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.

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The causes of dental anxiety can be simply categorized as those resulting from a direct experience or an indirect experience.

DIRECT EXPERIENCES
Research has shown that dental fear generally starts in childhood (85%) and the dentist’s professional behaviour/interpersonal behaviour was the most important cause. When fear was acquired in adult years pain was the most important cause.

INDIRECT EXPERIENCES

• The most common way dental fear is acquired indirectly is from parent to child. This route of acquisition can be from hearing parents talk of their fear or dislike of dentistry or by seeing a parent react adversely to dentistry.
• The mass media can communicate dental fear through cartoons, movies and television.
• Finally, distressing medical procedures can sometimes result in fear generalizing to the dental environment.

The fear experienced in the medical setting automatically gets triggered in the dental setting.

Additional sources that contribute to dental fear include the patient experiencing a sense of helplessness over a situation that may cause them pain or injury. Fearful patients can also be overwhelmed by negative/catastrophising thoughts. These patients anticipate pain “This is going to be very sore” or problems “The drill is going to slip and cut me”.

Some people also have a fearful disposition. These people experience anxiety and fear in numerous situations.

Identifying the cause of dental anxiety can often aid the treatment of dental anxiety by targeting specific behaviors, or cognitions (thoughts).

Congratulations James, the winner of our Father’s Day basket.

Definitions
Dental anxiety is a highly prevalent condition affecting approximately 30% of the population. Dental anxiety can be distinguished from dental fear and phobia by the way our mind and body react.

Dental fear is an individual’s emotional response to a perceived threat or danger. It includes negative thoughts and physiological changes such as increased heart rate, sweaty palms, shaking, shortness of breath or a tight sensation in the throat.

Dental anxiety is better defined as the response to situations in which the source of the threat to the individual is ill-defined, ambiguous or not immediately present. Anticipatory anxiety prior to dental procedures is commonly experienced.

Dental phobia is a more extreme example of dental anxiety. Phobia is defined as a marked and persistent fear of a clearly defined object or situation. Exposure to the phobic stimulus provokes an immediate anxiety response. Typically the individual will actively avoid the object or situation resulting insignificant distress and interference with a person’s ability to function.

Congratulations Christy, winner of our Mother’s Day basket!

We’re having a draw for a Father’s Day basket. All patients attending between May 12th and June 17th can enter their Father for the draw. Our basket includes an electric toothbrush (professional model); free tooth whitening voucher (value $250.00) and many other bright smile goodies.

We’re having a draw for a Mother’s Day basket. All patients attending between April 10th and May 6th can enter their Mother for the draw. Our basket includes an electric toothbrush (professional model); free tooth whitening voucher (value $250.00) and many other bright smile goodies.

By: David R. Farkouh BSc, DMD, MSc, FRCD(C)
On a daily basis in pediatric dental practices across Canada, practitioners are confronted by a severely destructive form of tooth decay that is most commonly seen in children under the age of three years, referred to as early childhood caries (ECC).1 Although we are often times called upon to treat these children once the caries has advanced into the pulp of the tooth or an infection is present, we can’t help but think to ourselves “I wish I would have seen this child sooner to help prevent the caries!”

Although taught otherwise the majority of general dentists are still recommending that a child’s first dental visit take place at three years of age.2 This recommendation is most likely based upon two fundamental facts. Firstly, that there is an inability for most young children to cooperate in a dental setting and secondly, that there is a lack of general practitioner training and experience in the area of infant dental care.3 However such a recommendation definitely is not based on the absence of dental disease in children under the age of three years of age. In order to prevent ECC and other oral diseases, patients and their parents need to be seen much earlier than three years of age.

The Canadian and American Academies of Pediatric Dentistry (CAPD and AAPD) recommend that all children have their first visit to the dentist to establish a dental home no later than 12 months of age.1 The concept of a dental home refers to the establishment of an early relationship between the child, parent(s) and the dentist. This initial meeting allows the dentist to record a thorough medical and dental history, complete a thorough oral examination, establish the child’s risk of developing dental disease (including a caries-risk assessment, establish a patient-specific recall interval and educate the parent(s) or care-giver(s) early on to prevent dental disease.1 It is important at this initial visit that the dentist discuss with the parent(s) the relationship between the child’s diet and dental caries and stress the importance of infant specific oral hygiene instruction. Other relevant topics for discussion at this visit include the use of fluoride with young children and the potential spread of bacteria such as streptococcus mutans from parents to their infants. General dentists should be ready to answer any questions parents may have regarding their child’s oral health. Therefore, the responsibility is on the practitioner to stay current with guidelines and recommendations regarding infant oral health.

With this issue of Oral Health being my first as pediatric editor, I felt it fitting to start with the topic of infant oral health. The articles in this issue focus on making the general dentist more comfortable with topics such as how to conduct a comprehensive infant exam, and factors affecting early childhood caries. The intent is that if dentists are better informed in these areas they are more inclined to see and treat young children in their offices and therefore help start these patients off on the right foot. OH

References
1. Reference Manual 2009-10. Pediatric Dentistry. Special issue. 31(6):13. 2009.

2. Brickhouse TH, Unkel JH, Kancitis I, Best AM, Davis RD. Infant Oral Health: A Survey of General Dentists, Pediatric Dentists and Pediatricians in Virginia. Pediatric Dentistry. 30(2): 147-152. 2008.

3. Nowak AJ, Casamassimo PS. The dental home: A primary care oral health concept. J Am Dent Assoc. 110: 184-6. 2002.