Psychology and dental anxiety

Question 1

Background (6)

Answer 1

A Conscious Decision: A review of the use of general anaesthesia and conscious sedation in primary dental care.’ DOH 2000
Public Health concerns
Child deaths due to GA.
Viable psychological alternatives.
No equality in provision.
General Dental Council guidance on misuse sedation (GDC 1997 revised 1999)

Question 2

Prevalence (5)

Answer 2

Dental anxiety is common (McGoldrick, et., al.2001).
Dental phobia was the most prevalent specific phobia in Holland (Oosterink 2009).
United Kingdom Adult Dental survey 1988 one third of the UK adult population are dentally anxious.
Patient’s with dental phobia consume of time and resources.
Dentists identify dentally anxious patients as a major source of stress (Cooper Watts and Kelly 1987, Moore and Brodsgaard 2001).

Question 3

Impact of dental anxiety (4)

Answer 3

3% avoid completely (Lenk 2013)
Dental health state Poor (Thom 2000)
Poor oral hygiene
Risks from sedation

Question 4

What are dental fears? (2)

Answer 4

The terms dental fears, anxiety, and phobia appear to be interchangeable and a distinction is largely disregarded in the dental literature (Gordon, Heimberg et al. 2013).
Fear is a primitive, basic emotion tied to the fight or flight response, activated in response to an imminent and specific threat; anxiety is a conditioned response characterized by anticipation of or worry about a potential future threat.

Question 5

Three main components of fear (3)

Answer 5

1. The subjective experience of apprehension.
2. Psycho-physiological changes.
   3 Attempts to avoid or escape.

Question 6

Distinction between fear and anxiety (2)

Answer 6

Fear describes feelings of apprehension about tangible and predominantly realistic dangers and anxiety refers to feelings of apprehension that are difficult to relate to tangible sources of stimulation. The inability to identify the source of ones fears is usually regarded as the hallmark of anxiety.

Question 7

The origins of fear and phobias (3)

Answer 7

Evolution
Preparedness
Predisposing Genetic & Environmental Factors

Question 8

Aetiology of dental anxiety (4)

Answer 8

Involve a spectrum of factor
Related to past dental experiences
General and specific fears
Other personality factors

Question 9

Three systems of fear - Lange 1969

Answer 9

Cognitive
Behavioural
Physical
-loosely coupled systems that can have differing levels of intensity
-responses need not be in synchrony and therefore systems can have different levels of reactivity

Question 10

What is early-onset dental fear related to? (4)

Answer 10

Conditioning experiences (indexed via caries level and tooth loss)
Service use patterns
Stress reactive personality
Specific beliefs about health professionals

Question 11

What is late-onset dental fear related to? (3)

Answer 11

Aversive conditioning experiences
Irregular service use
External locus of control

Question 12

Perception (3)

Answer 12

Research
Perceptions and visualizations are tricks played by the mind
Reflecting that perceptions/images are to a large degree self-constructed

Question 13

Cognitive (5)

Answer 13

1. Issues relating to control, feeling out of control within the dental setting. Also related to this are feelings of being trapped which again stem back to cognitions associated with control.
2. Related to the above is a sense of over-valued control held within the patients beliefs and therefore a pre-existent pattern associated with difficulties surrounding control.
3. Significant error and distortion in perception of dental procedure.
4. Hyper vigilance of behavioural stimuli also internal somatic changes.
5. Catastrophic misinterpretations of fear responses.

Question 14

Behavioural (7)

Answer 14

Avoidance of dental treatment.
Escape behaviours.
Limited attendance.
Use of anesthetics.
Use of anxiolytics.
Attachment to one dentist
Ritualized behaviour

Question 15

The looming cognitive style (3)

Answer 15

It is a negative cognitive style
It functions as a danger schema
Involves primarily imagery based mental representations of the intensification of threat

Question 16

Pathological fear (3)

Answer 16

Is not flexible
Rigidly imposed in a top down fashion by maladaptive mental representations
Tendency to represent threat as rapidly intensifying and the risk of danger growing

Question 17

Core characteristics of dentally avoidant patients (2)

Answer 17

It has been recognised by previous researchers in the area of dental anxieties (De Jongh et al 1994) that there are certain core characteristics both behaviourally and cognitively that mark these patients.

It is also not predictive that negative experiences in early life are the most common cause (see Locker et al 1996)