The assessment of dental anxiety is the most important aspect of treating dental anxiety. Often patients will report a generalized “I just don’t like the dentist”. These reactions must be explored carefully and the exact nature/cause/source of the anxiety has to be identified in order to then correctly establish the treatment modalities for addressing the anxiety.
Specific questions that explore the main categories of dental anxiety will provide a wealth of information to both the dentist and the often the patient that will facilitate treatment. The main categories of dental anxiety include: specific anxieties, generalized reactions, mistrust and catastrophe.
Specific anxieties related to dentistry include questioning about the individual components that cause anxiety. Needles are often a specific concern for anxious patients. Problems with needles can include the inability to accept a dental injection (needle phobia); fainting when a needle is used (Blood Injury Injection phobia); fear of the needle including fear of pain associated with the injection; fear that the needle will slip or move or break; fear that the needle will not provide sufficient anaesthesia and there will be pain. Other specific fears include fear of the drill. This includes fear of the noise, vibration or pain associated with the drill if there is insufficient local anaesthetic. Insufficient local anaesthetic resulting in pain during dental treatment is a common fear. Often the patient has experienced pain during dental treatment. They have either not informed the dentist or have informed the dentist and been told that they have had sufficient local anaesthetic and treatment has continued despite their pain. It is common that with additional local anaesthetic or additional time following the administration of local anaesthetic that profound anaesthesia can be obtained eliminating pain during treatment.
Generalized anxiety assessment begins by asking about sleep disturbances the night before a dental appointment. This gives a better indication of the level of anxiety associated with dental treatment. An assessment of the body’s reactions to dental anxiety that a person experiences while in the dental chair provides additional information about the extent of dental anxiety. Body reactions can include pounding heart, sweaty palms, shaking, butterflies in the stomach and nausea. Treatment can be tailored to address these specific reactions.
Mistrust is a different faucet of dental anxiety that also needs to be explored. Sometimes a patient has been inappropriately spoken to by a dentist, hygienist or other member of staff. Remarks about a patient’s dental condition or at home dental care or simply a condescending attitude can make a patient feel embarrassed or ashamed. Additionally, if there have been problems during dental treatment such as pain, unexpected changes to the dental treatment required, or errors or omissions on the dentists behalf can make a patient very wary of future dental treatment.
Catastrophising is a type of thought process that can undermine a patient’s ability to accept dental treatment. Thoughts or beliefs that involve catastrophic events can paralyze a dental patient. For example some patients hold the belief that they may have a heart attack during dental treatment or may suffer a serious allergic reaction, be unable to breath or may die as a result of dental treatment.
The discussion of these different categories of dental treatment usually identifies the specifics of the patient’s dental anxiety. Anxiety may involve only one category of dental anxiety or may involve elements of a number or all of the categories of dental anxiety. Once the specifics of dental anxiety have been identified specific tools and pathways are used to address the anxiety.