NEW Dental Anxiety

Recently a number of articles have been published in the dental press on dental anxiety. Dental anxiety or dental phobia is said the effect around 10-20% of the world’s population with the condition being extremely complex and debilitating in more extreme situations. Some cases can be exceptionally difficult to manage and treat often requiring specialist care and support. Patients suffering from dental anxiety may have a number of symptoms ranging from an uneasy feeling of nerves to palpitations, nausea, vomiting and syncope. The symptoms are often encountered when visiting the dental surgery but there are a number of people who never get that far and have a complete avoidance of dentistry. It can be difficult to establish what has led to this fear and anxiousness but usually it has occurred due to a previous bad experience or bad experience of a family member. Dental anxiety can also occur because of a fear of pain. A number of methods have been used to help patients suffering from the condition. These include behaviour therapy (BT) and cognitive behavioural therapy (CBT). However some patients may require treatment under sedation or general anaesthesia which often takes place in specialised practices or dental hospitals. This article will review the current literature on dental anxiety; covering the history of treatment and contemporary treatment options available.

Carlsson et al (2013) completed a review of the approaches to dental anxiety at the institute of Odontology, Gothenburg, Sweden. In the article the historical background and research is identified. Looking back to the early 1970’s, treatment options that were available for anxious patients involved sedation, general anaesthesia or treatment via the ‘tell-show-do’ format. Many patients returned still with dental anxiety and were not cured. They also returned with dental health problems and the need for further treatment. Due to this and the financial implications and risks associated with treatment under general anaesthesia, practitioners felt the there was a need for a more long term approach to treating these patients. In essence, there was a need for a cure for those patients suffering from dental anxiety. Psychologists were asked to assist and perhaps suggest other methods that could be employed to help those patients suffering from dental anxiety be free of the condition. Initially Systematic Desensitization’ was utilised. This is a type of BT that uses a ‘hierarchy of fear’. The patient works their way up the hierarchy, when they feel comfortable they can move onto the next stage until they reach the most anxiety-provoking situation. Patients being treated this way showed positive results with a significant reduction in their fear. Over the following years modifications were made to the ways in which this treatment was provided to patients. A number of reviews have taken place on this method of treatment in the Swedish clinic, the results of which have shown positive outcomes for patients suffering from dental anxiety, many of which have been able to receive future treatment in general dental practices. A systematic review has also reported on this method of treatment concluding that it showed moderate to good evidence of managing the condition of dental anxiety.

Further longitudinal studies should take place on the subject of dental anxiety to establish successful interventions and management options that can be utilised into general dental practice. Dental hygienists and Dental Therapists are often faced with nervous patients and it is important that we are aware of the options available for the treatment of this debilitating condition.

References:

Carlsson SG, Wide Boman U, Lundgren J, Hakeberg M. Dental anxiety ­ a joint interest for dentists and psychologists. Eur J Oral Sci 2013; 1-4. DOI: 10.1111/eos.12046

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