This document discusses the management of anxious dental patients. It begins by defining stress and outlining the stages of the stress response. It then discusses the scope of the problem, distinguishing between dental fear, anxiety, and phobia. Signs of acute anxiety are provided. The first consultation is emphasized as important for getting to know the patient, showing empathy, and taking a thorough medical history. Communication techniques like active listening and maintaining eye contact are recommended. Treatment approaches like iatrosedation, pre-medication, and vocal sedation during procedures are outlined. The importance of a comprehensive treatment plan and clear post-treatment instructions are also highlighted.
management of the anxious patients in dental office
1. Management of the
anxious patients
Assist.Prof.Dr.Alper KAYA
RAK College of Dental Sciences
RAK Medical & Health Sciences University
2. Stress
A physical, chemical or emotional factor that
causes bodily or mental tension and may be a
factor in disease causation
Factors that tend to alter an existent equilibrium
Cause of ¾ Medical Emergencies in Dentistry
3. Stages of Stress Response
Stage 1: One of the 5 senses sends stimuli to the brain
.
4. Stages of Stress Response
Stage 2: Brain analyzes it as a ‘Threat’ or ‘No Threat’
5. Stages of Stress Response
Stage 3: Body aroused until threat is over
.
6. Stages of Stress Response
Stage 4: Body returns to homeostasis (calm) once threat is gone.
7. Scope of the Problem
• Dental Fear
• Dental Anxiety
• Dental Phobia
8. Scope of the Problem
Dental Fear
• Fear is a natural, adaptive reaction and is supposed to protect
us against danger.
• Our response to the feeling of fear consist of three parts; a
physiologic, a cognitive and a behavioral component.
9. Scope of the Problem
Dental Fear
• The physiologic component consists of an activation of the
sympathetic nerve system with an increased adrenalin-level,
which can lead to sweating, increased heart beating and
stomach problems.
• The cognitive component involves negative thinking, like “this is
dangerous – I might die – I need to get away”,
10. Scope of the Problem
Dental Fear
• The behavioral part of the response will involve trying to
fight the situation or getting away from it.
• The fear is nevertheless controllable and the person is
capable of coping and thinking rationally.
11. Scope of the Problem
Dental Anxiety
• The anxiety response is almost identical to the fear response,
both having a physiologic, a cognitive and a behavioral
component.
• The main difference is the nature of the stimulus which will
trigger the reaction, and how powerful the reaction is to the
given threat.
12. Scope of the Problem
Dental Anxiety
• The anxious patient will still know that the anxiety is
an irrational and greatly exaggerated reaction, and
will often, despite of the anxiety, actually come to the
dental clinic
13. Scope of the Problem
Dental Phobia
• Phobia is a well-defined illness, and there are very
specific criteria of what is defined as odontophobia
14. Scope of the Problem
Dental Phobia
• Odontophobic persons will usually not go to a dental clinic at
all, or at the most only when they have an unbearable tooth
ache.
• Often they cease brushing their teeth, because looking at the
teeth is a constant reminder of not going to the dentist –a
feeling which gives them great discomfort.
15. Scope of the Problem
Dental Phobia
• Not going to the dentist often gives an increased treatment
need, and hence their anxiety and shame increase even more.
• Often they evolve a social phobia as well, because of their bad
tooth condition or –function, and their phobia affects their
everyday life to a great degree.
16. Anxiety
Release of epinephrine, nor-epinephrine
⇧ HeartRate
⇧ Blood Flow
⇧ Respiration
Vasodilatation in the periphery (arms and legs)
⇧ Serum Glucose Level
17. Signs of Acute Anxiety
Cold, sweaty palms or forehead
Flushing of face
Altered facial expression such as bulging eyebrows
Dry mouth orincrease in salivation
Bruxism or clenching of teeth
Increased need to urinate
Unnaturally stiff posture
18. Signs of Acute Anxiety
Inability to sit still
Trembling or tremors
Fiddling with items in his/her hands
White-knuckle syndrome
Tapping feet or fingers
Crying out or moaning
Hyperventilation, syncope, nausea or vomiting
Increased respiration, blood pressure, and heart rate
19. First Consultation
Get to know the patient
Try to be friend him/her
Medical History
Discuss likes and dislikes, acknowledge feelings
Empathy
Understand him/her well-it’s a long term affair...
21. Communication
Let them talk
Be a good listener
Show interest in their conversation
At an eye level
Away from the equipment
22. Iatrosedative Technique
“Making the patient calm by the dentist’s behavior,
attitude, and communicative stance “
A dentist can use to achieve this include making efforts
to avoid pain, giving the patient control and keeping the
patient informed of what the dentist is planning to do, and
what sensations the patient may experience
23. Iatrosedative Technique
The dentist should have some flexibility in the choice of
language, speed and attitude in order to adapt the
communication to the individual patient.
Full clarity about the expectations and demands placed
on the patient at any time, is also necessary and helpful
for the patient
24. AnxiousPatient
Short morning appointment followed by a good morning
breakfast
Pre-medication with Lorazepam 1mg (check interaction
with other drugs) night before sleep followed by 90
minutes prior to procedure
• No driving
• Need to be accompanied by friend/relative etc.
Extremely short or no waiting time in the waiting area
25. Diagnosis and Treatment Plan
Try to find the cause of the problem and discuss with
patient rather than just trying to pick up that handpiece
Make a preventive programme for the patient
Make a comprehensive treatment plan in phases
Emergency
Stabilization
Maintenance
Definitive
26. During the treatment
Duration, only as much as patient can tolerate
Making sure patient feels he/sheis in command
Better to have a short and simple procedure first
to gain patient’s confidence
Pain free
Topical gel
Local anesthesia; Buffered, warm, slow, 30G needle
27. Vocal Sedation
“I will be careful.”
“You may feel a slight sting.”
“I will make the area numb so that it is comfortable for
both, you and me.”
“I will apply this strawberry surface anesthetic first and
youwill hardly feel anything.”
“I am slowly putting some solution inside so that you
will not feel a thing.”
28. Vocal Sedation
• Avoid “needle”, “hurt”, “sharp”
• Talk to them as you go through the procedure.
• It will make them feel more relaxed and compliant.
• Don’t forget smiling
29. Post Treatment
Clear verbal and writteninstructions
Pain control medications
Phone number of the treating doctor (to call in case
of emergency)
Protocol for referral if needed