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Anxious or a Fearful Dental patient

DENTAL PHOBIAAnxious or a Fearful Dental patient

Assistant Professor Dr.Muhammad Adeel BDS,RDS,MCPS(Oral Surgery)Dip.Implant

Objectives:Nature and scope of problemWhat is dental phobia?Characteristics of dental phobiaEtiology of dental phobiaHow to recognize and diagnose dental phobia?Interviewing the Fearful PatientDelivery of Care to the Fearful Patient.

Nature and scope of problem

Fear of the dentist is a common phenomenon and is universally recognized.

Impacts of Dental phobiaImpacts on societyPatients who delay having dental treatment because of their fear, the consequences can be unnecessary pain and suffering.Society then pays through lost workdays and diminished productivity of its members.Impacts on dental team14% of the public report canceling or failing to appear for dental appointments because of fear.The cost of missed or unfilled appointments becomes a financial issue for the dentistImpacts on the patientphysical and psychological effectsemotional tollDifficulty in making well-reasoned treatment decisions

What is phobia?

PhobiaA persistent, irritational fear of a specific object, activity or situation that leads to a compelling desire to avoid it.

What is dental phobia?

Dental phobia is defined as an unpleasant mental, emotional, or physiologic sensation derived from a specific dental related stimulus.

Characteristics of Dental Phobia

Before discussing the characteristics of dental phobia, lets understand the following terminologies:

Anxiety:Anxiety is both a physical and emotional response to an anticipated experience that the individual perceives as threatening in some way.

Fear:Fear is an emotional response to a genuine threat or danger.

Phobia:When the fear of a particular stimulus dominates the indiviuals life, it is described as a phobia.

Etiology of dental fear is complex and multifactorial.

Dental fear may appear at any age, current data suggest that most fears begin in the preteen years.patients younger than 40 years of age are more fearful than those who are over 40.no differences among socioeconomic groups or racial/ethnic groups have been demonstratedFemales are more fearful than males.

Etiology of dental phobia

Bad experience

History of abuse

Uncaring dentist

Vicarious learning

Post-Traumatic Stress

Humiliation

Etiology of dental phobia

How to recognize a patient with dental anxiety or phobia?FEAR

ACTIVATES

SYMPATHETIC NERVOUS SYSTEMPRODUCING EPINEPHRINE

DILATED PUPILINCREASED HEART RATEINCREASED BLOOD PRESSUREINCREASED RESPIRATORY RATE

Interviewing the Fearful Patient

Kleinknechts Dental Fear Survey consists of 20items, has good psychometric properties, can be completed in less than 10 minutes in the waiting room, and can be quickly scored and interpreted.

Other includes,

Corah Anxiety ScaleIowa Dental Control Index

Incorrect position for interviewing a patientCorrect position when conducting a patient interview.

Different Phobias related to dentistry:FEAR OF UNKNOWN

FEAR OF DENTAL PROCEDURES

SENSITIVE GAG REFLEX

FEAR OF LOUD NOISE

Feeling Uncomfortable Lying Back In A Dentist's Chair

UNABLE TO BREATHE THROUGH NOSE

Fear of pain

Fear of unknownIt is a phenomenon in which with patients do not wish to accept or meet with anything unfamiliar in terms of any situation.How to overcome:-In such patients first visit counseling and tell show do technique is advised.

FEAR OF DENTAL PROCEDURES

Sensitive gag reflex

People with a sensitive gag reflex may loathe the part of the dentist's visit where those tabs are put in the mouth for the dental X-ray. These days, newer dentist offices offer panoramic X-rays.

Fear of loud noise

Dental tools can be really loud, and the noise can stir up fear in some people.

HOW TO OVERCOME :-

Wear EarplugsNoise cancelling head plugs to block out sound.

Feeling Uncomfortable Lying Back In A Dentist's Chair

Some people may be uncomfortable with something as simple as lying back in the dentist's chair, due to a bad back or some control issues.

HOW TO OVERCOME:A simple remedy may be for the dentist to only put the patient half-back so that it's more comfortable or can provide with supporting pillows.

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Unable To Breathe Through The Nose

Mouth breathers have phobia that they wont be able to breathe during their dental treatment.

How to overcome :-

Nasal strips to help them breathe

Nitrous oxide to relax the patient

Fear due to previous bad experiences

Previous bad experience.Heard of bad experiences from family or friends. 50-80% of dental fear and anxiety happens during childhood/ adolescence.

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Delivery of Care to the Fearful Patient.

Distraction:Music is a common distraction technique for use in the dental office. Some dentists provide individual headsets that allow patients to select the music of their choice.Relaxation:Deep breathing exercises help to reduce this unwanted stress and consist of as little as 2 to 4 minutes of breathing deeply in, holding the breath and then exhaling completely.Hypnosis and Guided Imagery:Hypnosis is a guided, self-controlled state of mind in which concentration and focus are directed inward.During guided imagery, the patient achieves an altered state similar to daydreaming or focused attention.Pharmacologic Intervention:Conscious sedationDeep sedationGeneral anesthetic

Tips to Remove the Dental PhobiaYou should discuss your fears with your dentist therefore, he/she will determine the best ways to prevent your uneasiness and feel more comfortable. If the dentist doesnt handle your fear seriously, you should go to another dentist. You should actively participate with your dentist, explaining all the possible outcome on every stage of the procedure therefore, you will avoid nervousness or fear, because youll be much prepared for the results. Another alternative solution if you lack control during the surgery, you need to give a signal like raising your hand when you want the dentist to stop asap. Every time you feel uneasiness, need to rinse your mouth or to catch your breath, you must use this signal.