*3.3.2. Modification of patient characters*

contributing to patients' unpleasant dental experience. Handling an anxious patient when not prepared has been reported to add stress on the dentist and the dental team as a whole [44].

Delaying, rescheduling, or avoiding dental visit due to dental anxiety leads to seeing a dentist only when it is inevitable, which may end up into a need for complicated treatment [36]. The latter might bring about more anxiety, failure to abide to instructions, or comply to preventive care hence exaggerate oral health problems [43]. Unfortunately, causes of dental anxiety such as personality, past dental experience, or family/peer influence are basically out of patients' control. Therefore, they need to be assisted to overcome the anxiety, which is a sole responsibility of the dental team. The dental team should have a broad approach on patient's needs, not be judgmental while managing the patient, instead do all that is required to allay the

Dental environment is generally perceived by patients to be unfriendly, offensive, and anxietyprovoking, especially so by anxious patients. The looks of the dental chair and its accessories may not give an appealing first impression. Smell of the medicaments as well as invasive contact in the mouth, sound of the drill, sight of blood are some of the situations that most patients may have difficulties to tolerate [45]. The dental environment condition, coupled with the nature and duration of dental treatment procedures, may bring about or amplify patient dental anxiety. This situation will interfere with delivery of dental care. It is, therefore, the responsibility of the dental team to make sure that the dental environment is friendly to patients with or

Like in any other disease/condition, prevention before development of dental anxiety is important for effective management of patients. This may entail putting in place modifications to address operators, patients, or dental clinic environment concerns. Further to this, strategies

Operators/dental team character plays a big role in determining future behavior of dental patients. Particularly, what the patient experiences at his/her first visit to a dentist is what shapes his/her attitudes with dental care services [46]. Positive behavior of operator and the dental team will automatically influence positive attitudes and minimize chances for dental anxiety. On the contrary, a bad operator/dental team behavior may induce, as well as exaggerate, dental anxiety in patients [43, 47]. To prevent operators/dental team from inducing dental anxiety, starting from the moment the patient enters the dental clinic to exiting, it is advisable for the team to have good communication skills, be sympathetic, have empathy, and be able to control temper. To make this happen, proper training and continuing education on prevention of dental anxiety

patient's anxiety, thus facilitating provision of proper care.

*3.2.2. Patient perspective*

42 Anxiety Disorders - From Childhood to Adulthood

*3.2.3. Environmental perspective*

without dental anxiety.

**3.3. Prevention of dental anxiety**

aiming at the community may be critical.

*3.3.1. Modification of operator characters*

Every dental patient has his/her own preconceived ideas about dental care. Apparently, each patient might be anxious depending on his/her personality trait, past dental experience, influence from family and peers, etc. Therefore, all patients attending the dental clinic should be calmed down and be made to relax regardless of whether the patient is anxious or not, (**Figure 2a** and **b**). This is a sole responsibility of the dental team [48].

#### *3.3.3. Modification of dental clinic environment*

Most patients consider the dental environment to be unfriendly and anxiety provoking. For this reason, various efforts have been made by dental professionals to modify the environment so as to counter that effect (**Figures 3** and **4**). The efforts include avoiding white uniforms by using attractive colorful attire, minimizing bright lights, playing soft/relaxing music, placement of nondental attractions in waiting rooms, making reception and waiting rooms colorful for children, minimizing noise from dental instruments/equipment by sound proofing the operating rooms, and intentionally engaging a receptionist who is charming, positive, and having caring attitudes to patients. Other measures are utilization of aromatherapy and sensory-adapted dental environment (SDE). Aromatherapy in dental settings is done using essential oils, the most common ones being smell of orange and lavender. Lavender smell has been shown to produce positive physiological and pharmacological effects which proved to

**Figure 2.** (a) A 7-year-old child presenting with dental anxiety trying to stop the doctor from performing oral examination. (b) The same child while a dentist employs behavior management techniques to allay the child's dental anxiety (pictures by courtesy of Dr. Gustav Rwekaza).

dental anxiety or negativity toward dentistry. Furthermore, it is beneficial to empower the community to prevent dental diseases, to encourage them on the importance of regular visit to a dentist for checkup, and to strongly disapprove the use of dental visit/services as punitive measure or to shape behavior [24, 48]. Moreover, population screening for dental anxiety will assist in identifying those who are affected thus earmarking them for preventive intervention.

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

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

45

Dental anxiety is a problem affecting populations of all ages, from all geographical locations. It affects individuals' oral health status, interferes with dental attendance and service delivery. Dental professionals, therefore, have a major role to play in the management and preven-

**1.** Dental professional associations and dental teaching institutions should conduct workshops and continuing education and professional development (CPD) courses for the

**2.** Dental professionals to educate themselves on the different options of management and

Authors acknowledge funding support by Swedish International Development Agency (Sida)

Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania

tion of dental anxiety among dental patients and the community at large.

dental fraternity on management and prevention of dental anxiety.

through Muhimbili University of Health and Allied Sciences (MUHAS).

The authors of this chapter declare no conflict of interest.

Irene Kida Minja\* and Febronia Kokulengya Kahabuka \*Address all correspondence to: ikminja@gmail.com

**3.** Dental professionals to educate community on dental anxiety.

**4. Conclusions**

**5. Recommendations**

prevention of dental anxiety.

**Acknowledgements**

**Conflict of interest**

**Author details**

We recommend that:

**Figure 3.** A patient-friendly dental clinic reception (picture by Jacob Francis, courtesy of Smiles dental clinic).

**Figure 4.** A child-friendly dental surgery (picture by Jacob Francis, courtesy of Smiles dental clinic).

be effective in reducing state anxiety [49]. Similarly, SDE, which has been utilized and proved to be effective for management of dental anxiety, is also helpful in reducing the anxiety and relaxing the patient [45].

#### *3.3.4. Community prevention*

At community level, prevention of dental anxiety through giving education is a responsibility of the dental team. The education should primarily be directed to children since the onset of dental anxiety often occurs in childhood. This implies that early intervention will help to prevent the problem from extending into adulthood, but adults should also be involved. Among measures of intervention at community level, it is to inform the community on the impact of dental anxiety on individual's oral health status, oral health-care attendance, and service delivery. Another measure is to educate and discourage individuals from sharing their dental fears and/or negative dental experiences in such a way that it may influence others to develop dental anxiety or negativity toward dentistry. Furthermore, it is beneficial to empower the community to prevent dental diseases, to encourage them on the importance of regular visit to a dentist for checkup, and to strongly disapprove the use of dental visit/services as punitive measure or to shape behavior [24, 48]. Moreover, population screening for dental anxiety will assist in identifying those who are affected thus earmarking them for preventive intervention.
