Anxiety in Dental Care GN PDF

Anxiety in Dental Care Intended learning outcomes A"er this session students should be able to:  Recognise signs of dental anxiety and describe its impact  Acknowledge sources/origins (ae>ology) of anxiety and fear  Describe methods to assess dental anxiety  Outline management strategies fo...

Anxiety in Dental Care Intended learning outcomes A"er this session students should be able to:  Recognise signs of dental anxiety and describe its impact  Acknowledge sources/origins (ae>ology) of anxiety and fear  Describe methods to assess dental anxiety  Outline management strategies for dental anxiety 2 Assessment Forma>ve  Discussion on moodle  Pa>ent care Summa>ve  Clinical prac>ce record Future  EHec>ve clinical prac>ce and pa>ent care 3 DeIni>ons, prevalence and impact CONTEXT 4 De;nional state (feelings of apprehension, uneasiness or dread) that precedes a dental encounter or dental- related threatening s>muli, it can range from mild to severe and be related to speciIc or general situa>ons.  Dental fear – a reac>on to threatening s>muli in dental situa>ons – Ight or Night responses.  Dental phobia – stronger, persistent and intense fear, an extreme form of dental anxiety and recognized as a condi>on that can be diagnosed and managed. O"en the terms dental fear and dental anxiety are used interchangeably and relate closely to each other. 5  May be one, two or all of these components Dental anxiety components They make up dental anxiety  Physiological – how the body changes  Increased heart rate, swea>ng, raised blood pressure, palpita>ons, nausea, muscle tension Physiological  Behavioural – what we do  Avoid dental care, cancel visits last minute, reduce >me in dental chair, me>culous oral hygiene to avoid care  Cognion, reduced concentra>on, poor memory 6  12 Prevalence of dental anxiety % ext Adult dental health survey 2009 was the Irst >me dental anxiety was measured. Included a re sample of the popula>on using the Modi;ed me Dental Anxiety Score:  No to low levels of anxiety = score 5-9 an  Moderate anxiety levels = score 10-18 36% xie  Extreme anxiety levels =score 19+ moderate ty anxiety Dental anxiety is common, it aHects all ages, with females likely to be dental phobic. 51% no or low anxiety 7  Origins of dental anxiety Dental anxiety is mul>-factorial and can include factors related to: Personal:  Nega>ve or trauma>c experiences (especially in childhood)  Triggers – sounds (of the drill, screams), sights (of the injec>on), smells (materials, infec>on), feelings (of numbness, vibra>ons)  Loss of control  Coping abili>es  Medical history Social:  Family members or friends' experiences  Cost of care or worries about costs  Social circumstances  Nega>ve media percep>ons Extract demonstrating negative media headlines related to dentistry. Source: Daily8 Impact of dental anxiety on oral health Avoid Associations attendance not causations Increased Poorer oral treatment health… need Oral health Remember the vicious cycle of dental fear impacts (Armfield et al 2007) – delay visit, dental problem, symptom driven Reduced Higher treatment reinforces quality of caries dental fear. life rates 9 Signs and assessment HOW TO IDENTIFY AND MEASURE? 10  Signs of dental anxiety Think about how anxiety may present.. Appuku^an D. P. (2016) iden>Ied in a literature review these signs: Physiologica  Behaviour – irrita>on, panicky, l  Emo>ons – outbursts, worrying,  Psychophysiological – posture, swea>ng, pulse, clearing throat, breathing  ….everyone is diHerent Behaviour Cognitive (emotions) (emotions) Observe your pa>ent for signs even when you greet them in the recep>on area. 11  Measures of dental anxiety The most suitable and accepted tools:  Modi;ed Dental Anxiety Score (MDAS) is a valid and reliable measurement tool (Humphris et al 1995, 2006)  Visual Analogue Scale (VAS) is a modiIed version for children (Wong et al 1998) These are intended for use with paent is asked verbally whether they are anxious about visi>ng the den>st. The MDAS is eSecents to rate their level of anxiety from 1 (not anxious) to 5 (extremely anxious) for 5 aspects of dental care in the boxes below: 1 Not anxious 2 Slightly anxious 3 Fairly anxious 4 Very anxious 5 Extremely anxious Teeth scaled Local Treatment Waiting Tooth drilled and anaesthetic tomorrow room polished injection 13  Modi;ed Dental Anxiety Score (MDAS) Scores are added up to determine level of anxiety: High 19+ Moderate Low 5-9 10-18 14 MDAS (le") VAS (right) Source: SCDEP 15 Strategies and referral HOW TO MANAGE? 16 Intervenve imagery  … Remember the video clip from Finding Nemo shown in Non-pharmacological interventions lecture reYecting the Source: https://www.publicdomainpictures.net/pictures/100000/velka/lavender- environment. Weld.jpg 20 Provision of preparatory informaents with moderate levels of anxiety can beneIt from informa>on about:  Procedure  Sensa>ons to expect  Behaviours to help Should be tailored to pa>ents' needs. Extract from a pa>ent informa>on leaNet for Intranasal Seda>on Dental treatment at the RNENTED. Source: ULCH intranet 21 Cognion combining behavioural and cogni>ve therapy aiming to modify maldap>ve beliefs and behaviours. It uses systema>c desensi>za>on where Thoughts pa>ents are gradually exposed to fearful situa>ons or objects from least to most over Behaviours >me, o"en 6-10 sessions. Referral to GP, dental psychological services or clinician with specialist training. 22 Pharmacological intervenon – inhala>on or intravenous  Medica>on prescrip>ons for pain management or relaxa>on Extract from a pa>ent informa>on leaNet for Intravenous Sedang a canula. Source: ULCH intranet 23  Services at the RNENT&EDH Special Care Denents with anxiety for management Clinical psychologists:  Facial pain service  Pain management Extract from patient information leaYet. Source: UCLH website 24  NHS Dental Psychology Service - Referral https://www.guysandstthomas.nhs.uk/our- services/dental-psychology-service/ overview.aspx 25 Summary Definitions, prevalence and Signs and aetiology impact Dental Anxiety Identification and Management measurement strategies 26  References  Appuku^an D. P. (2016). Strategies to manage pa>ents with dental anxiety and dental phobia: literature review. Clinical, cosme-c and inves-ga-onal den-stry, 8, 35–50. h^ps://doi.org/10.2147/CCIDE.S63626  ArmIeld JM, Stewart JF, Spencer AJ. The vicious cycle of dental fear: exploring the interplay between oral health, service u>liza>on and dental fear. BMC Oral Health. 2007 Jan 14;7:1. doi: 10.1186/1472-6831-7-1. PMID: 17222356; PMCID: PMC1784087.  SCDEP Guidance Oral Health Assessment and Review Version 1, 2012, available online: h^ps://www.sdcep.org.uk/published-guidance/oral-health-assessment/  h^ps://Iles.digital.nhs.uk/publica>onimport/pub01xxx/pub01086/adul-dent-heal-surv-summ-them-the8-2009-re10.pdf  Hakeberg M, Wide U. General and oral health problems among adults with focus on dentally anxious individuals. Int Dent J. 2018 Dec;68(6):405-410. doi: 10.1111/idj.12400. Epub 2018 Apr 11. PMID: 29638007.  Heidari, E., Banerjee, A. & Newton, J. Oral health status of non-phobic and dentally phobic individuals; a secondary analysis of the 2009 Adult Dental Health Survey. Br Dent J 219, E9 (2015). h^ps://doi.org/10.1038/sj.bdj.2015.853  Newton T, Asimakopoulou K, Daly B, Scambler S, Sco^ S. The management of dental anxiety: >me for a sense of propor>on? Br Dent J. 2012 Sep;213(6):271-4. doi: 10.1038/sj.bdj.2012.830. PMID: 22996472. 27