Lecture 3-4 Dental related fear and anxiety.pdf
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Dental Care-related Fear and Anxiety PART I Dr.Maram Alagla BDS, DScD, Pediatric Dentistry PSAU Outline What is stress What is anxiety Wha...
Dental Care-related Fear and Anxiety PART I Dr.Maram Alagla BDS, DScD, Pediatric Dentistry PSAU Outline What is stress What is anxiety What is fear What is phobia What is dental related anxiety Etiology of dental anxiety Response to dental fear Assessment of dental fear Feeling overwhelmed 2 Stress and Coping Stress – is a state of physiological or psychological strain. Causes: adverse stimuli (physical , mental or emotional, internal or external) Coping – is the response of the individual to stress ( emotionally and physically ) Types of Stress 1. Physical stress (Trauma, over exertion, pollution, illness) 2. Psychological stress (emotional and cognitive stress) 3. Psychosocial stress (Marriage, Relationships, unemployment) 4. Psycho-spiritual stress (a crisis of values, meaning, and purpose) Effect of Stress Prolonged chronic stress and acute stress can result in suppressed immune function, increased susceptibility to infectious and immune-related diseases. Emotional and prolonged stress can also result in hormonal imbalances that further interfere with healthy immune functioning. What is Anxiety ? A cognitively involved emotional response to stimuli associated with previous experiences. Anticipation of future threat, associated with muscle tension or caution or avoidant behavior. 6 What is Fear? A reaction and response to an immediate live threat. Fear is a psychological construct which is not directly observable but may manifest itself through physiological, cognitive and behavioral response which leads to activation of (fight or flight response) 7 What is Phobia? A “phobia” is traditionally defined as a severe fear that leads to avoidance of the feared situation, object or activity. Persistent, unrealistic and intense fear which leads to avoidance. Dental Care-related Fear and Anxiety PART II Dental Anxiety? An emotional response to stimuli or experiences associated with dental treatment. Children > adults (Oosterink et al., 2009) Women > men (Moore et al.,1993; Liddell & Locker, 1997; Doerr et al., 1998; Craske, 2003; Heftet al., 2007) 10 Etiology of Dental Anxiety/ Fear? 1. Exposure to painful or traumatic dental experience. 2. Heightened pain sensitivity./ low pain tolerance 3. Social or observational learning. 4. Cognitive factors (misperceptions, negative thoughts. 5. Patterns of thinking e.g., worries about danger or lack of control. 11 1- Self-reported Measures. Assessment of Dental 2- Physiological Measures. Fear 3- Behavioral Measures. 12 Patients are asked to respond to questions 1- Self-reported or instruction that provide information about Measures. their dental fear and anxiety either by: Questionnaires (Corah’s Dental Anxiety Scale DAS, Modified Dental Anxiety Scale MDAS, Dental Fear Survey DFS) A visual analogue (pictorial) scale to point out the severity of fear. 13 Perspiration on the palms, forehead, or 2- Physiological upper lip Measures Increase in cardiac rate Changes in gastric activity Changes in respiration Muscle tension 14 3- Behavioral Measures o Body movement and speech in the reception area and the clinic. o Canceling or missing appointments. Reducing Dental Fear 1- Introduction to the Clinic Introduce the patient to the clinic. Apply the (TELL-SHOW-DO) technique for young patients. Explain everything you need to do in steps. Do not force any dental treatment, let the patient absorb the situation. D r. E r i c J a c k s o n R u l e s To R e d u c e F e a r If there is any possibility that patients will feel pain, warn them. Don’t inflict pain if it is possible to avoid doing so. Accidental pain should be ceased immediately. Avoid using emotion charged words. If you say something be sure you are correct. D r. E r i c J a c k s o n R u l e s To R e d u c e F e a r Tell patient to signal you to stop working by his hand. Introduce new procedures slowly and gently. Praise desirable behavior, never criticize undesirable behavior. The dental environment should be quiet and relaxed. Interventions for Dental Fear Behavioral Interventions Stimulus control Social praise Behavioral control Exposure therapy Systematic desensitization Modeling Stimulus Control Dental professionals typically keep needles and syringes out of sight before, during, and after treatment and take special care in bringing a syringe toward the face and mouth such that the patient is not able to easily see them. Social Praise Acknowledge appropriate behaviors, or coping behaviors, particularly after a patient undergoes uncomfortable aspects of treatment. Behavioral control Giving the patient opportunities to make decisions before and during treatment, to stop for a break when needed, or to guide certain aspects. Exposure therapy Require that the patient has multiple visits to the clinic before actual treatment may begin. Systematic Desensitization Prompting new conditioning to take place helps patients to learn that stimuli that once evoked fear are not so threatening, and to develop coping abilities that allow them to successfully participate in dental treatment. Systematic Desensitization Paced Respiration Procedure Paced breathing is slowing the breath down purposefully to focus on the length of the breath. Modeling It has been extensively applied to treat fearful disruptive child Patients. Filmed modeling has been shown to be as effective as live Models. Modeling Combined Interventions Success rates of combining modeling and relaxation is around 78% Allow patients to spend some time to be used to the dental setting before undergoing actual treatment. Reference McNeil, D. W., & Randall, C. L. (2014). Behavioral dentistry, chapter 12 Dental fear and anxiety associated with oral health care: conceptual and clinical issues 165-192. Thank you [email protected]
