Anxiety

Question 1

what is dental fear

Answer 1

a normal emotional reaction to one or more threatening stimuli in the dental environment e.g needle, noise of the drill

Question 2

what is dental anxiety

Answer 2

a sense of apprehension that something dreadful is going to happen in relation to dental treatment, coupled with a sense of losing control

Question 3

what is dental phobia

Answer 3

a severe type of dental anxiety manifested as a marked and persistent anxiety in relation to clearly discernible situations or objects e.g use of drill or to the dental situation in general

Question 4

what is required for a diagnosis of dental phobia

Answer 4

there must be either complete avoidance of necessary dental treatment or endurance of treatment only with dread and in a specialist treatment situation

Question 5

what is the cycle of dental fear and anxiety

Answer 5

fear/anxiety –> avoidance –> deterioration in dental status –> feelings of shame and inferiority

Question 6

what is the etiology of dental anxiety

Answer 6

negative medical and dental experienced
influenced by family and peers
media representation of dentistry 
expectation of pain and discomfort 
poor knowledge of modern analgesia

Question 7

what are the 3 pathways that explain how children become dentally anxious

Answer 7

conditioning
modelling
information

Question 8

What is the conditioning pathway

Answer 8

arising from pathology in the teeth and dental/medical experiences
the dentist’s personal sensitivity to children fears is also crucial

Question 9

what is the modeling pathway

Answer 9

children imitation of mothers behavior
mothers of anxious children, higher in state anxiety and behave more variably during consultation than those of non-anxious children

Question 10

what is the information pathway

Answer 10

possibly through unwitting provision of frightening information, but more likely through absorbing mothers attitudes to dentistry

Question 11

what are the characteristics of the anxious

Answer 11

high neuroticism and trait anxiety
pessimism and negative expectation 
process to somatisation (the manifestation of psychological distress by the presentation of physical symptoms) 
low brain threshold 
co-morbid anxiety 
co-morbid depressive disorders

Question 12

describe anxious and neurotic thinking

Answer 12

fear of negative evaluation 
pessimistic and vulnerable 
catastrophic 
very negative thinking  (life is a disaster etc)
worry as a habit

Question 13

how does depression effect dental phobia

Answer 13

have inaccurate memories for treatment experiences and also benign experiences are recalled negativity and hence consistent with a pessimistic and fearful ‘ache,a’ about dental treatment

Question 14

what are the provoking factors for fearfulness

Answer 14

bad experience
high neuroticism
depression and anxiety

Question 15

how do we assess dental anxious adults

Answer 15

Dental anxiety scale and its derivatives DAS-R and MDAS

Question 16

what is the DAS, DAS-R and MDAS

Answer 16

they take the form of 4 or 5 item questionnaires which can be given to patients to complete

Question 17

how do we assess dental anxious children

Answer 17

picture tests help when there is limited cognitive functioning
measure should assess specific triggers of dental anxiety or unhelpful thoughts

Question 18

what are different treatment strategies for mild/moderate dental anxiety

Answer 18

1. general attitude and the application of a general anxiety reducing treatment style
2. pharmacological support
3. teach coping mechanisms

Question 19

describe general attitude and the application of a general anxiety reducing treatment style

Answer 19

explain the fight and flight response 
acknowledge their anxiety
engender a trusting relationship 
provide realistic info 
provide control
provide high level of predictability

Question 20

describe pharmacological support

Answer 20

if necessary contact GMP regarding prescribing oral sedation prior to treatment (adults), use nitrous oxide

Question 21

describe teach coping strategies

Answer 21

relaxation and distraction

Question 22

what are the different ways to allow the patient to feel they have control

Answer 22

stop signals
rest signals
proceed signals
provide options

Question 23

how do stop signals allow control

Answer 23

give control over the pace of the procedure

Question 24

how do rest signals help control

Answer 24

allow the patient to stop with the understanding that the treatment is not finished yet

Question 25

what are proceed signals

Answer 25

allow you to proceed

Question 26

how do you provide options

Answer 26

ask them what they want to happen

ask them which tooth they want to restore first

Question 27

what are different methods of distraction

Answer 27

thinking pleasant and relaxing thoughts
do puzzles in your head
think of things that make you happy

Question 28

what are the behavioral treatment strategies for mod/severe dental anxiety

Answer 28

patient first trained in relaxation
after this they are encouraged to expose themselves to a hierarchy of fearful situations
this procedure can be carried out individually or in a group setting using imagined, video, computer based or real life confrontation

Question 29

what is the fear hierarchy

Answer 29

uses a step by step approach

Question 30

what happens in simple desensitisation

Answer 30

relaxation training
give control in a calm manner
fear hierarchy
successive approximations

Question 31

what are dentists well placed to carry out exposure therapy for

Answer 31

those with uncomplicated specific fears
those with more complex cases, their treatment should be carried out by clinical psychologist in close cooperation with he dentist

Question 32

what are cognitive treatment strategies

Answer 32

using pleasant and positive imagery
identifying challenging and modifying negative and unhelpful thoughts and replacing these with more positive and realistic thoughts
use of coping statements “i can and i will”

Question 33

how does challenging the evidence work

Answer 33

when highly anxious patients have to come up with facts that do not confirm their fears, there is a subsequent decline in their perception of risk

Question 34

when do you refer a patient on to a psychologist

Answer 34

when the dental anxiety may be a manifestation of underlying emotional problems or more serious mental difficulties

Question 35

when do you refer a patient for a pharmacological approach

Answer 35

when there is a high treatment need but the psychological consequences would be too overwhelming or demanding for the patient such that the patient is unwilling to have the treatment

Question 36

describe the optimal interventions

Answer 36

phobic avoidance needs densensitisation - refer to local clinical psychology service
information giving improves knowledge and dispels fears, hence reducing uncertainty and anxiety, combing sensory and procedural information appears to be the most effective approach
simple desensitization can be carried out in the clinic
inappropriate beliefs can be evaluated, challenged and reconstructed
severe anxiety or psychological disturbance plus high need for treatment/pain - patient may also benefit with being offered sedation

Question 37

what is maladaptive fearful behavior provoked and maintained by

Answer 37

traumatic experiences, inappropriate beliefs and expectations and neurotic traits