Dental Fear (Dentophobia): Assessment, Causes, Treatments, Help The Patient

Dental fear, the anxiety, dental and dental phobia are often used interchangeably. We can also say that it is a normal emotional reaction to one or more specific threatening stimuli in the dental situation. However, dental anxiety is indicative of a state of apprehension that something terrible is going to happen about dental treatment and is usually accompanied by a feeling of loss of control.

Similarly, dental phobia denotes a severe type of dental anxiety. It is characterized by marked and persistent pressure about real situations or objects (e.g., drilling, local anesthetic injections) or the dental environment. The term “dental fear and anxiety” is often used to refer to the strong negative feelings associated with dental treatment among children, adolescents, and adults, regardless of whether or not the criteria for a diagnosis of dental phobia are met.

Evaluation

It is considered counterproductive to discuss dental fear with patients because it is believed that this can exacerbate the pre-existing anxiety. Despite this common idea, it is more beneficial to discuss dental anxiety with the patient in most cases. The first step in accommodating patients with dental anxiety is:

• Identify that the patient is afraid.
• This can be done through observation (constant movement, talking loudly, sweating) or asking the patient directly.
• Then create a conducive environment and open dialogue that allows the patient to feel more comfortable in the dental environment.

Causes

• Sexual abuse
• Dental fear is associated with prior sexual abuse.

Genetics

• Dental fear was 30% hereditary, and fear of pain was 34% hereditary.

Others

• Dental fear can be broadcast through social media, reading a comic dental paper, watching a movie involving gruesome dental scenes, and hearing a scary dental story from a friend or family member.
• Dental fear can also arise from observing other people attending complex dental treatments.

Treatments

• Dental fear varies through a continuum, from very mild anxiety to severe fear.
• Therefore, in the dental field, it is also the case when the technique and treatment that work for one patient may not work for another.
• Some individuals may require a tailored management and treatment approach.

Psychological

Communication, communication and trust-building skills

Verbal communication

• It is essential for dentists to have a positive communicative demeanor, attitude and posture.
• Dentists must establish a direct approach by communicating with the patient in a friendly, calm, and non-judgmental manner, using the appropriate vocabulary, and avoiding negative phases.

Non-verbal communication

• Positive eye contact, friendly facial expressions, and positive gestures are essential to an empathic relationship between the patient and the dentist.
• Communication skills create a bond of understanding, trust, and confidence between the dentist and the patient.

Behavior modification technique

Signaling

• This allows the patient to communicate with the dental professional during any stage of treatment using previously established signals with specific meanings.

Positive reinforcement

• This technique aims to reward any positive effort made by the patient and thus strengthen the recurrence of these behaviors.
• Encouraging phrases (using positive voice modulation), such as “thank you for helping me by sitting still in the chair and keeping my mouth wide open,” or physical manifestations, such as smiles or thumbs up, encourage the patient to cooperate during treatment.

Relaxation breathing therapy

• Slow, deep, and steady breathing for 2-4 minutes provides more oxygen to the body, thus reducing the patient’s heart rate.

Progressive muscle relaxation

• Ask the patient to focus on specific voluntary muscles and, in sequence, tense for 5-7 seconds and then relax for 20 seconds.
• As this sequence progresses, other aspects of the relaxation response also occur naturally.

Modeling

• Patient behavior can be altered through modeling.
• The modeling can be presented for viewing on television, computer, or live by having the patient observe the behavior of his siblings, family members, or another patient with a similar situation.
• This conditions the positive behavior of the patient.

Guided Imagery / Hypnosis

• This technique uses a direct and deliberate daydream to create a focused state of relaxation.
• For example, the patient sitting in the dental chair is taught to develop a mental image or is asked to use his imagination skills to establish a pleasant and calm experience.
• This continually guides the patient’s attention to relaxation.

Systemic desensitization

• It is strongly recommended that treatment be planned in phases (systemic desensitization) with the least fearful, painful, and traumatic techniques.

Early-stage

• Teach the patient relaxation techniques.
• The most commonly used relaxation techniques are deep breathing and muscle relaxation.

Final phase

• Gradually expose the patient to treatment that ranges from the least to the most distressing (from simple procedures to more extensive dental work).

Cognitive-behavioral therapy Dental fear often leads patients to have unrealistic expectations about dental treatment, especially in children.

• Cognitive therapy aims to alter and restructure negative beliefs to reduce dental fear by improving negative thought control.
• “The process involves identifying the misinterpretations and catastrophic thoughts often associated with dental fear, challenging the patient’s evidence for them, and replacing them with more realistic thoughts.”

You may also be interested in reading: Fear Of Needles: Characteristics, Causes, Symptoms, Treatment.

Medicines

• Benzodiazepines
• Nitrous oxide

General anesthesia

• Although it is not recommended due to the possible infrequent risk of death and its high cost, it requires specialized facilities’ intervention.

Help the patient

Coping skills. Some common strategies for the patient to help carry out the appointment:

Speak louder

• Talk to your doctor about coping skills that have worked for you in the past.
• Don’t be afraid to ask questions; Accept a sign you can give.

Distract

• Bring headphones and some music or an audiobook to listen to.
• Occupy your hands by squeezing some soft toys or playing with them; ask your doctor for other options that can help you distract yourself.

Deep breathing

• Practice deep breathing anywhere.