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DENTAL ANXIETY

Dental fear refers to the fear of dentistry and of receiving dental care. This can be quite severe when diagnosed as a dental phobia, odontophobia, dentophobia, or dental phobia, or less severe when described as generalized anxiety. 

 

A phobia is traditionally defined as an irrational severe fear that leads to avoidance of the feared situation, object, or activity. Exposure to the feared stimulus provokes an immediate anxiety response, which can take the form of a panic attack. The phobia causes a lot of distress and impacts other aspects of a person’s life, not just oral health. Dental phobics will spend a great deal of time thinking about their teeth or dentists or dental situations, or else spend a lot of time trying NOT to think of teeth or dentists or dental situations.  

 

Dental anxiety is feeling nervous about or being fearful of, visiting a dentist. It can sometimes be a barrier to people getting dental treatment. 

 

This course will explore:

Dental Anxiety

Types of Anxiety

Methods to reduce anxiety

 

About Dental Anxiety:

 

Dental anxiety is common and affects people of all ages. As noted, there are different levels of dental anxiety, ranging from slight nervousness to severe phobia.  It is estimated that as many as 75% of adults in the United States experience some degree of dental fear, from mild to severe.  Approximately 5 to 10 % of adults are considered to experience dental phobia and as such avoid dental care at all costs.  Many fearful individuals will only seek dental care when they have a dental emergency, such as a toothache or dental abscess.  Many individuals who are very fearful of dental care often experience a cycle of avoidance, in which they avoid dental care due to fear until they experience a dental emergency requiring invasive treatment, which can reinforce their fear of dentistry.

 

Women tend to report more dental fear than men, and younger people tend to report being more fearful than older individuals.  Individuals tend to report being more fearful of more invasive procedures, such as oral surgery, than they are of less invasive treatment, such as professional dental cleanings, or prophylaxis. 

 

Phobia of dental care is sometimes diagnosed using a fear measurement instrument like Corah’s Dental Anxiety Scale or the Modified Dental Anxiety Scale.  The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), lists diagnostic criteria of a specific phobia to include:

  • marked and persistent fear of the specific object or situation that is excessive or unreasonable,
  • an immediate anxiety response upon exposure to the feared stimulus, which may take the form of a panic attack,
  • recognition that the fear is excessive or unreasonable,
  • avoidance of the anxiety-producing situation,
  • the phobia interferes with normal functioning or causes marked distress.

 

Common Areas that Induce Anxiety:

Dental anxiety is most commonly caused by traumatic dental experiences, although there can be other causes, as well. Children are often influenced by their parents’ fears and attitudes toward dental treatment. Dental anxiety may involve fear of dentists, dental procedures, a specific fear of needles, teeth, or objects, and situations that remind the sufferer of the phobic situation. The dentist’s drill is often a major factor in these fears.

  • The embarrassment of Bad Teeth, Gagging, Crying
  • Loss of Control
  • Sights, Sounds & Smells
  • Pain
  • The Drill
  • Needles
  • Fear of Fainting
  • Sexual Abuse
  • Can’t Get Numb
  • Bad Reaction to Local Anesthetic
  • Choking
  • Cost
  • Extensive Treatment
  • Unnecessary Treatment

 

 Strategies: 

 

However nervous or fearful someone is of having dental treatment, several things can be done to help overcome the anxiety.

 

Many people hate the feeling of being tipped back in the chair, and/or lying down as it makes them feel exposed, defenseless, and helpless. If this is the case for your patient perhaps offering to leave the chair in a more upright position could ease the anxiety.

 

Many people complain that their childhood dentists never explained to them what they were doing or why. They were treated like a set of teeth rather than like living, breathing people with feelings and emotions. While these types of dentists exist, most dental professionals view their patients as partners in their care.

 

As a professional in the dental industry, you should explain the treatment in advance, how they are done, what a procedure involves from the patient’s point of view, what the alternatives are, and what the pros and cons of the various options are. The patient has to give their informed consent before any treatment is started.

 

If the patient needs more time to make the decision, for example, because they need to think it over or they want to read up more on suggested options, this should be accommodated.

 

Many dental professionals use the Tell-Show-Do technique with patients with anxiety.  This technique involves telling the patient about the procedure, showing them the tools they are going to use, and demonstrating the procedure beforehand.  Many people fear a loss of control like being informed in this way. It removes the element of unpredictability which many people dread. 

 

Some individuals are less anxious with their eyes closed so they don’t have to see the instruments.  If they still prefer to know the procedure a dentist can perform a demonstration on their hand without them needing to see the tool. 

 

A stop signal is a signal that a patient and dental professional has agreed upon which will signal the professional that the patient needs a break.  Some examples of stop signals include:

 

  • Raised arm
  • Raised leg
  • Devise that emits a noise such as a dog clicker/noisemaker

 

Stop signals must be followed by the dentist or hygienist or trust will be damaged. Also, the patient must be able to give the stop signal when needed.  Some individuals will get too fearful to be able to make the motion. Another really useful strategy is called structured time.  It involves talking with the patient to first determine the likely length of treatment and agree to take breaks at fixed intervals (for example, 5 minutes). This way the patient does not suffer in silence afraid to interrupt.  This is a great way of establishing trust.

 

 

Sedation:

 A patient may find treatment easier if they have some form of sedation. This relieves anxiety and helps them to relax. The patient will still be awake but will probably not be able to remember much about the procedure afterward. There are three main types of sedation used in dentistry.

 

 

Oral sedation

The dentist may prescribe medicine, such as temazepam or diazepam, to help reduce anxiety. The patient will take this as a tablet, usually about an hour or two before the appointment. The patient must take these medicines exactly as directed by the dentist.

 

Inhalation sedation

This is also known as ‘gas and air. It’s a mixture of nitrous oxide and oxygen. The patient breathes it in through a mask placed over the nose. The patient should be able to understand what the dentist or hygienist is saying throughout the treatment, but the sedation should reduce the anxiety.

When the treatment is finished, the sedation will wear off after a few deep breaths and the gases will soon leave the body. However, the patient may be asked to stay in the clinic for up to 30 minutes for the effects of the sedation to wear off fully.

 

Intravenous sedation

If a patient has intravenous sedation, a medicine will be injected through a fine plastic tube (cannula) into a vein (usually on the back of the hand). The medicine will make the patient feel relaxed, but they will still be able to talk and listen to the dentist (although they may not remember any of it afterward).

In this situation, the patient should have someone accompany them to and from the dental appointment. Sedation temporarily affects coordination and reasoning skills, so they must not drive, drink alcohol, operate machinery, or sign legal documents for 24 hours afterward.

 

General anesthesia

Occasionally, people who have severe dental phobia, young children, and people with special needs may need general anesthesia in a hospital to have dental treatment. However, all possible alternatives should be explored first.

 

 
Distraction Techniques:

A patient may find that distracting their attention away from the dental treatment helps them to relax.

For example, they may like to try:

  • listening to music or audiobooks
  • watching a video or DVD 
  • concentrating on relaxing each part of their body in turn
  • thinking about something they’re looking forward to

 

 

Cognitive Behavioral Therapy:

 Behavioral psychotherapists can teach patients ways to reduce their anxiety with Cognitive Behavioral Therapy. Regular meetings and exercises can help them to change the way they feel about something they’re scared of.

 

Sometimes it is the little things that make the difference.  Try to look at the situation from the patient’s point of view.  Arriving for a first appointment and having to sit around for ages waiting is every nervous patient’s nightmare. So if possible set up your practice systems so that new patients coming to see you who are nervous are identified in advance and wherever possible offer a time slot where you are most likely to be on time. For example, the first appointment of the day, after a break, or after lunch.

 

It is true that you only get one chance to make a good first impression. There are many ways of doing this including simply walking out to your waiting room, introducing yourself to your patient, and making polite chats on the way to the dental chair.

 

You need to listen harder than ever before to the patient as they tell you their story, in it will be all the clues you need to help them, their fears, their triggers, and what things you need to find a way around to stop from scaring them half to death. By asking questions you are showing that you are interested in what the patient has to say and as such are more likely to act on it. Resist the temptation to jump in with solutions as they come to mind, just take notes and let the patient talk out all of their fears.

 

Finally, recognize that working with nervous patients who have recently joined your practice can be seriously hard work. But, like so many things in life, by giving first without expecting to receive, you will be pleasantly surprised when your early efforts are repaid. And if you help a patient overcome their fear you have a patient for life and someone very likely to tell their friends about your care.

 

Every nervous patient must receive her very best efforts. It is truly wonderful to see the personal growth that often follows when someone resolves a long-standing dental fear.

 

Communication and Support:

 

Before any strategy can be employed, the dental professional and patient need to communicate.  Sometimes an initial visit can consist solely of an interview to ask questions and get to know the office staff and environment.  Items to discuss can include

 

Timing

Letting the patient know that you will go at their pace.  For example, the patient might choose to just have an examination at their first appointment, or even just sit in a chair. Once the first stage doesn’t frighten them anymore, you can move on to the next. This way they may be able to overcome their anxiety gradually.

 

Control

Talk to the patient about the fact that they have control over the amount of treatment they’re getting. They mustn’t feel pushed further or faster than they can cope with. They may feel more in control if they have a signal (raising their hand, for example) that lets you know that they would like you to stop.

 

Specific concerns

If there are particular things that they are worried about, or if they have had a traumatic experience in the past this allows them to discuss this without being in the dental chair already feeling vulnerable.

 

Choice

Several treatment options may help them to relax. Explain which options may be most suitable for them.

 

 

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