
2) Why was the biopsychosocial model developed?
3) what does to biopyschosocial model help us understand?

Answer 2

1) treatment, Continuing symptoms related to unresolved pathology.
2) out of a recognition that some people with physical illness recover much better than others and that this
seems to be influenced by a wide range of factors
3) important in understanding patient satisfaction,
attendance, compliance and barriers to treatment.

Question 3

Give an example of social things in the biopyschosocial model?
2) and psychological things?

Answer 3

1) family, culture, beliefs

2) thoughts, emotions, beliefs, concerns, behavours

Question 4

what is the function of fear usually?

2) What is activated by potential danger?
3) what hormones are heavily involved in 2?
4) are we predisposed to fear or is it acquired?

Answer 4

to help us to get out
of danger.
2) Fight or Flight Response
3) cortisol and adrenaline
4) both, evolution = natural fear of heights, spiders and snakes
acquired fear e.g. mam is scared so is kid (learn of mam) or had painful treatment

Question 5

when evaluating a situation what helps us determine to be fearful or not?
2) How can fear be reduced?

Answer 5

Evaluation of potential danger.
• Similarities (and differences) to original situation
where fear developed.
• Presence of safety factors.
• Personal resources to cope.
• Thoughts and feelings about feelings, e.g. concern
about looking stupid, weak, shame about not being
able to contain emotion
2) How others behave
• How you talk to yourself
• Aspects of the situation / environment
• Deliberate efforts to cope

Question 6

What is classical conditioning?

2) e.g.
3) What is operant conditioning?
4) e.g.

Answer 6

1) Classical conditioning: two things that always occur
together will become linked.
2) Pavlovs’ dog, Being powerless in a chair while somebody more
powerful gets very close to you.
3) behaviour is shaped by what
happens immediately following the behaviour.
4) positive or negative reinforcement, punishment, extinction

Question 7

1) What factors shape fear?

Answer 7

1) a) association e.g. classical conditioning
b) re-inforcement e.g. operant conditioning?
c) escape and avoidance (a type of negative-reinforcement)
d)Vicarious
learning

Question 8

These are are types of operant conditioning, define them:

1) positive reinforcement
2) negative reinforcement
2) b) escape conditioning
2) C) avoidance conditioning
3) punishment
4) extinction

5) WHAT IS operant conditioning?

Answer 8

Positive re-inforcement
a behaviour is followed by a rewarding outcome.
• Negative re-inforcement
a behaviour is followed by the cessation of an
unwanted experience(not the same as punishment)
b) negative stimulus applied results in fight/flight response/ triggering event = behaviour (e.g. escape fire/ dental surgery)
c) stimulus applied (fire alarm/ upcoming dental appointment) before main negative stimulus/triggering event (fire/ dental surgery pain) results in fight/flight response = behavour
• Punishment
a behaviour is followed by an unwanted experience.
• Extinction
a behaviour is followed by no rewarding outcome (and
eventually stops).
5) Our responses are shaped by the consequences of similar responses in
the past.

Question 9

What is vicarious learning? e.g *3

Answer 9

Vicarious learning is learning through the experience
of somebody else.
e.g.
• Observing the responses of somebody else.
• Hearing about the experiences of somebody else.
• Picking up on the emotion of somebody else in the
room.

Question 10

How could you intervene on clinic to reduce fear?

2) What to do if this doesn’t work?

Answer 10

Keep yourself calm!
• Let the patient know how that they can signal for you
to stop at any point.
• Tell them that the unpleasant feelings are caused by
hormones which are there to assist the fight or flight
response and that the body is only able to release a
certain amount of these hormones.
• Help them to slow their breathing (but not breathe
deeply). A good rule of thumb is to breathe to 7 on a
breath in and 11 on a breath out.
• Ask how you can help. They may have existing coping
strategies that you could support them with, eg
listening to music, repeating a helpful phrase.
• Check consent for every stage of the procedure.
2) onward referral ( we don’t have access to bespoke psychological services, patients can self-refer to IAPT services and GP for psychological services)

Question 11

Put this in order of what patients are most anxious of:

1. whole process/ feeling of powelessness
2. needles
3. drilling (including the sound of the drill)
4. pain in treatment

Answer 11

1, 3, 4, 2

Question 12

Give the dental fear cycle:

B) What initiates fear of the dentist?

Answer 12

1. delayed visiting
2. dental problems
3. symptom driven treatment
4. dental fear/ anxiety
   B) initiated by personal experience, vicarious experience
   or learning from others

Question 13

What needs of the patient need to be met:

a) biological
b) psychological
c) social

Answer 13

a) dental care to maintain good oral health
b) treatment planthat can
acknowledge, address and
hopefully over time reduce her anxiety, grounded in relevant theory and regulary reviewed
c) Respect, acknowledgement,
support and understanding, ‘Not the only one’. Involved in treatment plan.

Question 14

What do anxious feelings lead to?

2) how do we challenge result of 1?
3) Why does this happen?

Answer 14

1) anxious thoughts (thinking the worse)
2) It can be important to recognise that they are not facts, and that they are related to the way that we feel.
3) impact of thinking

Question 15

When addressing social aspects behind dental anxiety how can you tackle the following:
• Respect, acknowledgement,
support and understanding.
• ‘Not the only one’.
• Involved in treatment plan.

Answer 15

the 3 A’s
1) ask ( how anxious they feel, what particular concerns they have and any way they think you
could help them)
2) acknowledge (what they have said to you with
respect and without judgement, simple reflections)
3) address (their concerns by offering ideas that may help)

Question 16

How is the 5 areas model used?

2) what does it provide:

Answer 16

it is used to explain the biospychosocial model, each aspect effects others,
2) Provides a framework for organising how we describe an experience.
Thoughts (social/pycho)
Emotions (pycho)
Physical sensations (biological)
Behaviours
Social context (social)

Question 17

For anxous patients what shoudl you do when:
1) inviting to make an appointment
2) making an appointment
A) for each give one social reason why we do this?
B) for each given one psychological reason why we do this?

Answer 17

1) Consider how you could communicate that the team takes dental anxiety
seriously and will be willing to help.
2) Ask about anxiety, offer resources, express confidence that we can
help, be friendly and supportive.
A)1) patient won’t feel alone, or like they are the only one OR Testimonials from others about successful treatment can
help patients to make links with their own situation (vicarious learning)
2) Social support increases the chance of getting
through a challenging situation.
B) 1) prevents avoidance behaviour (that would be reinforced by negative reinforcement) OR information will support helpful thoughts
2) Patients may find it useful close to the day to use
strategies such as distraction and calm breathingwhich were introduced to them earlier. OR positive impression OR challenge thoughts when nearer time

Question 18

How can you positively reinforce going to the dentist, what part of biopsychcosocial model does this fall under?

Answer 18

pyscho
on attendance, give them a positive experience be friendly, positive experience supports preparation for attendance next time

Question 19

pain is an experience, what different elements does it include:
2) other than nociception, what influences pain?

Answer 19

• Sensory
• Attitude
• Beliefs
• Emotional
• Motivational
2) • The situation
• Interpersonal factors
• Previous experience
• Temperament
• Response
• Deliberate strategies

Question 20

1) Nociceptors cause pain ,-expand
2) Pain can be measured unambiguously
3) Pain can be measured - expand?
true or false

Answer 20

1) yes and no, nociceptors send “warning messages” not “pain messages” from periphery to CNS, pain is only experienced when all stimuli have been interpreted by the brain
2) false
3) true, using self-report scales with visual analogue scales

Question 21

True or false

1) pain is a sign of injury
2) pain is an alarm
3) pain occurs once the brain takes into account all infomation and determines it is not safe to ignore
4) Pain is like hunger or thirst

Answer 21

1) false
2) true
3) true
4) true

Question 22

0) How can both anxiety and pain be managed in a dental setting:
1) How can pain be managed in a dental setting:
2) on attendance to appointmanent how can anxiety be manadged?

Answer 22

0) -be frienfly/ greet warmly
- be or look calm
- discuss and agree a “stop” signal (explain limits f stop signal)
1) breifly explain what you are doing, ask how much info they would like (taylor), discuss strategies (listen to music), support staff could provide emotional support
2) acknowledge you know its difficult for them to be here, ask if there is anything they;d like you to know, ask if there is anything you can do to help manadge their anxiety, take your time, use Tell show do, give some positive feedback at the end of the session

Question 23

Sources of pain to dental patient:

Answer 23

• Part of necessary procedures.
• A symptom, eg toothache.
• A Long term condition
(persistent pain).

Question 24

What does tell show do achieve?

Answer 24

to prepare, acclimatise and reduce child anxiety

Question 25

What psychological process is relevant to giving
children a sticker and praise after dental
treatment?

Answer 25

Positive reinforcement

Question 26

What is learning theory?

Answer 26

ABC,
antecedents, behaviour, consequences
antecedents comes before and consequences after the behaviour. We can’t control B, but we can can control A and C.
A links into working out what triggers B and includes eveything you do before treatment. C is the cause of operant conditioning,

Question 27

What 5 things are in the 5 areas model?

Answer 27

thoughts, feeling, physical sensations, behaviours and context

borrow cars to fuck philippa’s shoes

Question 28

in the 5 areas model. what physical sensations might the patient be experiencing?
2) How could this be challenged

Answer 28

1) Trembling, tense, fast heart rate,
‘butterflies’ changed breathing, hot, sweaty
2)Acknowledge situation is
challenging.
• Link symptoms of ‘stress
response’ to challenge of
situation.
• Encourage patient to slow
breathing, count breaths.
• Encourage patient to focus on
supportive cues such as the
sound of your voice.

Question 29

in the 5 areas model. what thoughts might the patient be experiencing?
2) How could this be challenged

Answer 29

1) This is going to hurt.
Will I be able to cope?
What if it gets really bad and they don’t stop?
They probably think I’m pathetic
2) find out and address unhelpful thoughts, • Give accurate information.
• Stop signal.
• Warm manner, acknowledge and
normalise response.
• Encourage throughout.

Question 30

in the 5 areas model. what feelings might the patient be experiencing?
2) How could this be challenged

Answer 30

1) Scared, anxious,
worried,
irritable,
ashamed,
annoyed

2) Acknowledge feelings as NORMAL
and UNDERSTANDABLE. Offer
coping methods if appropriate

Question 31

When developing a treatment plan , what do you need to be careful of? (link into behaviour in 5 areas model)

2) do we want to encourage avoidant or approach behaviour
3) What could you do to encourage 2?

Answer 31

does not inadvertently
reinforce avoidance behaviour,
positively or negatively
2) approach behaviour (a form of behaviour in which an object or person is moved towards, This is in contrast to avoidant behaviour where there is movement away)
3) 7/11 breathing

Question 32

How stresses can impact individuals?

Answer 32

• Take more time off
• Arrive at work late
• Be twitchy and nervous
• Mood swings
• Withdrawn
• Loss of motivation,
commitment, confidence
• Heightened sensitivity,
tearfulness, aggressiveness

Question 33

How stresses can impact team performance?

Answer 33

• Arguments
• Higher staff turnover
• More sickness absence
• Decreased performance
• More complaints and grievances