Have a visit due to your dentist that you have
been avoiding for a long time? Is there a general sense of fear associated with
that dental chair and the various sounds and noises it produces? Do not worry.
You are not the only one. The idea of going to a dentist can cause as much
anxiety as the pain that a decayed tooth may be causing. The responses are not
age related. Different people could have different reactions dealing with
dental anxiety. Some may be calm and composed and some may be total wrecks. A
lot depends on the dentist and the environment he/ she creates for the
patients. Understanding the patients and their levels of anxiety could be
crucial in assessing their levels of anxiety and help them overcome it.
Assessment of dental anxiety
There are numerous ways
available to assess dental anxiety, both in children and adults. A five point
scale that is reliable and quick to administer. It has cut-offs for mild,
moderate, and phobic levels of anxiety.
Interventions for individuals with low levels
of anxiety
For children attending with low levels of
dental fear, approaches that can be adopted include:
· Rapport building: like use of a magic trick. The
use of magic trick increases cooperation when compared to no intervention or
the use of tell-show-do technique.
· Voice control: using loud voice with deep tone
is more effective in reducing disruptive behavior of a child & interaction
more pleasurable than the normal voice level
· Distraction: there are number of ways which can
be used for distraction such as: the use of video-taped cartoons, audio-taped
stories and video games. Distraction techniques are equally effective as relaxation-based
techniques, and superior to no intervention.
· Modeling: modeling has been used extensively
with children and is generally most effective if the observed child is similar
in age, gender and level of dental anxiety to the child watching, if the child
enters and leaves the surgery without adverse consequences.
· Environmental change: three studies have sought
to make the dental environment more attractive to children attending the Dental
Surgery.
Approaches can be used in patients with low
dental fear:
· Enhancing the sense of control: One of the most
commonly used techniques to do this is the stop signal. In this patient
can raise the hand and give signal to the dentist.
· Cognitive distraction: the patient is encouraged to think about
something other than the Dental
Clinic in Delhi, be in a happy place or think of a less stress
causing situation.
· Environmental change: soothing smell of lavender
in dental waiting area to reduce the immediate fear of the patient but it will
not reduce the underlying cognitive factor.
Interventions for individuals with moderate
levels of anxiety
Patients with moderate levels of dental anxiety may benefit from
the prior preparatory information.
· Information about what will happen (procedural
information)
· Information about what sensations the individual
will experience (sensory information)
· Information about what the individual can do to
cope with the situation (coping information).
Interventions for individuals with high levels
of anxiety
Pharmacological management
This includes relative
analgesia, conscious sedation and general anesthesia. These management
techniques are not much used but there are ongoing needs for such services when
patient is not regular to visit for treatment or to the point where they are in
severe pain or with compromised oral health
Cognitive behavioral therapy
It is a synthesis of behavior
therapy and cognitive therapy and uses both behavior modification techniques
and cognitive restructuring procedures to change maladaptive beliefs and behaviors. Behavioral
aspects of CBT include learning relaxation skills, conducting mini-experiments
and systematic desensitization. An important principle underlying CBT is its
focus on the 'here and now' as what started a problem is often not the same as
what is keeping it going.
