**2.2. Causes of dental anxiety**

Dental anxiety has a wide range of causes and hence it is considered complex and multifactorial [25]. The causes may be patient, provider, or environment related. The patient-related 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].

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

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

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

39

• Utilize the four "s" principle by reducing triggers of stress. These are *sight* of injections, handpieces, and blood; *smell* of materials such as eugenol; *sound* of drilling or other patients

• Give a sense of control over the procedure by involving the patient during treatment, like

• Provision of relaxation therapy for older children that will assist patients to gain control over their psychological state. The techniques can be given before and even during the procedure. These may include *Jacobsen's progressive muscular relaxation*, *paced breathing* 

In highly anxious patients who could not do any of the psychotherapeutics, pharmacotherapy

• Conscious sedation technique, whereby drugs are provided to render an anxious patient to a depressive state. The routes of application can be oral, sublingual, intramuscular, rectal, and in dental setting with enough resources, intravenous administration, or inhalation

• When the above techniques do not help, the practitioner can refer the patient to a specialist psychologist for further management or can resort to general anesthesia if equipment and

All the techniques used in children can be utilized when managing adults with dental anxiety.

• 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.

as explained below according to the age group of the patient.

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

*2.4.1. Management in children*

• Communicate effectively.

*techniques*.

may be indicated such as:

using nitrous oxide (N<sup>2</sup>

trained personnel are available.

*2.4.2. Management in adults and older adults*

• Allocate enough time for appointment.

• Distract the patient using music, video.

• Reduce pain by giving enough anesthesia.

crying; and *sensation* of vibrating instruments.

to raise hand when feeling pain or uncomfortable.

O) gas.

In addition, the following techniques can be employed:

• Provision of cognitive behavioral therapy (CBT).

### **2.3. Diagnosis of dental anxiety**

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