Management Of Dental Fear And Anxiety In Children And Adolescents

Project and Seminar Material for Dentistry

Management Of Dental Fear And Anxiety In Children And Adolescents


Abstract


This study assessed the management of dental fear and anxiety in children and adolescents. The findings revealed that the respondents knew that Dental fear is considered to be aroused by a real, immediately present, specific stimulus (76.8%); Dental fear includes emotions and cognitions (79.0%); Dental fear also includes behavior and physiological reactions (76.4%); Dental anxiety is described as state anxiety as it occurs due to the dental treatment procedure (78.3%); and Dental anxiety is related with negative expectations which are often linked to earlier traumatic experiences (69%). Findings showed the causes to include; Earlier traumatic experiences (87.7%), Negative attitudes in the family (80.2%), Fear of pain and trauma (70.0%), Perceptions of an unsuccessful and/or a painful previous dental treatment (69.1%), Fear of blood-injury (76.8%), Personality Characteristics (77.8%), and Dentist-Patient interactions (79.2%). From the findings, the management measures were shown to include; Personal interaction with health professional (82.9%), Proper education on benefit of dental health (72.4%), Support from family or friends (80.9%), Psychological support and distraction (71.0%), and Internal coping strategies to counteract the negative feelings (85.2%). In conclusion, this study highlights that the utilization of any management approach for dental fear and anxiety in children and adolescents is a function of how one rates his/her dental health.There is a need for close cooperation with children and family in order to overcome educational and knowledge barriers. Since dental anxiety is closely related to daily stressful situations, both of which can influence the behaviour of children in the dental setting, there is a need to address these predisposing and causative factors


Table of Content


Preliminary Page(s)

  • Title Page
  • Declaration
  • Approval
  • Dedication
  • Acknowledgement
  • Abstract
  • Table of Content

Chapter One

1.0 Chapter One

  • 1.1 Background of the Study
  • 1.2 Statement of Problem
  • 1.3 Research Objectives
  • 1.4 Research Questions
  • 1.5 Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Definition of Terms
  • 1.8 Organization of Study

Chapter Two

2.0 Literature Review

  • 2.1 Introduction
  • 2.2 Prevalence of Dental Anxiety
  • 2.3 Causes of Dental Anxiety
  • 2.4 Consequences and Complications of Dental Anxiety
  • 2.5 Psychological Basis
  • 2.5.1 The Freudian Theory of Anxiety
  • 2.5.2 The Behavioural Paradigm
  • 2.5.3 Other Psychological and Physiological Theories of Anxiety
  • 2.6 Dental Fear
  • 2.7 Classification of Dental Fear
  • 2.8 Models of Dental Fear Acquisition
  • 2.9 Dental Phobia
  • 2.10 Factors Involved in Dental Phobia

Chapter Three

3.0 Methodology

  • 3.1 Research Design
  • 3.2 Research Setting
  • 3.3 Target Population
  • 3.4 Sampling Technique
  • 3.5 Instruments for Data Collection
  • 3.6 Method of Data Collection
  • 3.7 Method of Data Analysis

Chapter Four

4.0 Result and Discussion

  • 4.1 Results
  • 4.2 Discussion

Chapter Five

5.0 Conclusion and Recommendation

  • 5.1 Conclusion
  • 5.2 Recommendation
  • References
  • Appendix

Chapter One


1.0 Chapter One

1.1 Background of the Study

Dental anxiety is a fear of going to the dentist that may be a slight or very excessive dread of anything being done to the teeth.1 A review of studies in children and adolescents published in 2007 revealed that prevalence of dental fear and anxiety (DFA) varies from 6% to 20% in 12 different populations, with a mean of 11%.2 DFA is significantly associated with irregular use of dental services, avoiding and delaying dental treatment, and may also be a risk factor for higher caries incidence.3 Therefore, research aimed towards discovering and alleviating DFA may enhance oral health and quality of life. Understanding mechanisms responsible for development of a child’s DFA would help to create appropriate interventions.

A number of factors have been associated with DFA – psychosocial, behavioral, sociodemographic, and genetic. It has been shown that adults have often already acquired dental anxiety from childhood.4 Painful and unpleasant stimuli associated with dental treatment may lead to the development of DFA.5 However, among children with comparable dental history, some have DFA, while others do not.5 Thus, it has coping abilities.9 Since dental treatment is associated with stressful conditions,10 children may use a variety of coping strategies to deal with pain in dentistry.11 Stress has been defined as an orchestrated set of bodily defenses against any form of noxious stimulus, including psychological threats.12 While stress is an inevitable aspect of the human condition, it is coping that makes the big difference in adaptation to stress.13 Coping may be seen as a defense mechanism, which deals with threats to an individual’s psychological integrity.14

Dental anxiety is multifactorial. Research indicates that a child’s dental anxiety is attributed to factors such as the child’s own dental experience, mostly related to intrusive restorative treatments (e.g. extractions) [1] as well as other factors such as parental dental fear, age and gender [2]. These studies are often retrospectively performed in adults who tend to attribute the reason for their dental anxiety to one or more events in their childhood. 25 Many mechanisms for developing dental anxiety refer to conditioning processes [3-5]: the pathways mentioned in the process include, amongst others, aspects such as a person’s dental experience, parental dental fear or modelling by siblings [6]. The mechanism by which the development of dental anxiety can be postponed by initial regular routine visits (latent inhibition) [7, 8] fits in this theoretical network. However, not explained in the pathway theory are aspects that seem to have a mediating role on the development of a child’s dental fear, factors such as a child’s developing personality [9, 10], temperament and trait anxiety [8]. It is these factors, observable at very young age, that seem to play an important role in the occurrence of Behavioural Management Problems (BMP) and the concomitant development of dental anxiety, if not adequately managed [11].

In dentistry, BMP displayed in the treatment room are often mistaken for dental fear. BMP are closely related to dental anxiety and are frequently seen together in the same child. This is often confusing, and a good estimate of the child’s dental anxiety prior to treatment will enable the dentist to adjust the treatment. Restorative treatment for children in the Netherlands is usually not started prior to the age of 4. When a younger child, a toddler, is in need of extensive restorative treatment mostly sedative regimens are utilized [12]. Dental anxiety questionnaires are mostly used from the age of 4, since only after that age are parents able to answer questions on aspects of dental anxiety. Most existing dental anxiety measures are based on behaviour during dental treatment, observed either by the parent or the operating dentist. Because of a lack of experience with dentistry at that age dental anxiety can be difficult to measure. For an adequate estimate of how a child reacts at the dential office, treatment might benefit from tools to assess the abilities of a toddler to deal with new and aversive situations [13], including the way a child reacts in response to behaviour of its parents or other persons directly involved. From this point of view it might be important to assess the relation between early child behaviours, being the result of nature and nurture, and a child’s level of dental anxiety. Use of a structured questionnaire based on day-to-day stressful situations may give the dentist an idea of how the child might cope with the new event of a dental treatment. Furthermore, this assessment may help the dentist to know which children have a greater risk of being anxious about dental treatment or show BMP before the first dental treatment.

Oral health is a fundamental component of overall health. Dental decay has a complex determination and various etiological factors. Diet and bacteria in the dental plaque play an essential role in the development of caries. Interventions in children and adolescents are considered to be very effective, because the disease has a dynamic evolution in a group or in the same subject at different periods of life.Preventive measures for dental caries should be included in the patient’s treatment plan at any age, in order to preserve restorative treatment outcomes and reduce future caries risk.


1.2 Statement of Problem

Children’s uncooperativeness in dentistry has been conceptualized in different ways. Dental fear (DF) and dental anxiety (DA) are used to denote early signs of dental phobia (DP): an excessive or unreasonable fear or anxiety with regard to the challenge/threat of dental examination and treatment, which influences daily living and results in prolonged avoidance of dental treatment [1]. Dental anxiety and fear (DFA) in children has been recognized in many countries as a public health dilemma [2], and has been studied at length. In the late 1960s, Norman Corah developed the Dental Anxiety Scale (DAS), providing an organizing principle to examine this issue [3]. Dental fear is a normal emotional reaction to one or more specific threatening stimuli within the dental situation, while DA denotes a state of apprehension that something dreadful will happen in relation to dental treatment, coupled with a sense of losing control. Dental phobia represents a severe type of DA and is characterized by marked and persistent anxiety in relation either to clearly discernible situations/objects (e.g., drilling, injections) or to dental situations in general [4]. Henry Lautch investigated whether these patients’fear was related to the nature and the characteristics of dental care [5], while Elliot Gale concluded that clinicians needed to assess the situation of the patient, rather than actual pain under any circumstances, when assessing DF [6]. Moore et al compared the overall demographic trends and their relation to the factors and degrees of DF [7]

Among other physical problems seen after birth and persisting into adolescence, toothache due to dental caries often begins in infant. Despite great progress in dental health through dentistry, most youths require dental treatment of various forms. However, teenagers, who are often immature psychologically and physically, can manifest a great fear of dental treatment. Holtzman et al found that, patients for fear of dental treatment missed appointments 3 times more than other patients. They did find that as age increased, fear and anxiety decreased, measured through physiological responses to critical reaction symptoms, such as patients’muscle tension when sitting in the dental chair; further, that younger women expressed more DF than older women, while men reporting DF was unrelated to age [8]. Similarly, many investigators have reported fear of dental treatment in children that may result in treatment management difficulties [9]. Behavior management problems are also related to dental factors, such as earlier negative treatment experiences [10,11], particularly injection, drilling, and extraction, which have been shown to carry the most negative emotional loads [12,13]. Furthermore, the dentist’s attitude toward the pediatric patient is of vital importance for good treatment outcomes [14]. A study of children aged 5 to 11 years by Milgrom et al. [15] suggested that conditioning is an important contributor to DF in childhood and adolescence. Prevalence estimates of childhood DF vary considerably, from 3% to 43% in different populations [4]. However, there are few previous studies examining the relationship of DFA to dental pain among children and adolescents. Thus, the purpose of this study was to examine the management of Dental fear and anxiety in children and adolescents.


1.3 Research Objectives

The main objective of this study is to determine the management of dental fear and anxiety in children and adolescents.

The specific objectives;

  1. To determine the knowledge of dental fear and anxiety management in children and adolescents
  2. To identify the causes of dental fear and anxiety in children and adolescents
  3. To identify the approach in dental fear and anxiety management in children and adolescents

1.4 Research Questions

  1. What is the knowledge of dental fear and anxiety management in children and adolescents?
  2. What are the causes of dental fear and anxiety in children and adolescents?
  3. What is the approach in dental fear and anxiety management in children and adolescents?

1.5 Hypothesis

HO1: There is no significant relationship between knowledge and management of dental fear and anxiety management in children and adolescents


1.6 Significance of the Study

Dental fear is considered to be aroused by a real, immediately present, specific stimulus (e.g. needles, hand pieces), whereas for anxiety, the source of threat is unclear, ambiguous or may not be present immediately. The elements of fear can be divided into two categories: subjective (includes emotions and cognitions) and objective (includes behavior and physiological reactions). One of the most important channel for the child’s behavior is the subjective experience of dental treatment to accept or to avoid treatment. Thus, it is imperative to understand the knowledge of a child’s subjective dental fear rather than consider the objective dental fear; and development of these have to be based on the child’s subjective feeling which must be given its due importance. This study will be significant to children, adolescents, parents, health stakeholders and the society in general.


1.7 Definition of Terms

Dental Fear:

Is a normal emotional reaction to one or more specific threatening stimuli in the dental situation.

Dental Anxiety:

Is indicative of a state of apprehension that something dreadful is going to happen in relation to dental treatment, and it is usually coupled with a sense of losing control.

Management:

Refers to the strategies and measures to control or prevent the complication of dental fear and anxietyin children and adolescents


1.8 Organization of Study

The study comprises of 5 chapters. In chapter one, the concepts are introduced and the problem of the study is established with the research objectives and questions. Chapter two presents the literature review while chapter three presents the research methodology. The fourth chapter presents the results and discussion, and the last chapter presents the conclusion and recommendation.


Chapter Five


5.0 Conclusion and Recommendation

5.1 Conclusion

Dental fear is a complex phenomenon and many factors are associated with its prevalence, causes and maintenance. A nomological network including all the factors related to dental fear underlines the complex and multifactorial nature of this phenomenon. Most of the pathways causing dental fear are based on conditioning. This study assessed the management of dental fear and anxiety in children and adolescents. The findings revealed that the respondents knew that Dental fear is considered to be aroused by a real, immediately present, specific stimulus (76.8%); Dental fear includes emotions and cognitions (79.0%); Dental fear also includes behavior and physiological reactions (76.4%); Dental anxiety is described as state anxiety as it occurs due to the dental treatment procedure (78.3%); and Dental anxiety is related with negative expectations which are often linked to earlier traumatic experiences (69%). Findings showed the causes to include; Earlier traumatic experiences (87.7%), Negative attitudes in the family (80.2%), Fear of pain and trauma (70.0%), Perceptions of an unsuccessful and/or a painful previous dental treatment (69.1%), Fear of blood-injury (76.8%), Personality Characteristics (77.8%), and Dentist-Patient interactions (79.2%). From the findings, the management measures were shown to include; Personal interaction with health professional (82.9%), Proper education on benefit of dental health (72.4%), Support from family or friends (80.9%), Psychological support and distraction (71.0%), and Internal coping strategies to counteract the negative feelings (85.2%).In conclusion, this study highlights that the utilization of any management approach for dental fear and anxiety in children and adolescents is a function of how one rates his/her dental health.


5.2 Recommendation

  1. There is a need for close cooperation with children and family in order to overcome educational and knowledge barriers
  2. Since dental anxiety is closely related to daily stressful situations, both of which can influence the behaviour of children in the dental setting, there is a need to address these predisposing and causative factors
  3. Lastly, proper management strategies and measures should be adopted by parents and children should be encouraged to adopt same

Management Of Dental Fear And Anxiety In Children And Adolescents


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