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DENTAL PHOBIAAnxious or a Fearful Dental patient

Assistant Professor Dr.Muhammad Adeel

BDS,RDS,MCPS(Oral Surgery)Dip.Implant

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Objectives:• Nature and scope of problem• What is dental phobia?• Characteristics of dental phobia• Etiology of dental phobia• How to recognize and diagnose dental phobia?• Interviewing the Fearful Patient• Delivery of Care to the Fearful Patient.

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Nature and scope of problem

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

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Impacts of Dental phobia

• Impacts 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 dentist”• Impacts on the patient• physical and psychological effects• emotional toll• Difficulty in making well-reasoned treatment decisions

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What is phobia?

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

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

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Characteristics of Dental Phobia

Before discussing the characteristics of dental phobia, let’s 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 indiviual’s life, it is described as a phobia.

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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 demonstrated

• Females are more fearful than males.

Etiology of dental phobia

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• Bad experience

• History of abuse

• Uncaring dentist

• Vicarious learning

• Post-Traumatic Stress

• Humiliation

Etiology of dental phobia

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How to recognize a patient with dental anxiety or

phobia?

• FEAR ACTIVATES

SYMPATHETIC NERVOUS SYSTEM

PRODUCING EPINEPHRINE

DILATED PUPIL INCREASED HEART RATE INCREASED BLOOD PRESSURE INCREASED RESPIRATORY

RATE

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Interviewing the Fearful Patient

• Kleinknecht’s 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 Scale• Iowa Dental Control Index

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Incorrect position for interviewing a patient

Correct position when conducting a patient interview.

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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

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Fear of unknown• It 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.

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FEAR OF DENTAL PROCEDURES

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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.

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Fear of loud noise

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

HOW TO OVERCOME :-

Wear Earplugs Noise cancelling head plugs

to block out sound.

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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

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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

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Tips to Remove the Dental Phobia

1. You should discuss your fears with your dentist therefore, he/she will determine the best ways to prevent your uneasiness and feel more comfortable.

2. If the dentist doesn’t handle your fear seriously, you should go to another dentist.

3. 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 you’ll be much prepared for the results.

4. 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.

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