Dental fear and anxiety Flashcards Preview

BDS2 Paediatric dentistry > Dental fear and anxiety > Flashcards

Flashcards in Dental fear and anxiety Deck (36)
Loading 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 e.g. use of drill or to the dental situation in general


What is required for a diagnosis of dental phobia

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


What is the UK prevelence of dental anxiety

11.6% adults, 4 times greater in 18-39 years old v 60+


Describe the cycle of dental fear and anxiety

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


A good thing to say to a dentally anxious patient

'we're going to take this step by step'


What causes 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 3 pathways identified which make children dentally anxious

- arising from objective dental pathology and subjective dental experiences.

- children's imitation of mother's behaviour

- unwitting provision of frightening info
- absorbing mother's attitudes to dentistry


Characteristics of the anxious

- high neuroticism and trait anxiety
- pessimism and negative expectation
- proneness to somatisation (manifestation of psychological distress by the presentation of physical symptoms)
- low pain threshold (they are expecting pain)
- co-morbid anxiety disorders
- co-morbid depressive disorders
- fear of negative evaluation
- pessimistic and vulnerable
- catastrophic
- over-inclusive negativity
- worry as a habit


What are examples of anxious and neurotic thinking

- fear of negative evaluation
- pessimistic and vulnerable
- catastrophic
- over-inclusive negativity "life is a disaster/ failure/ pointless etc"
- worry as a habit


How do a patients negative thoughts impact their memories of treatment experience

inaccurate memories
benign experiences are recalled negatively


what are the 3 provoking factors to fear/ avoidance/safety-seeking/ anticipating disaster

bad experience
high neuroticism
depression and anxiety


what are the 3 maintaining factors to fear/ avoidance/safety-seeking/ anticipating disaster

selective memory and attention
high neuroticism
biased judgement


how is dental anxiety assessed in adults

The modified dental anxiety scale (MDAS) and the DAS-R


what is the diagnostic cut off for the MDAS



how is dental anxiety assessed in children

picture tests (for young children and adolescents)

child experience of dental anxiety measure (CEDAM) for age 9-16

modified child dental anxiety scale (faces version) MCDASf for age 8-16


What are the treatment strategies for Mild/moderate dental anxiety

1. general attitude and the application of a general anxiety reducing treatment style

2. pharmachological support

3. teach coping strategies


What should the general attitude and application of a general anxiety reducing treatment style be like?

explain the 'fight and flight' (how they can take control)
- acknoledge patient's anxiety
- build trusting relationship
- give realistic information
- provide control e.g. agreed stop signal
- provide high level of predictability (tell them at the start what you're planning on doing and introduce the next appointment the same day)


What pharmachological support can be used for treatment

nitrous oxide sedation (if necessary liaise with GMP regarding prescribing oral sedation prior to treatment)


what coping strategies can be taught

relaxation and distraction


What control signals can be used by the patient

Stop signals - gives control over the pace of the procedure

Rest signals - allows the patient to stop with the understanding that the treatment is not finished yet

Proceed signals - just as important

Provide options e.g. which tooth will we restore first?


An example of a relaxation exercise

breathe in for 2 and out for 3 - helps lower tongue in place too


How effective is music at relaxing a patient

not effective with children
effective with adults


What ways can someone distract themselves

- think pleasant and relaxing thoughts
- do puzzles in their head (anagrams/ number games)
- think of 5 things which makes them happy


What are the behavioural treatment strategies for mod/severe dental anxiety/phobia

exposure-based treatment programme e.g. systematic desensitisation:
- trained in relaxation
- then encouraged to expose themselves to a hierarchy of fearful situations
(can be individual or group setting using imagined, video, computer based or real life confrontation)

For more complex cases, treatment could be carried out by a clinical psychologist in close cooperation with dentist


What is the fear hierarchy

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


What is involved in simple desensitisation

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


What are cognitive treatment strategies

- using pleasant and positive imagery
- identifying challenging and modifying negative and unhelpful thoughts and replacing these with more positive and realistic thoughts
- use of coping statements e.g. I can and I will


How could you challenge evidence supporting negative thoughts

e.g. Belief: I have never coped well with pain and am prone to fail

What about when your child was born
What about your marriage
How are you enjoying your work