Management of fear and anxiety in the dental clinic: a review

doi:10.1111/ADJ.12118

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Management of fear and anxiety in the dental clinic: a review

Journal Article•DOI•

Management of fear and anxiety in the dental clinic: a review

Jason M. Armfield¹, Lisa J. Heaton²•Institutions (2)

University of Adelaide¹, University of Washington²

01 Dec 2013-Australian Dental Journal (Aust Dent J)-Vol. 58, Iss: 4, pp 390-407

TL;DR: It is concluded that successfully managing dentally fearful individuals is achievable for clinicians but requires a greater level of understanding, good communication and a phased treatment approach.

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Abstract: People who are highly anxious about undergoing dental treatment comprise approximately one in seven of the population and require careful and considerate management by dental practitioners. This paper presents a review of a number of non-pharmacological (behavioural and cognitive) techniques that can be used in the dental clinic or surgery in order to assist anxious individuals obtain needed dental care. Practical advice for managing anxious patients is provided and the evidence base for the various approaches is examined and summarized. The importance of firstly identifying dental fear and then understanding its aetiology, nature and associated components is stressed. Anxiety management techniques range from good communication and establishing rapport to the use of systematic desensitization and hypnosis. Some techniques require specialist training but many others could usefully be adopted for all dental patients, regardless of their known level of dental anxiety. It is concluded that successfully managing dentally fearful individuals is achievable for clinicians but requires a greater level of understanding, good communication and a phased treatment approach. There is an acceptable evidence base for several non-pharmacological anxiety management practices to help augment dental practitioners providing care to anxious or fearful children and adults.

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Journal Article•DOI•

Strategies to manage patients with dental anxiety and dental phobia: literature review.

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Deva Priya Appukuttan¹•Institutions (1)

Ramakrishna Mission¹

10 Mar 2016-Clinical, Cosmetic and Investigational Dentistry

TL;DR: Dental anxiety and phobia result in avoidance of dental care, and formulating acceptable evidence-based therapies for such patients is essential, or else they can be a considerable source of stress for the dentist.

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Abstract: Dental anxiety and phobia result in avoidance of dental care. It is a frequently encountered problem in dental offices. Formulating acceptable evidence-based therapies for such patients is essential, or else they can be a considerable source of stress for the dentist. These patients need to be identified at the earliest opportunity and their concerns addressed. The initial interaction between the dentist and the patient can reveal the presence of anxiety, fear, and phobia. In such situations, subjective evaluation by interviews and self-reporting on fear and anxiety scales and objective assessment of blood pressure, pulse rate, pulse oximetry, finger temperature, and galvanic skin response can greatly enhance the diagnosis and enable categorization of these individuals as mildly, moderately, or highly anxious or dental phobics. Broadly, dental anxiety can be managed by psychotherapeutic interventions, pharmacological interventions, or a combination of both, depending on the level of dental anxiety, patient characteristics, and clinical situations. Psychotherapeutic interventions are either behaviorally or cognitively oriented. Pharmacologically, these patients can be managed using either sedation or general anesthesia. Behavior-modification therapies aim to change unacceptable behaviors through learning, and involve muscle relaxation and relaxation breathing, along with guided imagery and physiological monitoring using biofeedback, hypnosis, acupuncture, distraction, positive reinforcement, stop-signaling, and exposure-based treatments, such as systematic desensitization, "tell-show-do", and modeling. Cognitive strategies aim to alter and restructure the content of negative cognitions and enhance control over the negative thoughts. Cognitive behavior therapy is a combination of behavior therapy and cognitive therapy, and is currently the most accepted and successful psychological treatment for anxiety and phobia. In certain situations, where the patient is not able to respond to and cooperate well with psychotherapeutic interventions, is not willing to undergo these types of treatment, or is considered dental-phobic, pharmacological therapies such as sedation or general anesthesia should be sought.

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274 citations

Cites background from "Management of fear and anxiety in t..."

...They were 1) anxious of specific dental stimuli, 2) distrust of the dental personnel, 3) generalized dental anxiety, and 4) anxious of catastrophe.(23,24)...
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...Patients can also be given mirrors to watch the procedure, so as to feel they are in control.(24) Systematic desensitization or exposure therapy Wolpe’s technique,(89) known as systematic desensitization, is based on relaxation and played a very prominent role in the evolution of behavior therapy during the 1960s and 1970s....
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...The final step is to gradually expose the patient to these situations in the hierarchy, from the least to the most anxiety-promoting.(24,88,89) When it is difficult to expose the patient directly to the dental setting, it may be appropriate to instruct the patients to practice imaginary systematic desensitization, wherein the patients are encouraged to imagine that they are entering the dental clinic, able to sit in the dental chair, and eventually able to receive dental treatment....
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Journal Article•DOI•

Prevalence of dental anxiety in children and adolescents globally: A systematic review with meta-analyses.

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Barbara Monteiro Grisolia¹, Ana Paula Pires dos Santos¹, Izabel Monteiro D’Hyppolito¹, Heather Buchanan², Kirsty Hill³, Branca Heloisa de Oliveira¹ - Show less +2 more•Institutions (3)

Rio de Janeiro State University¹, University of Nottingham², University of Birmingham³

01 Mar 2021-International Journal of Paediatric Dentistry

TL;DR: DA is a frequent problem in 3- to 18-year-olds worldwide, more prevalent in schoolchildren and preschool children than in adolescents, and the scale used for DA assessment was shown to influence pooled prevalence in preschoolers and adolescents.

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Abstract: Background Dental anxiety (DA) negatively impacts oral health-related quality of life, and patients with DA usually require more dental treatment time. Aim To describe the global prevalence of DA in children and adolescents and to examine the influence of individual factors (age, sex, and caries experience) and variables related to DA measurement on pooled prevalence. Design Systematic review with meta-analyses of observational studies published between 1985 and 2020 (PROSPERO CRD42014013879). Results Searches yielded 1207 unique records; 224 full-text articles were screened, and 50 studies were used in the qualitative and quantitative synthesis. No study was considered as having high methodological quality according to 'The Joanna Briggs Institute assessment tool'. Overall pooled DA prevalence was 23.9% (95% CI 20.4, 27.3). Pooled prevalence in preschoolers, schoolchildren, and adolescents was as follows: 36.5% (95% CI 23.8, 49.2), 25.8% (95% CI 19.5, 32.1), and 13.3% (95% CI 9.5, 17.0), respectively. DA was significantly more prevalent in preschool children (one study) and schoolchildren (two studies) with caries experience and in female adolescents (one study). The scale used for DA assessment was shown to influence pooled prevalence in preschoolers and adolescents. Conclusion DA is a frequent problem in 3- to 18-year-olds worldwide, more prevalent in schoolchildren and preschool children than in adolescents.

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47 citations

Journal Article•DOI•

Nonpharmacologic Intervention on the Prevention of Pain and Anxiety During Pediatric Dental Care: A Systematic Review

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Marília Leão Goettems¹, Eduardo Jung Zborowski¹, Francine dos Santos Costa¹, Vanessa Polina Pereira da Costa¹, Dione Dias Torriani¹ - Show less +1 more•Institutions (1)

Universidade Federal de Pelotas¹

01 Mar 2017-Academic Pediatrics

TL;DR: More research is needed to know whether the techniques are effective for improving behavior and reducing children's pain and distress during dental treatment, but the majority of the techniques improved child's behavior, anxiety, and pain perception.

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44 citations

Cites background from "Management of fear and anxiety in t..."

...Also, despite the mixed evidence existing for some techniques, given the ease of introducing music distraction, for instance, into the clinic, and the absence of any known deleterious effects, the potential for positive outcomes and stated patient preference recommends it for more systematic and widespread use.(45) It is important that further studies be conducted comparing usual techniques to the interventions we describe here....
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Journal Article•DOI•

Psychological Factors in Dental Patient Care: Odontophobia

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Rosa De Stefano¹•Institutions (1)

University of Messina¹

08 Oct 2019-Medicina-lithuania

TL;DR: A future perspective concerns precisely the implementation of non-invasive practices such as hypnosis in the management of dental phobic patients and the role of this condition in the practice of dentistry.

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Abstract: Dentistry and oral health are at the heart of the systemic health of humans. Often this branch of medicine is underestimated either due to socioeconomic reasons or due to fear. In fact, in dentistry, there is often a widespread condition of odontophobia among patients. A clinician's knowledge of this condition, and an accompanying understanding of how to successfully manage it, is surely one of the first steps to gaining a patient's trust and maintaining his or her patronage. Being able to manage a dental phobic patient in the best way is the key to successful therapy. Psychological techniques often have to work alongside dentistry in managing these patients. A future perspective concerns precisely the implementation of non-invasive practices such as hypnosis in the management of the latter.

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43 citations

Cites methods from "Management of fear and anxiety in t..."

...This test, according to the most recent literature, is simple and considered to be the best in terms of internal consistency and test–retest reliability [20,21]....
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Journal Article•DOI•

Changes induced by music therapy to physiologic parameters in patients with dental anxiety.

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Cynthia Mejía-Rubalcava¹, Jorge Alanís-Tavira¹, Hugo Mendieta-Zerón¹, Leonor Sánchez-Pérez²•Institutions (2)

Universidad Autónoma del Estado de México¹, Metropolitan University²

01 Nov 2015-Complementary Therapies in Clinical Practice

TL;DR: Music therapy has a positive effect in control of dental anxiety and correlation between salivary cortisol and other physiologic parameters is determined.

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41 citations

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References

PDF

Open Access

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Albert Bandura¹•Institutions (1)

Stanford University¹

01 Jan 1977-Canadian Journal of Sociology-cahiers Canadiens De Sociologie

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Abstract: Una exploracion de los avances contemporaneos en la teoria del aprendizaje social, con especial enfasis en los importantes roles que cumplen los procesos cognitivos, indirectos, y autoregulatorios.

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"Management of fear and anxiety in t..." refers background in this paper

...The idea behind modelling is that one person’s behaviour can be altered as a result of them observing another person performing a given behaviour.(138) Modelling in other health settings has been well studied(139)...
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TL;DR: In this paper, a meta-analysis of 128 studies examined the effects of extrinsic rewards on intrinsic motivation and found that engagement-contingent, completion-contengent, and performance-contagioning rewards significantly undermined free-choice intrinsic motivation, as did all rewards, all tangible rewards and all expected rewards.

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Abstract: A meta-analysis of 128 studies examined the effects of extrinsic rewards on intrinsic motivation. As predicted, engagement-contingent, completion-contingent, and performance-contingent rewards significantly undermined free-choice intrinsic motivation (d = -0.40, -0.36, and -0.28, respectively), as did all rewards, all tangible rewards, and all expected rewards. Engagement-contingent and completion-contingent rewards also significantly undermined self-reported interest (d = -0.15, and -0.17), as did all tangible rewards and all expected rewards. Positive feedback enhanced both free-choice behavior (d = 0.33) and self-reported interest (d = 0.31). Tangible rewards tended to be more detrimental for children than college students, and verbal rewards tended to be less enhancing for children than college students. The authors review 4 previous meta-analyses of this literature and detail how this study's methods, analyses, and results differed from the previous ones.

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TL;DR: A meta-analysis of 128 studies examined the effects of extrinsic rewards on intrinsic motivation, finding that Tangible rewards tended to be more detrimental for children than college students, and verbal rewards tend to be less enhancing for children compared with college students.

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"Management of fear and anxiety in t..." refers background in this paper

...Positive reinforcement, and positive feedback in particular, is considered to be a universally accepted behaviour management technique when providing dental care to children(86) and is based on longstanding psychological principles that have been consistently demonstrated to be effective.(87) Many dental practitioners are encouraged to use positive reinforcement to obtain cooperation with dental procedures....
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"Management of fear and anxiety in t..." refers background in this paper

...Progressive muscle relaxation is a systematic technique initially developed several decades ago(102) and subsequently standardized for use by therapists and researchers.(103) The procedure has been widely, and successfully, used to manage and treat a variety of anxiety disorders....
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