Dental Anxiety & Non-Pharmacological Interventions PDF

Dental anxiety & Non- pharmacological interventions  Dental anxiety = emotional Dental fear = a Dental phobia = stronger, state that precedes a dental reaction to persistent and intense fear, encounter or dental rel...

Dental anxiety & Non- pharmacological interventions  Dental anxiety = emotional Dental fear = a Dental phobia = stronger, state that precedes a dental reaction to persistent and intense fear, encounter or dental related threatening stimuli an extreme form of dental threatening stimuli, it can range in dental anxiety and recognised as a from mild to severe and be situations, fight or condition that can be related to specific or general flight responses. diagnosed and managed. situations. Impacts: Dental anxiety components Avoid attendance Physiological Poorer oral hygiene How the body changes Increased caries/perio risk Dental anxiety is common Increased heart rate, Reduced quality of life and affects all ages. sweating, palpitations, Increased treatment need Females are more likely nausea, muscle tension, to be dental phobic. raised blood pressure. * Behavioural Cognitive What we do How and what we Avoid dental care, cancel visits last minute, reduce time in dental chair, gre think Thoughts about situation, reduced concentration, meticulous oral hygiene to poor memory avoid treatment Origins of dental anxiety Personal: Social: Negative or traumatic experiences Family members and friends experiences Triggers (sounds, sights, feelings) Worries about cost of care Loss of control Social circumstances Coping abilities Negative media perceptions Medical history  Signs of dental anxiety Physiological Behavioural Cognitive Observe patient for signs Posture Irritations Outbursts even when you greet them in Sweating Panicky Worrying reception. Pulse Avoidance Asking questions Cleaning throat Excessive talking Breathing Measuring dental anxiety Modified dental anxiety score (MDAS) — Adults Visual analogue scale (VAS) — Children Ask each patient (Intended for patients who may be anxious or showing signs of dental anxiety). verbally if they are anxious. MDAS Asks patients to rate their levels of anxiety from 1-5 for 5 aspects of dental care (1=not anxious, 5=extremely anxious) How they feel about treatment tomorrow How they feel in waiting room Low = 5 — 9 How they feel about getting teeth drilled How they feel about getting teeth scaled and polished Moderate = 10 — 18 How they feel about local anaesthetic injections Scored are added up for the 5 aspects and overall score is used to determine overall anxiety. High = 19+ How to manage dental anxiety Pharmacological = anaesthesia, conscious sedation, medication-analgesia (Referral required unless you have additional skills). Non-pharmacological = communication skills, behaviour modification, psychotherapeutics (CBT) (Referral for CBT required). Pharmacological interventions General anesthesia Conscious sedation (inhalation or intravenous) Medication for pain management/relaxation Referral to specialist Eastman services Special care dentistry — anxiety management Clinical psychologists — pain management Non-pharmacological interventions Memory reconstruction Patients often recall negative aspects when feeling anxious Help patients recall positive aspects and how they managed Examples: images of smiling, remember positive feelings/aspects. Environmental change Smells, sounds and visuals to decrease anxiety Change of environment to create a more pleasant environment Examples: soothing muscle, positive imagery. Provision of preparatory information Patients with moderate anxiety levels can benefit from information Tailored to patients needs Do not overload them Examples: information about procedure, sensations to expect, behaviours to help, music for distraction. Cognitive behavioural therapy (CBT) Required referral Common strategy used Brief psychological intervention aiming to modify maladaptive beliefs and behaviours Combination of thoughts, feelings and behaviours Examples: gradually exposed to fearful situations/objects over time. Flow chart for the outline of approaches for management of dental anxiety. Non-pharmacological interventions (NPIs) are used to Manage behaviour Instil positive attitudes towards oral health care and behaviours Improve oral health Reduce anxiety Manage pain Talk Demonstrate TELL SHOW DO Action Explain Model Communication skills Open questions, affirmations, reflections, summaries Non-verbal skills (body language) Language/terms used (age and patient appropriate) Tone of voice Every patient is different and not all With children and special needs patients interventions will be Important to get patient’s parent/carer involved appropriate May be able to help with managing difficult behaviour OR may become hindrance. Distraction Help shift patients focus from something unpleasant to something or somewhere else more pleasant. Guided imagery — visual distraction. Listen to music. Relaxation Important to have a conversation with the Guided breathing techniques. patient to find out what Guide patient to take 5 deep breaths. works for them. Listen to music Positive reinforcement Acknowledge appropriate behaviour, increases it being repeated. (Super, excellent, well done) Ignore inappropriate behaviour to not draw attention to it, discourages it being repeated. Tone of voice. Body language. Encouragement. Combination of techniques are used Enhancing control and adapted to patients needs Using signals and signs for control. (Stop sign) Important to give patients back some control during a dental visit. Rehearse this to gain patients trust. Don’t ignore it! Think about what you say and how Modelling you say it Leaning by observation of someone important to them. (Family, tv) Watch videos, reading leaflet prior to dental visit. When to use NPIs? Structured time Children Special needs Tolerance can increase if they know realistically how long it will take. Dentally anxious 5 seconds count down. Explain procedures Appropriate to patients development. Make sure you stick to it.