How to manage Dental Phobia and anxiety ?

Dental phobia and anxiety towards the dentist is an extremely common affliction and it definitely represents a barrier for some patients in achieving oral health.

Pain and dentistry are often synonymous in the minds of those patients.
Even if they know that this fear is totally irrational, they are unable to do much about it. Almost half of patients (48%) in France expressed anxiety during a dental examination. (1).

Patients perceive a good dentist as a practitioner who causes little or no discomfort.

Numerous techniques are available to the dental profession to assist patients in accessing and accepting the dental treatment they require.

In fact, many dental practices have improved at acknowledging dental phobia as an issue that requires intervention.
What are the types of dental phobia ?

Three of the major types of dental phobia are :

-Dentophobia,
-Odontophobia,
-Trypanophobia.

These are related to the dentist, dentistry or receiving dental care, and medical procedures involving injections or hypodermic needles, respectively.

No matter which category a patient falls into, all these fears usually have common points.

Of the most common causes for dentophobia are bad experiences with past dentists or hygienists who were uncaring or harsh with their patients.

A second cause can be the fear of being embarrassed or teased about their dental hygiene or feel helplessness or lack of control .

Otherwise, parents who have also had a fear of dentists may have instilled the fear in their children.

4 ways to manage dental phobia :
The etiology for dental phobia is multifactorial, and hence there is no monotherapy for management.

Proper evaluation of the patient and identifying their source and level of anxiety can enable the dentist in choosing a proper treatment plan.

Non-pharmacological management techniques are essential in treating patients with dental phobia such as :

-deep breathing
-meditation
-distraction (such as listening to music or the use of screens)
-guided imagery
-hypnosis.

However, for a lot of patients, non-pharmacological techniques will require to be supplemented with conscious sedation in order to carry out the treatment with a minimum level of stress.

Sedation :

Sedation is a form of anxiety control used to relax patients and place them in a dreamlike state before any treatment or examination begins.

It is an important fundamental aspect of the modern practice of dentistry and should be available to patients.

It offers a modern alternative to general anesthesia for most dental procedures.

-Oral sedation
-Relative analgesia ( gas and air)
-Intravenous Sedation
-Intranasal conscious sedation

1-Oral sedation :

Medication-induced methods of sedation have been established and were proven to be effective in dental medicine.
These sedatives are active substances from the group of benzodiazepine compounds, which have been used for decades as tranquilizers.
The most popular medications used are:

Valium® (active substance diazepam)
Dormicum® (active substance midazolam)
Restoril® (active substance temazepam)
2-Relative Analgesia or Nitrous Oxide Sedation
Relative Analgesia or Nitrous Oxide Sedation is a carefully controlled technique which allows dental treatment to be performed with minimal stress.

RA is a mixture of Nitrous Oxide gas and Oxygen which is delivered through a comfortable fitting nose mask. The patients breaths the gas in during their dental treatment, the effect is a feeling of relaxation, tingling and a sense of floating.

3-Intravenous Sedation

This type of sedation involves receiving medication through a drip placed into a vein of the arm or hand.
Intravenous (IV) sedation is provided by a dental sedationist (a dentist with advanced training in sedation) or an anaesthtist.
It can be undertaken at a dental practice that has additional equipment, or in a hospital.
4-Intranasal conscious sedation :

Intranasal administration of sedative medications is taking advantage of the highly vascularized mucosa of the nasal and sinus cavities to quickly disperse either local or systemically-active substances.
The most commonly used drug is midazolam which can also be administered intranasally.
To conclude , we may say that dental phobia can have many impacts on a person’s quality of life, and hence it is imperative to identify and alleviate these significant obstacles to pave the way for better oral health and overall well-being of the individual.

It is the duty and responsibility of the dentist to provide excellent dental care to patients with special needs.

Source:

Étude OpinionWay, Doctolib mars 2015

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