Many patients only visit the dentist for emergency situations or when the pain of a dental problem becomes so severe that they can't stand it anymore. Why don't these people seek treatment when they first notice the symptoms? Why aren't they scheduling routine maintenance visits?
Some people can't face dental treatment because it terrifies them. They would rather live with the pain or poor esthetics caused by lack of dental care. A study by Dr. Scott in 1984, shows that dental fear affects as much as eighty percent of the United States population to some degree. Current data shows that up to twenty-percent of those needing dental care avoid the dentist due to fear and anxiety. In fact, dental phobias are one of the most common types of phobias around the world.
Many of those patients experiencing dental phobia seek a referral for IV sedation or general anesthesia for dental procedures, but does sedation really help the patient overcome his or her fears? Many experts agree that medication for sedation will only propagate the cycle of emergency treatment and avoidance of routine care. (Kroeger 1988)
Additionally, dental professionals agree that anxious patients can be difficult to manage and treat. In addition to taking up to twenty-percent more appointment time (Jepsen 1992), the anxious patient is more likely to be late and three times more likely than any other patient to not show up for their appointment at all (Mendola 1991). Many dental professionals experience feelings of frustration or inadequacy leading to increased stress when treating anxious patients (Glassman 1993). While treating an anxious patient can be difficult, exceptional care may lead to more referrals for the dental office that is willing to take the time to treat the patient's anxiety.
The key to treating patients who experience dental fear and anxiety lies in a concept as simple as compassion. In addition to common techniques that can ease pain during dental procedures, this manual will provide helpful assessment techniques and revisit the idea of a compassionate and caring dental team.
Fear is a learned reaction characterized by physiological symptoms such as quickened heart rate, nausea, sweating, muscular tension, and increased respiration. The response is initiated by a real or imagined threat to one's safety. The patient poises in a fight or flight stance ready to either escape the stimulus or stand and defeat it.
Anxiety is a different type of disturbed emotional state. Usually associated with dangerous or unpredictable situations, the physiological symptoms include sweating, increased heart rate, pounding chest, dry mouth, diarrhea, muscle tension, and hyperventilation. The patient may have a sense of impending doom. Unlike fear, where the source is easily identifiable, when a patient is questioned about the stimulus for anxiety, the source is not easily identifiable.
Phobia is an irrational fear reaction. It is excessive, persistent, and exaggerated. The physiological reactions are the same as anxiety, but the phobic state is beyond conscious control. Reason or explanation cannot comfort the phobic. Often a dental phobic feels as though no one understands his or her problem. They are usually embarrassed and ashamed of their fears and may be concerned that they are mentally unstable.
Pain is an anatomical and physiological reaction to a stimulus. The thoughts and emotions of the patient as well as previous experiences, expectations, and distractions can influence the patient’s perception of pain. The physiological and emotional symptoms are very similar to those of anxiety. Often anxiety and pain occur at the same time.