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People with high dental fear are much more likely to delay
or avoid dental visiting, and a number of fearful people
regularly cancel or fail to show for appointments.
2.
People with high dental fear, both children and adults, may
prove difficult to treat, require more time, and present with
behavioural problems which can result in a stressful and
unpleasant experience for both the patient and treating
dental practitioner.
3.
4.
Sexual abuse
There is also an observed association between dental anxiety and
having been the victim of past sexual abuse11.
seek LIGHT
Summary
All these various factors might be indirectly or directly implicated in a
patients dental-related anxiety and should be determined.
the Dental Fear Survey (DFS) for adults which has 20 items
related to various situations, feelings and reactions to dental
work9;
2.
3.
Rest breaks. Either the dental practitioner or patient may initiate breaks
during a procedure. Many dentally fearful individuals feel the need to
continue with a procedure until they cant bear it any longer, at which
time it is more difficult for patients to calm themselves down enough
to continue with the procedure. When the patient initiates a rest break,
being able to pause the procedure can increase the patients sense of
control over treatment.
Distraction
There is evidence that focussing attention on specific alternative visual
or auditory stimuli in the dental clinic might be beneficial for patients
with mild to moderate dental anxiety. Several options are available
in the clinic, ranging from background music to television sets to
computer games to 3D video glasses for watching movies.
Relaxation breathing
One exercise which is believed to be of benefit to almost every fearful
patient is relaxation through paced breathing. There are several
variations on relaxation breathing. For example, patients can be taught
to take slow, deep breaths, holding each breath for approximately
5 seconds, before slowly exhaling. Slow, steady breathing for 24
minutes is regarded as effective in reducing a patients heart rate and
making anxious patients noticeably more comfortable.
The various breathing techniques can be taught quite easily at the
dental clinic and can be practised at home by the patient prior to an
initial examination.
Table 1. Dental anxiety assessment using the Index of Dental Anxiety and Fear
(a) Painful or
uncomfortable
procedures
(j) Having an
unsympathetic or
unkind dentist
> Items 1a 1h get summed to create an overall fear score ranging from
8 to 40. Higher scores indicate more anxiety. People responding 4
or 5 to any one item or who score over 20 overall may have enough
concerns to warrant further enquiry.
> Items 2a 2j are used to help identify some possible concerns of
people and are especially useful when combined with the results from
the first section.
seconds, with attention focussed on the feeling of tension and then the
specific sensations of muscle relaxation.
Systematic desensitisation
3.
References
1. Armfield JM. The extent and nature of dental fear and phobia in Australia. Aust Dent J
2010;55:368-377.
2. Armfield JM, Spencer AJ, Stewart JF. Dental fear in Australia: whos afraid of the dentist?
Aust Dent J 2006;51:78-85.
3. Armfield JM, Stewart JF, Spencer AJ. The vicious cycle of dental fear: exploring the
interplay between oral health, service utilization and dental fear. BMC Oral Health 2007;7:1.
4. Armfield JM, Heaton LJ. Management of fear and anxiety in the dental clinic: a review. Aust
Dent J 2013;58:390-407.
5. Armfield JM, Slade GD, Spencer AJ. Dental fear and adult oral health in Australia.
Community Dent Oral Epidemiol 2009;37:220-230.
6. Armfield JM. What goes around comes around: revisiting the hypothesized vicious cycle of
dental fear and avoidance. Community Dent Oral Epidemiol 2013;41:279-287.
7. Armfield JM, Slade GD, Spencer AJ. Cognitive vulnerability and dental fear. BMC Oral
Health 2008;8:2.
8. Armfield JM. Towards a better understanding of dental anxiety and fear: cognitions vs
experiences. Eur J Oral Sci 2010;118:259-264.
9. Milgrom P, Weinstein P, Heaton LJ. Treating fearful dental patients: a patient management
handbook. Dental Behavioral Resources: Seattle WA, 2009.
4.
5.
A joint program by
Colgate Oral Care and The University of Adelaide
10. Pohjola V, Mattila AK, Joukamaa M, Lahti S. Anxiety and depressive disorders and dental
fear among adults in Finland. Eur J Oral Sci 2011;119:55-60.
twitter.com/uniofadelaide
11. Willumsen T. The impact of child sexual abuse on dental fear. Community Dent Oral
Epidemiol 2004;32:73-79.
youtube.com/universityofadelaide
12. Wong HM, Humphris GM, Lee GTR. Preliminary validation and reliability of the modified
child dental anxiety scale. Psych Reports 1998;83:1179-1186.
13. Armfield JM. Development and psychometric evaluation of the Index of Dental Anxiety and
Fear (IDAF-4C+). Psych Assess 2010;22:279-87.
14. Australian Dental Association. Conscious sedation in dentistry. ADA, 2014. URL: http://
www.ada.org.au/app_cmslib/media/umlib/policy%20statement%206.17%20sedation%20
in%20dentistry.pdf. Accessed February 2016.
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CRICOS 00123M The University of Adelaide. Published March 2016