Anxious or Phobic Dental Patients

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Anxious or Phobic Dental Patients

from the Academy of Dental Learning

Table of Contents

Objectives 3

Introduction 4

Definitions 4

The Body's Response To Pain And Fear 6

Gate Control Theory 7


Assessment Techniques 8

The Corah Anxiety Scale17 9

Children 13

The Child’s First Appointment 13

Children’s Fears 14

Behavior 14

Voice Control 15

Tell-Show-Do 15

Restraint 15

Medication 16

Socio-Legal Concerns 16

How Do Dentists Treat Anxious Patients? 17

The Role of the Dental Staff 18

Actions to Avoid 20

Intervention Strategies 22

The Latrosedative Process 22

The Dental Fears Control Program 24

Deep Breathing 26

Modeling 26

Pharmacological Sedation Techniques 28

Referral to a Mental Health Specialist 30

University Dental Fears Clinics 30

Conclusion 31

Test 32

Bibliography and Suggested Reading List 36

This is an Intentionally Blank Page



pon completion of this course, the student should be able to:

  • Define fear, anxiety, phobia, and pain. Describe how they are related.

  • List some of the methods of assessment of dental fear or phobia.

  • Describe the physiological reactions to fear stimuli.

  • List common reasons for patient's fear of dentistry.

  • List some current methods used by dentists to reduce the anxiety of their patients.

  • Describe the role of the dental staff in reducing patient anxiety.

  • List actions that experts recommend avoiding in order to reduce patient anxiety.

  • Describe ways of teaching the patient to relax during dental treatment.

  • Describe some current methods of anesthesia.

  • List the conditions when is it appropriate to refer the patient to a mental health professional or a dental fears treatment clinic associated with a dental school.


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.

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