Talk:Dental fear

Friend/partner removal
The sentence had been uncited since 2010 Feb, and it wasn't supported by the previous refs. While I totally agree that a dental phobic (dental feared? dentally feared? dental anxious?) person should bring someone who can restrain them from either running from the office or punching an aide or doctor, in this article the "advice" is completely uncited. 71.234.215.133 (talk) 05:21, 22 July 2010 (UTC)

Information from article page
'''BELOW INFORMATION IS REVISED AND UPDATED. THE TREATMENT INFORMATION IS OUTDATED AND HENCE IT IS REPLACED WITH THE INFORMATION FROM RECENT STUDIES.'''

Diagnosis
Phobia of dental care is sometimes diagnosed using a fear measurement instrument like Corah's Dental Anxiety Scale or the Modified Dental Anxiety Scale.

Treatment
Treatments for dental fear often include a combination of behavioral and pharmacological techniques. Specialized dental fear clinics use both psychologists and dentists to help people learn to manage and decrease their fear of dental treatment. The goal of these clinics is to provide individuals with the fear management skills necessary for them to receive regular dental care with a minimum of fear or anxiety. While specialized clinics exist to help individuals manage and overcome their fear of dentistry, they are rare. Many dental providers outside of such clinics use similar behavioral and cognitive strategies to help patients reduce their fear.

Many people who suffer from dental fear may be successfully treated with a combination of "look, see, do" and gentle dentistry. People fear what they don't understand and they also, logically, dislike pain. If someone has had one or more painful past experiences in a dental office then their fear is completely rational and they should be treated supportively. Non-graphic photographs taken pre-operatively, intra-operatively and post-operatively can explain the needed dentistry. Pharmacologic management may include an anxiety-reducing medication taken in a pill, intravenously and/or using Nitrous Oxide (laughing) gas. Most importantly is the need to provide an injection of anesthetic extremely gently. Certain parts of the mouth are much more sensitive than other parts; therefore it is possible to provide local anesthesia (a "novocaine" shot) in the less sensitive area first and then moving the injection within the zone of just-anesthetized tissue to the more sensitive area of the mouth. This is one example of how a dentist can dramatically reduce the sensation of pain from a "shot." Another idea is to allow the novocaine time (5 – 15 minutes) to anesthetize the area before beginning dental treatment.

Behavioral techniques
Behavioral strategies used by dentists include positive reinforcement (e.g. praising the patient), the use of non-threatening language, and tell-show-do techniques. The tell-show-do technique was originally developed for use in pediatric dentistry, but can also be used with nervous adult patients. The technique involves verbal explanations of procedures in easy-to-understand language (tell), followed by demonstrations of the sights, sounds, smells, and tactile aspects of the procedure in a non-threatening way (show), followed by the actual procedure (do).

More specialized behavioral treatments include teaching individuals relaxation techniques, such as diaphragmatic breathing and progressive muscle relaxation, as well as cognitive, or thought-based techniques, such as cognitive restructuring and guided imagery. Both relaxation and cognitive strategies have been shown to significantly reduce dental fear. One example of a behavioral technique is systematic desensitization, a method used in psychology to overcome phobias and other anxiety disorders. This is also sometimes called graduated exposure therapy or gradual exposure. For example, for a patient who is fearful of dental injections, the therapist first teaches relaxation skills to the patient, then gradually introduces the feared object (in this case, the needle and/or syringe) to the patient, encouraging the patient to manage his/her fear using the relaxation skills previously taught. The patient progresses through the steps of receiving a dental injection while using the relaxation skills, until the patient is able to successfully receive a dental injection while experiencing little to no fear. This method has been shown to be effective in treating fear of dental injections. Cognitive restructuring, if applied in a non-threatening situation, might be a useful alternative as a first step after years of avoidance of dental care and less threatening than immediate exposure to the feared stimuli.

It is interesting to take into account the views of people who have been provided with behavioural treatments for dental fear. From a psychologist's perspective, techniques such as graded exposure, relaxation techniques or challenging catastrophic thinking are important. However, it has been noted that from the patient's perspective, interventions can be conceptualized quite differently. He argues that high levels of anxiety or phobia should not be considered as residing simply within the individual or in the individual's perceptions of dental care, but more within the relationship with the dentist. For example, when patients who had successfully completed a cognitive-behavioural programme were asked what had helped them to tolerate treatment, they mentioned factors such as the provision of information, the time taken, being put in control by the dentist, and the dentist understanding and listening to their concerns. Such findings suggest that an interpersonal model of anxiety and anxiety-reduction is useful when trying to understand and treat dental fears.

Certain aspects of the physical environment also play an important role in alleviating dental fear. For example, getting rid of the smells traditionally associated with dentistry, the dental team wearing non-clinical clothes, or playing music in the background can all help patients by removing and replacing stimuli which can trigger feelings of fear (see classical conditioning). Some anxious patients respond well to more obvious distraction techniques such as listening to music, watching movies, or even using virtual-reality headsets during treatment.

Pharmacological techniques
Pharmacological techniques to manage dental fear range from mild sedation to general anesthesia, and are often used by dentists in conjunction with behavioral techniques. One common anxiety-reducing medication used in dentistry is nitrous oxide (also known as "laughing gas"), which is inhaled through a mask worn on the nose and causes feelings of relaxation and dissociation. Dentists may prescribe an oral sedative, such as a benzodiazepine like temazepam (Restoril), alprazolam (Xanax), diazepam (Valium), or triazolam (Halcion). Triazolam (Halcion) is not available in the UK. While these sedatives may help people feel calmer and sometimes drowsy during dental treatment, patients are still conscious and able to communicate with the dental staff. Intravenous sedation uses benzodiazepines administered directly intravenously into a patient's arm or hand. Intravenous sedation is often referred to as "conscious sedation" as opposed to general anesthesia (GA). In IV sedation, patients breathe on their own while their breathing and heart rate are monitored and are still responsive to a dentist's prompts. Under a general anesthetic, patients are more deeply sedated and unable to breathe on their own and are not responsive to verbal or physical prompts.

Self-help and peer support
Recent research has focused on the role of online communities in helping people to confront their anxiety or phobia and successfully receive dental care. The findings suggest that certain individuals do appear to benefit from their involvement in dental anxiety online support groups.

In children
Dental phobia or dental fear, and dental anxiety have been used interchangeably in the dental literature to describe the overwhelming discomfort that some youth and adults experience in dental situations. The prevalence of dental anxiety (fear or phobia) in children and adolescents is between 5.7% and 19%. Klingberg & Broberg reviewed these studies and estimated that about 9% of children and adolescents suffer from the condition. In the literature, dental phobia is categorised as a specific phobia – like Needle phobia. It is difficult to differentiate between Dental Behaviour Management Problems (DBMP) and dental phobia. DBMP is defined as disruptive behaviour that counteracts cooperation and makes dental care difficult or impossible. About 27% of children with DBMP present dental fear and 61% of children with dental phobia have DBMP.

Cognitive behaviour therapy
Several studies show that psychological methods based on exposure treatment such as Cognitive Behaviour Therapy (CBT) are effective for dealing with various anxiety disorders. A meta-analysis of CBT studies for children and adolescents found CBT to be effective in the treatment of anxiety disorders such as specific phobias. A number of studies have investigated the effect of cognitive and behavioural therapeutic methods in conjunction with treatment of dental anxiety in adults. The fundamental basis of CBT is the exposure principle, supported by home exercises with parental assistance.

Advice for student editors
Please review the following guidelines for writing medical content on Wikipedia:


 * WP:MEDMOS - gives recommended sections etc.
 * WP:MEDRS - gives guidance about suitable sources.

Thank you. Lesion ( talk ) 07:09, 3 December 2013 (UTC)

Old page history
Some old page history that used to be at the title "Dental phobia" can now be found at Talk:Dental phobia/Old history. Graham 87 13:03, 4 December 2013 (UTC)
 * Moved to Talk:Dental fear/Old history.--Srleffler (talk) 19:27, 6 December 2014 (UTC)

Copyright problem removed
Prior content in this article duplicated one or more previously published sources. The material was copied from: https://www.adelaide.edu.au/arcpoh/dperu/special/dfa/Dental_Fear_Professional.pdf. Copied or closely paraphrased material has been rewritten or removed and must not be restored, unless it is duly released under a compatible license. (For more information, please see "using copyrighted works from others" if you are not the copyright holder of this material, or "donating copyrighted materials" if you are.)

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Discussion Group 2
PLANNING

1. Defining (dental fear/phobia and dental anxiety) (RABIA)

2. Prevalence of dental fear (RABIA) 3. What causes it (external and internal contributory factors)? (SHEKIEB)

4. The impact of dental fear on daily life. Are we talking about children, or adults? (AMIRA)

5. Diagnosis and assessing dental fear (IFEMIDE)

6. Management of dental fear (RIYA)

7. Related topics (ALL)

8. References (ALL)

9. External links

— Preceding unsigned comment added by 18961065RP (talk • contribs) 04:06, 8 April 2018 (UTC)

The content on the "article" page is good, so we will just follow that outline. One thing is added: "the impact of dental fear on daily life"

Definition
Can you please find articles that says fear and anxiety are inter-related because there are more evidences available on treatments for dental anxiety.

Do we need to find that they are inter-related because that means I have more to say in my paragraphs. However if it is limited to dental fear only there seems to be not many research conducted on it.

YES. Say that they are inter-related. They are different, but one can cause another. E.g anxiety may be due to fear of injection.

Okey I'll research more to prove that they are interrelated, however our main focus is dental fear.

I have completed my part and focused on dental fear to prove impact on overall health. I have also included the cycle that was discussed earlier and the image has been added. — Preceding unsigned comment added by EGYPT1998 (talk • contribs) 11:29, 9 May 2018 (UTC)

Should we also add links to the definition of the words fear, anxiety and phobia as well?

Yes, I also believe adding images will make it more visual for the readers. - RN — Preceding unsigned comment added by N.RABIA (talk • contribs) 12:46, 8 May 2018 (UTC)

Hey :) do we have a concise definition of dental fear/phobia/anxiety?

Prevalence
Does this just include prevalence on dental fear or will it also include dental phobia and dental anxiety.

Just on dental fear. :)

Prevalence of dental fear across the world: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4233415/

will this focus on children or adults or both?

— Preceding unsigned comment added by 2001:8003:4F5D:BA00:74B7:B9A2:EC8D:7E5F (talk) 03:11, 8 May 2018 (UTC)

Causes
Can we use articles from British Dental Journal or it has to be Australian one? I have also downloaded a book called (Dental Fear and Anxiety in Paediatric Patients) which is a good literature. I can share it if anyone need it. — Preceding unsigned comment added by Mastoor39 (talk • contribs) 13:36, 9 May 2018 (UTC)

The causes of dental fear are mainly categorised into two sections; the external and the internal factors.

External Factors

 * Direct experience: Dental fear can be due to negative or difficult past experiences, such as, noise of dental drill, fear of loss of control by the operator and any other medical procedure in the past.


 * Indirect modeling experience: Dental fear can be developed by observation of an anxious dental patient, friend or family member.


 * Information transmission: Dental fear can be transmitted through social media, reading a comic dental paper, watching a vicarious dental movie and listening to a fearful dental story from a friend or a family member.

Internal Factors
Some people are inherently or genetically fearful and, thus, are more vulnerable to being traumatised by a dental experience. However, age and gender can also influence dental fear.


 * Genetics: Evidence shows that there is a strong relationship between parents and child fear as well as some evidence suggests that fear has robust genetic relationship. It is worth mentioning that psychological factors may result in developing dental fear.


 * Age: Generally, young children aged 4-12 have the greatest number of fears and anxieties.


 * Gender: Evidence suggests that girls and women have higher degree of dental fear, especially, about drilling and local anesthesia than boys and men. This could be partly due to societal mentality that it is okay for girls and women to express fear but not for boys and men.

Experiences and perceptions Sexual abuse Number of studies have concluded that ‘’dental fear is associated with a history of sexual violence victimisation.’’

Genetics Number of studies have concluded that in addition to environmental factors, genetic influences also play important role in the aetiology of dental fear. The researchers found that dental fear was 30% heritable and fear of pain was 34% heritable.

Other causes of dental fear Dental fear can be transmitted through social media, reading a comic dental paper, watching a movie involving gruesome dental scenes and listening to a fearful dental story from a friend or a family member. Dental fear can also arise from observation of other patients attending for complex dental treatments. — Preceding unsigned comment added by Mastoor39 (talk • contribs) 09:32, 20 May 2018 (UTC)

The impact of dental fear on daily life
Dental fear is frequently encountered within dental offices and is not unusual to detect amongst patients. The development of dental fear within an individual creates a barrier for seeking oral health as it evokes physical, cognitive, emotional, and behavioural responses in an individual. Thus, affecting the individuals emotional well-being and overall quality of life as it begins general health complications such as;"septicemia skin problems, joint and heart problems, facial osteo-myelitis and many more". This can negatively affect the individuals functional well-being emotional well-being, social interaction and sense of self care. Therefore, research conducted has revealed that individuals suffering from dental fear are more often subjected to poorer quality of life in comparison to other individuals who are not dentally afraid. Dental fear creates long term avoidance of care, thus results in deteriorated dentition, missing teeth, decayed dentition and poor periodontal status. As a result individuals have difficulties interacting with different people, as they may be embarrassed due to poor aesthetics which makes smiling difficult and social interactions awkward. Therefore, this creates isolation and withdrawal impacting the emotional health.

This is further supported with vicious cycle of dental fear, whereby and individual is fearful of the dentist and as a result they begin delaying dental visits, dental problems begin to arise and as a consequence symptom driven treatment must take place increasing the dental fear. The inability to break this cycle may put the individual at an increased risk of developing chronic disease.

Amira, you may have to change this information as it talks about dental phobia and not fear (they are two different things).

I will make some changes, I had just thought based on what Rabia had stated that they were interrelated :)

Riya: Hey Amira, Can you add somewhere that the impact of dental fear leads to "vicious cycle of dental fear"

Amira: hey riya yes i have just had a look at the article and I will be including it into this part. — Preceding unsigned comment added by EGYPT1998 (talk • contribs) 08:45, 13 May 2018 (UTC)

Okay Amira :) — Preceding unsigned comment added by 18961065RP (talk • contribs) 06:38, 15 May 2018 (UTC)

— Preceding unsigned comment added by EGYPT1998 (talk • contribs) 10:54, 6 May 2018 (UTC)

— Preceding unsigned comment added by EGYPT1998 (talk • contribs) 09:38, 30 April 2018 (UTC)

Diagnosis
As afore mentioned there is a distinction between dental phobia, dental fear and dental anxiety. It is viewed as counterproductive to discuss dental fear with patients because it is believed that this can exacerbate the pre existing fear. Despite this common idea, it has been found that it is actually more beneficial in most cases to discuss dental fear with the patient. The first step in accommodating to patients with dental fear is to - 1. Identify the patient has fear. This can be done through observation (constant moving, talking loudly, sweating) or by asking the patient directly. 2. Then to create a conducive environment and open dialogue which can allow the patient to feel more comfortable in the dental setting. In this section we will then explore further the diagnosis available to determine these conditions. Self- report scales that can be used to measure include- 1. Dental fear survey (DFS) which incapsulates 20 items relation to various situations, feelings and reaction to dental work which is used to diagnose dental fear. 2. Modified child dental anxiety scale (MCDAS), used for children and it has 8 items with a voting system from 1-5 where 1 is not worried and 5 is very worried. 3. The index of dental anxiety and fear (IDAF-4C+) used for adults and it is separated into 8 item module and then a further 10 item module. Look up DSM-V manual for diagnosis of dental phobia, it is important to keep in mind that the three terms: dental phobia, dental fear and dental anxiety are different terms, and therefore, there may be different ways of diagnosing it/different diagnoses.- IA

High dental fear statistically in adults- 1/6 children- 1/10 middle aged women (subgroup)- 1/3 Dental phobia which is a sub category of dental fear that affects peoples every day life affect 5% of the Australian population. Self report dental anxiety scales and a good method used to diagnose a patients level of dental fear and anxiety. There are different freely available ones.

Corahs dental anxiety scale, revised 1-4 questions and then 1-26 question. This scale has a ranking system and the second section with 26 questions has 1-4 options ranging from 'low' to 'dont know' which is used to asses dental concern. The first section with 1-4 questions has options a-e which are worth 1-5 points and the possible about of maximum point is 20. Then depending on the result you rate the dental anxiety. 9-12 being moderate 13-14 being high, and 15-20 being severe.

Treatment/Management
Dental fear varies across a continuum, from very mild fear to severe. Therefore, in dental setting, it is also the case where the technique and management that works for one patient might not work for another. Some patients may require a tailored management and treatment approach. Numerous dental fear management strategies and techniques are put forward, illustrated in figure 1.1.

Non-pharmacological interventions
Communication skills, rapport and trust building
 * Verbal communication : It is important for dental practitioners to have a positive behaviour, attitude and communicative stance. Dental practitioners should establish a direct approach by communicating with the patient in a friendly, calm and non-judgmental manner, using appropriate vocabulary and avoiding negative phases.


 * Non-verbal communication : positive eye-contact, friendly facial expressions and positive gestures are essential to achieve an empathetic relationship between the patient and dental practitioner.

By doing so, communication skills create a bond of understanding, trust and confidence between the dental practitioner and the patient.

Cognitive behavior therapy Dental fear often lead patient to cause unrealistic expectations about dental treatment, especially in children. Cognitive therapy aims to alter and restructure negative beliefs to reduce dental fear by enhancing the control of negative thoughts. “The process involves identifying the misinterpretations and catastrophic thoughts often associated with dental fear, challenging the patient’s evidence for them, and then replacing them with more realistic thoughts.”

Pharmacological interventions

 * Benzodiazepines
 * Nitrous oxide
 * General anesthesia : though it is discouraged due to possible but rare risk of death and high cost since it requires the involvement of specialist facilities.

For the patient – Coping skills for facing dental fear
Some common strategies for the patient to help get through the appointment:


 * Speak up : Talk to the clinician about the coping skills that have worked for you in the past; Do not be afraid to ask questions; Agree on a signal you can give.


 * Distract yourself : Bring headphones and some music or an audio book to listen to; Occupy your hands by squeezing some soft toys or play with fidget toy; Ask your clinician for other options that may help in distracting yourself.


 * Deep breathing : Practice deep breathing anywhere.

Ref
There's a real problem with the refs in this article. It looks like the ==External links== section has the actual refs. The article just has a number. If you want to make this work, please put the ref in the article itself. So instead of, the bit in the paragraph says. It should be a simple cut-and-paste job, except that there are 15 named refs, and 16 slots to put them in, so every ref needs to be verified by hand. WhatamIdoing (talk) 05:49, 13 April 2008 (UTC)

La Trobe Assessment
Discussion Group 2 PLANNING 1. Defining (Anita and Carolin) 2. Signs and Symptoms dental fear (Anita and Carolin) 3. Causes (Ange and Anika) 4. Diagnosis and assessing dental fear (Carolin and Anita) 5. Management of dental fear (Anne and Steph) 6. Epidemiology (Anika) 7. Related topics (ALL) 8. References (ALL) 9. External links StephanieS95 (talk) 12:08, 21 June 2019 (UTC)

Medication
Means the same as "Pharmacological management" and is simple easier to understand. Thus restored it. Doc James (talk · contribs · email) 02:00, 22 February 2020 (UTC)