TYPES OF DENTAL FEAR: ETIOLOGY AND SIGNIFICANCE
Despite advances in technology that make dental procedures much more comfortable than in the past, the incidence of dental fear remains fairly stable. Dental fear remains one of the most challenging problems facing dentists and their staff. Various studies have reported that the prevalence of dental fear ranges from 4 to 20% in the general population of industrialized nations (Tellez et al., 2015; White et al., 2017). Dental fear has been reported as being more prevalent among women than men (Fallea et al., 2016; Stenebrand et al., 2016), and younger individuals report more dental fear than older persons (Appukuttan et al., 2015). Oyekunle and colleagues (2016) report that 4 to 30% of the population worldwide experiences fears related to dentistry. These discrepancies can be attributed to different study criteria and assessment techniques. Regardless of the exact numbers, dental fear is a significant barrier to improving oral health worldwide. Dental fear causes many individuals to avoid seeking dental care or seeking it only in case Anxiety and dental fear The terms anxiety and dental fear are used interchangeably by many investigators. Although these conditions frequently overlap, some authorities make a distinction between the two (Appukuttan, 2016; Wiener, 2015). Dental anxiety is often the result of a prior traumatic dental experience or is learned from a friend, parent, relative, or the media. Anxious patients anticipate a nonspecific negative event. Unlike anxious patients, individuals suffering from dental fear do not necessarily anticipate an unpleasant experience. Their fear occurs at the moment of a painful or undesirable stimulus. This elicits a “fight or flight” response. Unlike dental anxiety, the reaction of an individual suffering from dental fear is often quickly resolved and dissipated. Patients report a variety of fears and sources of dental anxiety. These include fear of the following: ● Pain or discomfort. ● Needles and injections. ● Gagging or choking. Dental phobia Dental phobia resembles dental anxiety and fear in many respects but involves a much greater avoidance response. Correctly assessing the number of phobic patients is difficult because many of them never seek dental care. It is estimated that dental phobia affects 5 to 10% of the adult population (Singh et al., 2015). Phobic dental patients are usually seen in dental practices only in cases of extreme emergency. They cannot face a dental environment and avoid dental care at all costs. For these individuals, any thought connected to dentistry is terrifying. Trying to talk a truly phobic patient out of their phobia is futile. Characteristics of a phobic patient may include: Recognizing the fearful patient The simplest way to find out if a patient is fearful is just to ask the patient (Armfield, 2016). In addition to discussing the topic directly with the patient, practitioners may also use any of a number of patient assessment questionnaires and scales that measure self-reported fear and anxiety. One quick and easy questionnaire is Corah’s Dental Anxiety Scale (Pocket Dentistry, 2016). It consists of four questions, each having a selection of five responses. A high score indicates high anxiety. Other available questionnaires include the following: ● Dental Fear Survey for adults (20 items). ● Modified Child Dental Anxiety Scale for children (8 items). ● Index of Dental Anxiety and Fear for adults (8 assessment items plus 10 stimulus items). (Armfield, 2016) If dentists can identify anxious patients before dental treatment, they can anticipate the behavior and use specific management techniques that will help alleviate their patient’s anxiety (Suhani et al., 2016). Anxiety scores are rarely used in general practice (Suhani et al., 2016), and their use is limited primarily to research studies. Dentists may fear that asking patients to report their dental fears and previous negative dental experiences
of dire emergency (Appukuttan, 2016; Wiener, 2015). Avoidance of or infrequent dental care results in more complex oral health problems and pain for the patient, followed by even more fear and increasingly expensive treatments. A vicious cycle of increasing pain and fear is thus established (Appukuttan, 2016; Wiener, 2015). Fearful patients may be ashamed of their fears and may also be embarrassed by the appearance of their teeth. It is not surprising that studies show that very anxious or fearful patients suffer from impaired oral health-related quality of life (Rosehill, 2020). Coping with a fearful patient presents a challenge for every member of the dental team. Such incidents can disrupt schedules, lead to failed treatment, and cause a great deal of stress for everyone concerned, including the patient, the dentist, and the dental staff (Al Atram et al., 2016). ● Loss of control. ● Dental staff being in their personal space. ● Blood. ● Being judged or ridiculed. (Appukuttan, 2016; Clay, 2016; Pocket Dentistry, 2016; Singh et al., 2015) Oyekunle and colleagues (2016) also cite other factors that can contribute to a patient’s overall state of dental anxiety, namely, the perceived negative attitude of the dental staff, prior traumatic dental experiences, and the influence of friends and family who also have dental fear or anxiety. Because anxious patients are very sensitive to the sights, sounds, and smells associated with a dental office, needles and syringes and other threatening-looking instruments are best kept out of sight in the operatory (Rosehill, 2020). Staring at a syringe while waiting for the dentist to enter the room can be very unnerving.
● A highly developed avoidance response. ● Inability to explain the reaction. ● Embarrassment and shame. ● Fear of ridicule. ● Additional phobias.
Patients’ additional phobias may include fear of closed spaces, flying, spiders, or heights. In one study that examined general fearfulness and anxiety in adolescents, general fearfulness was found to be moderately to strongly correlated with dental anxiety (Doganer et al., 2017). may heighten their anxiety. However, according to a study of anxious individuals, completion of a brief dental anxiety questionnaire had no significant effect on patients’ state of anxiety (Appukuttan, 2016; White et al., 2017). Occasionally, fearful patients may claim to have no fear yet at the same time be tensing their body, gripping the armrests tightly with white knuckles showing (Appukuttan, 2016). It would therefore seem that even without the benefit of patient-reported dental anxiety, close observation by the dentist provides the best clues to the patient’s state of mind. Dental team members should be attentive to signs and symptoms of anxiety. Common signs while in the waiting room include the following: ● Fidgeting.
● Sitting on the edge of the chair. ● Changing positions frequently. ● Wandering around the waiting room. ● Startling easily. ● Sighing or breathing heavily. ● Talking loudly.
EliteLearning.com/Dental
Page 183
Powered by FlippingBook