Many people with disabilities experience anxiety and fear when they visit the dentist. Some may even have dental phobia.
Anxiety is a general uneasiness about a situation, while phobia involves intense or exaggerated fears and worries. Fortunately, mental health professionals can help patients cope with their anxiety and fear.
Identifying the Problem
Several factors contribute to dental anxiety in special needs patients. Some of these include past experiences, the level of invasiveness of treatment, and expectations and fears that may be present before attending a dental clinic.
In addition, some of these patients have a psychiatric diagnosis, such as generalized anxiety disorder or depression, and are prone to anxiety attacks. In such cases, additional help from a psychologist is required to manage the anxiety effectively.
Anxiety in these patients is genuine, and getting the care they need can be challenging. Often, they will avoid appointments altogether, leading to further tooth decay and the need for more extensive and complex treatment in the future. This can also feed the underlying anxiety, creating an ongoing vicious cycle. Dentists need to understand how to identify and address these issues in special needs dentistry. The first step is to have a calm, uninterrupted discussion with the patient and to find out what causes their anxiety.
Understanding the Patient’s Needs
Several things may be done to calm patients’ fears and make dental procedures more bearable. Some examples are cognitive behavioral therapy, relaxation techniques like deep breathing, and meditation. Some patients find bringing music or other diversions to their appointments helpful.
The patient may occasionally be prescribed medicine to aid with relaxation. This medication is only used after a thorough discussion with the dentist or doctor. The patient must be accompanied to and from the dentist by someone else while under the influence of these drugs.
It is critical to realize that fear and anxiety related to dental procedures can impact people of all ages. However, children with unpleasant dental experiences will probably be more apprehensive as adults. This is because they’ll likely struggle to get past their painful recollections. It is recommended to seek counseling for these individuals if necessary.
Creating a Plan for Treatment
The underlying reason for dental anxiety is complex and can be attributed to external and internal factors. External factors include the attitudes and beliefs of patients regarding dental treatment, as well as social and cultural contexts. Internal factors are related to negative evaluations of past experiences with dental treatment.
Anxiety can be diagnosed using self-reporting fear and anxiety questionnaires, which enable the categorization of patients as mildly anxious, moderately anxious, extremely nervous, or phobic. These questionnaires can be combined with objective assessments such as blood pressure, heart rate, pulse oximetry, galvanic skin response, and finger temperature.
A recent study conducted at a student dental clinic found that a patient’s level of anxiety before treatment was determined by the results of the modified dental anxiety scale (MDAS), which is a set of five questions assessing anticipation of future appointments, sitting in the waiting room, having teeth cleaned and polished, having a tooth removed, and receiving a local anesthetic injection. Patients were also asked to rate the student dentist’s perceived interpersonal skills and clinical ability.
Managing the Anxiety
Dental anxiety can be treated in many ways. A psychologist may be able to help with short, targeted therapy such as cognitive behavior therapy (CBT). Medications can also be used, including anti-anxiety pills, oral sedation or nitrous oxide inhalation analgesia (“laughing gas”), conscious sedation (twilight sedation), and general anesthesia.
Patients and their caregivers should be open about anxiety when talking to dentists. This will allow the dentist to work with the patient to develop a plan to manage stress. Ensuring the dentist knows that the anxiety is about treatment and not the specific doctor or staff is essential.
If anxiety is so severe that it prevents a person from attending regular dental appointments, this can lead to dental disease and emergency dental care. This can further exacerbate the anxiety, creating a vicious cycle. For this reason, avoiding dentistry is never a good idea. Early intervention can often stop this cycle from happening in the first place.
