**2.4. Management of dental anxiety**

When managing a patient with dental anxiety, utilization of different measures to counter anxiety will depend on the patient's history, age, and cooperation. In all instances, a dental care provider needs to portray behavior that will contribute to reducing anxiety to the patient. These include, but not limited to, being composed and relaxed, friendly to the patient, avoiding being judgmental or instilling pain, being supportive and encouraging to the patient, and working efficiently [26, 29]. Different measures are employed in managing patients with dental anxiety as explained below according to the age group of the patient.

### *2.4.1. Management in children*

causes include past dental experience, pain, influence of family, or peer experience and personality, whereas provider-related causes include communication techniques and provider's bad behavior. Environmental-related causes include sounds of drills or other apprehensive patients, unpleasant smell/clinic area, and sight of blood or local anesthetic injections [26].

The importance of proper diagnosis of dental anxiety cannot be underrated. Identifying anxious patients helps a dental care provider to plan for appropriate ways and procedures for managing the patient. Several means have been developed to identify patients who have dental anxiety before treatment is initiated, so as to assist a dentist to provide appropriate treatment with no negative consequences to both the patient and provider. The measures are

Using reliable and easy-to-administer tools for assessment of dental anxiety at the dental setting is beneficial for the dental team [27]. Despite the presence of a number of pretreatment questionnaires for patient administration, very few dental health-care providers utilize them [28]. Using self-reported questionnaire has been reported to be useful to assist in disclosing as well as reducing dental anxiety, as it might be a way for the dental team to gently build rapport with a patient [29]. A number of self-rated tools are available and no single instrument can be regarded as a gold standard set of questions. Mentioned here are the most commonly used and have shown acceptable psychometric properties for use in different languages worldwide. These measures are simple, easy to use, and acceptable to both patients and dental team [30–32]. They include a four-item Corah's dental anxiety scale (CDAS) and a five-item modified dental anxiety scale (MDAS) which proved to be suitable for use among adults. The results can be utilized in grouping patients according to the level of dental anxiety that is *low, moderate,* and *high*. Other measures suitable for use among children are the modified child dental anxiety scale (MCDAS) containing eight questions; and a faces version of the modified child dental anxiety scale (MCDASf) that incorporates facial images on the response format, and this can be used by children as young as 3 years old [27, 29]. Use of questionnaires assists in identifying patients with dental anxiety thus allows planning for possible approaches that can be utilized

grouped into two: *use of questionnaires* and *objective measures* of dental anxiety.

for management of patients, as suggested by Newton and coworkers [33].

Measuring patients' vital signs can add into the identification of patients with dental anxiety at the dental clinic setting. These measures are assessment of blood pressure, pulse rate, pulse oximetry to assess blood oxygen levels which is affected by stress and anxiety, finger temperature, and galvanic skin response that measures skin conductance of weak electric current [29, 34].

When managing a patient with dental anxiety, utilization of different measures to counter anxiety will depend on the patient's history, age, and cooperation. In all instances, a dental care

**2.3. Diagnosis of dental anxiety**

38 Anxiety Disorders - From Childhood to Adulthood

*2.3.1. Use of questionnaire*

*2.3.2. Objective measures*

**2.4. Management of dental anxiety**

In managing children with dental anxiety, the following is suggested:


In highly anxious patients who could not do any of the psychotherapeutics, pharmacotherapy may be indicated such as:


#### *2.4.2. Management in adults and older adults*

All the techniques used in children can be utilized when managing adults with dental anxiety. In addition, the following techniques can be employed:

• Utilization of computer-assisted relaxation learning (CARL), which is a self-paced treatment by patients to cope with dental anxiety (needle specific) without the presence of a therapist.

• Individual systematic desensitization, whereby patients are gradually introduced to a fearful stimulus and learn to cope with anxiety by utilizing another method such as CARL or relaxation therapy methods.

The cycle of dental anxiety (**Figure 1**) explains the interrelationship of the above. Whereby, an individual with dental anxiety is usually worried and anticipates that something bad is going to happen if she/he visits a dentist; thenceforth, tends to delay or avoid dental attendance. This action deprives the individual from receiving dental preventive care and treatment and thus leads to deterioration of oral health, poor oral health status, and poor dental-related quality of life. Poor oral health, coupled with feeling of guilt, shame, inferiority, and worry of being reprimanded by a dentist for oral neglect, further increases dental anxiety and the cycle continues [40, 41]. Failure to provide the required treatment to counter dental anxiety, the vicious cycle will continue. It has been suggested that effective treatment of dental anxiety

Dental Anxiety and Its Consequences to Oral Health Care Attendance and Delivery

http://dx.doi.org/10.5772/intechopen.82175

41

Good oral health-care delivery entails harmonious environment contributed to by both providers and patients as well as dental environment. When either party's attributes are not positive toward reaching a harmonious environment, it may interfere with attaining the intended

Provider's good communication skills coupled with proper use of behavior management techniques as well as positive behavior toward dental patients play a significant role in creating a harmonious dental treatment environment. The reverse may induce dental anxiety or exacerbate the already anxious situation [43]. Ultimately, treatment may take longer or may have to be rescheduled but may also be compromised. Various consequences of this situation include loosing patients, bad provider reputation, and negative professional image, as well as negative economic implications. Consequences affecting the patient directly include eliciting pain and

will improve dental attendance and ultimately the oral health of individuals [42].

**3.2. Influences of dental anxiety on oral health-care delivery**

management goals.

*3.2.1. Provider perspective*

**Figure 1.** The vicious cycle of dental anxiety [40, 41].

