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BDS2: PMHP > Psychology > Flashcards

Psychology Flashcards

1
Q

What is dental fear?

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

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

Marked and persistent anxiety in relation to clearly discernible situations or objects (e.g. use of drill) or to the dental situation in general.

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4
Q

What is necessary for diagnosis of dental anxiety?

A

Complete avoidance of necessary dental treatment or endurance of treatment only with dread & in a specialist treatment solution.

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5
Q

How many people suffer from dental anxiety in the UK?

A

11.6% of the population

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6
Q

What are the causes of dental anxiety?

A 
Negative dental experiences e.g. pain, embarrassment
Influenced by family and peers
Media representations of dentistry
Expectations of pain and discomfort
Poor knowledge of modern analgesia
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7
Q

What are the characteristics of dental anxiety?

A

High neuroticism and trait anxiety - phobic avoidances, obsessions and compulsions
Pessimism & negative expectations
Low pain threshold
Co-morbid anxiety or depressive disorders

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8
Q

What are the three pathways of dental anxiety in children?

A

Conditioning - from bad experience
Modelling - Mother’s behaviour
Information - subjection to frightening information

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9
Q

How can you assess dentally anxious adults?

A

Dentally Anxious Scale (DAS)

Available freely online

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10
Q

How can you assess dentally anxious children?

A

Picture tests e.g. Venham Picture Test

Facial Image Scale (FIS)

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11
Q

Distinguish between dental fear, anxiety and phobia.

A

Fear - normal emotional reaction when you feel threatened
Anxiety - apprehension that bad things will happen, feeling of loss of control
Phobia - persistent anxiety triggered by dentistry resulting in avoidance behaviours

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12
Q

What is involved in picture tests for anxiety?

A

Children are asked to point to the picture they most feel like.

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13
Q

What are the stages of treatment for dental anxiety?

A
  1. General attitude - relationship with patient, giving info, provide control, predictability
  2. Specific pharmacological support - benzodiazepine prior to treatment or use of nitrous oxide sedation
  3. Teach coping strategies - distraction, relaxation
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14
Q

What are the methods of relaxation for anxious patients?

A 
Intravenous sedation
Nitrous oxide
Music distraction
Muscular relaxation (train the patient)
Fear hierarchy
Successive approximations
Exposure therapy
Challenging the evidence - ask patient to justify their anxiety
Referral to clinical psychologist
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15
Q

When would a pharmacological approach (sedation) be appropriate for dental anxiety?

A

When high risk patients refuse treatment

Severely anxious patient

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16
Q

When would you refer a dentally anxious patient to a psychologist?

A

If patient develops a phobic avoidance or refuses necessary treatment

17
Q

What is proven to be the most effective approach in dealing with anxiety?

A

Combining sensory and procedural information

18
Q

What are the three core symptoms of depression?

A

low mood
anhedonia (inability to find pleasure in experiences you used to find enjoyable)
decreased energy

19
Q

What is dysthymia?

A

Mild chronic depression.

Patient experiences mild depressive symptoms, but they are not severe enough to meet a diagnosis of depression.

20
Q

How can you screen for anxiety and depression?

A

Hospital Anxiety and Depression Scale (HADS)

21
Q

What effect does depression have on oral health?

A

Self neglect - affects routine oral hygiene, adherence to advice
Comfort eating - increased likelihood of caries
Antidepressant Meds - some can reduce salivary flow
Decreased cell-mediated immune activity
Correlation between depression and periodontal disease, independent of oral hygiene

22
Q

What are the physical symptoms of anxiety/stress?

A

Autonomic arousal:
Cardio - palpitations, tachycardia, chest discomfort
GIT - dry mouth, lump in throat, nausea
Respiratory - hyperventilation, chest tightness, difficulty catching breath
UT - frequent urination, sexual dysfunction
Other - muscle tension, hot flushes or chills, tremor, sweating, headache, faintness

23
Q

What is stress?

A

Three types - harm, threat and challenge
Harm - physiological damage that has already been done
Threat - anticipation of harm that has not yet happened
Challenge - difficult demands that we feel we can overcome
Psychological pressure or tension.

24
Q

What is eustress?

A

Positive and beneficial form of stress

25
Q

What are the different models of stress?

A

Cannon - fight or flight model (1932)
Selye - General adaptation syndrome (1956)
Holmes & Rahe - Life Events Theory (1967)
*must know criticisms of all

26
Q

What is the Transactional Model of Stress?

A

Stress involves a transaction between the individual and their external world.
Primary appraisal - an event can be perceived as either irrelevant, benign, harmful & a threat, harmful & a challenge
Secondary appraisal - the individual cost-benefit analyses the coping strategies

27
Q

What effect does stress have on the immune system?

A

Can induce immune dysfunction
Most commonly with continuous stressors (e.g. living with a chronic disease)
Can downregulate cellular immune response

28
Q

What effect can stress have on periodontal disease?

A

Stress hormones are either released by hypothalamo-pituitary adrenal axis (corticosteroids) or the SNS (adrenaline & noradrenaline).
SNS action has an immunosuppressive effect and therefore indirectly provokes periodontal tissue breakdown.

29
Q

What dental problems can stress cause?

A

Periodontal disease
Temporomandibular pain dysfunction sysdrome (TMPD)
Myofacial Pain Dysfunction Syndrome (MPD)
Bruxism
Subjective oral dryness and hyposalivation
Increased salivation
Overeating or Undereating
Increased likelihood of accidents

30
Q

What dental problems can anxiety cause?

A

Acute necrotising ulcerative gingivitus
Periodontal disease
Lower tooth brushing frequency
Subjective oral dryness and hyposalivation

31
Q

What is anorexia nervosa?

A

An ability to maintain body weight through intentional extreme restriction of food and drink, that can be accompanied by increased physical activity.

32
Q

What is bulimia nervosa?

A

Apparently normal weight maintained. Control of weight by restriction, then binge eating after which they purge food from their bodies by either vomiting or use of laxatives.
*palatal erosion is indicative of this

33
Q

What are the dental consequences of AN and BN?

A

Palatal/labial erosion from vomiting, decreased salivary flow or high fruit diet.
Parotid gland hypertrophy
Saliva - dry mouth, reduced resting flow rates (BN), bicarb conc reduced

34
Q

What is burning mouth syndrome?

A

A hot sensation affecting the tongue, lips, palate, or areas all over your mouth. a.k.a. ‘glossodynia’.

Caused by changes in the way the nerves in your mouth send messages to your brain - for example, about taste and temperature. When your brain doesn’t understand these messages properly it can cause the feeling of pain or burning. Can also have psychological causes - anxiety, depression etc.

35
Q

What is globus hystericus?

A

Lump or obstruction in the throat.
Leads to forced swallowing/gulping.
Diagnosed by exclusion of serious pathology.

36
Q

What is the fight-or-flight model?

A

External events elicit the fight-or-flight response involving increased activity rate and increased arousal

37
Q

What are the criticisms of fight-or-flight model and general adaptation syndrome?

A

Both conceptualise stress response as being automatic and not considered individual variability or psychological factors.
Stress response is conceptualised as being the same regardless of stressor.
Stress response is seen as being automatic and stressed individuals as being passive.

38
Q

What is the criticism of the Life Events Theory of stress?

A

Too simplistic

39
Q

What is the General Adaptation Syndrome?

A

Stress involves a transaction between the individual and their external world.
The elicitation of a stress response depends on the potentially stressful event being appraised as actually stressful.
Primary (looks at outside world) & secondary (appraisal of self) appraisal.
3 stages: alarm, resistance, exhaustion.
4 stress responses: direct action, seeking information, doing nothing, developing a means of coping.

BDS2: PMHP (4 decks)

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