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Concept in Pain and Anxiety Management in Dental Clinic

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Concept in Pain and Anxiety Management in Dental Clinic

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    1. Concept in Pain and Anxiety Management in Dental Clinic

    3. Would you like going to see your dentist…..?!

    9. Fear Short-lived phenomenon, disappearing when the external danger or threat passes. Feeling that something terrible is going to happen. Reaction occurring at the dental office. (Milgrom et al. 1985)

    10. Basic fears Fear of pain Fear of the unknown Fear of helplessness and dependency Fear of bodily change and mutilation Fear of death

    11. Anxiety A specific unpleasurable state of tension which indicates the presence of some danger to the organism. (Weiss and English 1957) Reactions that develop in anticipation of or at the thought of something eg. dentistry

    12. Fear / Anxiety Fear A response to an immediate threat. The reaction occurring at the dental office. Anxiety Reactions that develop in anticipation of or at the thought of dentistry.

    13. FEAR of Dentistry Indirect measure of the failure of current therapeutic approaches to reduce pain and anxiety sufficiently to enable people to visit the dentist.

    14. Fear of dentistry is still prevalent. Fearful people would seek oral health care more regularly if GA or conscious sedation were more readily available. Fear of dentistry in the general population

    18. The most frequently reported emergency (887 GP dentists in northern England) Girdler NM, Smith DG. Prevalence of emergency events in British dental practice and emergency management skills of British dentist. Resuscitation 1999;41:159-67 Vasovagal syncope (1.9 cases/dentist/year) Hypoglycemia (0.17) Angina (0.17) Epileptic fit (0.13) Choking (0.09) Asthma (0.06) Hypertensive crisis (0.023) Anaphylaxis (0.013) Myocardial infarction (0.003) Cardiac arrest (0.002)

    20. Vicious cycle of fear / anxiety Moore et al. BMC Psychiatry 2004 4:10.

    21. Dental t(h)reat(en)ment Oral examine with a sharp instrument. Filling the cavity with a noisy drill. Remove the saliva stone with a sharp, noisy and tinkling handpiece. Removal one or more teeth after injection. Minor oral surgery such removal wisdom tooth.****

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    24. Therapeutic goals of oral and maxillofacial surgery Alleviate pt’s fear and anxiety. Sedate and calm patient intraoperatively. Minimize spontaneous movements intraoperatively. Alter patient’s recall (antegrade amnesia)

    25. Therapeutic goals of oral and maxillofacial surgery Maintain protective reflexes. Allow rapid and complete recovery in OPD case. Achieve safe and effective pain and anxiety control (intra / postoperatively)

    26. Patient with a wisdom tooth Accept to undergo operation Fearless Can not tolerate the symptoms such pain or dysphagia Severe complication Postpone or cancel the operation Fear and anxiety Socio-economic problem Wait until it develops any consequence

    27. How can a dentist evaluate anxiety of a patient? History taking and physical examination Corah’s Dental Anxiety Scale (DAS) Kleinknecht’s Dental Fear Survey (DFS)

    28. Recognition of anxiety Medical history questionnaire Art of observation** Anxiety/fear ? exacerbation of medical problems; angina, seizures, asthma, hyperventilation, vasodepressor syncope. Usual feeling ? Fear is irrational, childish. Irrational =???????????Irrational =???????????

    29. Art of observation Shaking hands ? presumption of anxiety (cold and sweaty palms) Sit at the edge of the chair Eyes roaming around Unnaturally stiff posture Nervously play with a handkerchief or tissue White-knuckle syndrome Diaphoresis (sweating) of palms/forehead

    30. Corah’s Dental Anxiety Scale (DAS) Corah NL. Development of a Dental Anxiety Scale. J Dent Res. 48:596; 1969.

    31. Stress-Reduction Protocols Minimize stress during treatment Decrease the risk Prevention and reduction of stress Pre-operative Intra-operative Post-operative

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