Search

A random sample of residents of the municipality of Aarhus were telephone interviewed about fear of dental treatment and characteristics of any pre-existing dental anxiety. Results showed that 4.2% of 539 residents surveyed had extreme anxiety and 6% were moderately afraid. Results of dental anxiety, especially in the odontophobic group, were years of avoidance of treatment and associated poor subjective perceptions of oral health. Logistic analyses revealed that although dental drilling was the identifying feature of dental anxiety characteristics, the drill could be symbolic for the many persons who perceived dentists as treating them with putdowns, angry comments and hardhandedness. Other persons suffered from multiple fears, which may have an accumulative effect on dental treatment anxiety. A conceptual model is presented as derived from present results and existing clinical and epidemiologic literature.

Odontophobia is a rather unique phobia with special psychosomatic components that impact on the dental health of odontophobic persons. It also has psychosocial components largely as a result of destruction of the teeth and subsequent embarrassment that can affect a person and cause a vicious cycle of dental fear. The phenomenon is facilitated by misunderstandings and myths generated by both patients and dentists. The most common reasons given in the literature for such strong fears of dental treatment are: 1) bad experiences in childhood for 85% of cases, 2) feeling of powerlessness and lack of control over personal emotional reactions and over the social situation in the dental chair, 3) social learning processes in which the image of the dentist is cast in a negative light by the mass media or by the person's relatives or friends and 4) that the person has other psychologic problems (in 20% of cases), such as serious phobias and/or neuroses. A strategy of researching and thus tackling the problem is presented which focuses on three essential targets that require studying and change: 1) the community at large and their image of the dentist, 2) the patient role and 3) the dentist role. Various model projects are presented along with their diagnostic systems. These are seen to focus in varying degrees on different elements of the target groups that effect the dentist-patient relationship but the need to come out into the community and make the social environment right for these patients is an important factor in all strategies.(ABSTRACT TRUNCATED AT 250 WORDS)

The treatment of odontophobia is often relegated to treatment under general anesthesia as a quick solution, but this has proven to be ineffective in the long run. Other more cognitive approaches include flooding, where the patient learns through courageous participation to endure the fear through several routine dental treatments. Since this can often backfire on the patient, systematic desensitization is preferred, in combination with psychotherapy that is aided by progressive muscle relaxation or fading, biofeedback training or stress inoculation training. Hypnosis can also help the patient to restructure negative thinking towards more positive expectations from treatment. These are all meant to build up the patient's psychic coping resources. Assertiveness training in psychotherapy is used to build up the patient's social skills so that he/she can deal with dental personal in a diplomatic yet self determined way. Finally, modelling good patient behaviors to dental fear patients has been shown to be effective and is especially used by childrens' dentists. Use of sedatives the night before a dental appointment is often helpful and enables some patients with insomnia to be fresh and rested in order to deal with the often strenuous learning processes described above.

The measurement of complex behavioral phenomena like dental fear requires allegiance to two great domains that often seem to conflict with one another: natural scientific method and the seemingly unpredictable human psyche. The need to preserve strict objectivity in scientific observations and yet flexibility enough to appreciate the contextual facets of psychological and social variables are a difficult combination. There are differing scientific philosophies that are presented here not as incompatible opposites, but as a complementary team of approaches to aid human behavioral problem solving in dental clinical science. The "positivistic falsification" tradition requires "objective" double-blind type experimental hypothesis testing, while the "phenomenologic-hermaneutic" tradition requires the researcher to grasp the context of the phenomena to be studied in order to understand and thereafter test the most relevant variables. Thus, there is a need for both traditions, since the relevant variables should be systematically evaluated (qualitative phase) before they can be adequately tested (quantitative phase). Clinical evaluation of dental fear draws on information gathered about a patient's verbal (cognitive) descriptions, behavioral symptoms and physiologic reactions. Commonly used psychometric testing scales developed to differentiate fears specific to dentistry, as opposed to general anxiety syndromes, are the result of observations made in several qualitative studies that not all dental phobics have general anxiety symptoms. Examples of these and other tests are listed and described, noting that verbal and behavioral testing appear more reliable than physiologic indicators. The patient's subjective sense of improvement is deemed to be an important factor in their confidence and efficacy to deal with the threats that the dental environment can bring them.(ABSTRACT TRUNCATED AT 250 WORDS)