**3. Dental anxiety and its consequences to oral health-care attendance and delivery**

Generally, dental procedures take a couple of minutes to accomplish, and therefore require a patient to be calm and cooperative in the dental chair. Unfortunately, this is not always the case, since some patients are apprehensive probably because most procedures are either believed or are actually associated with some degree of pain to the patient. Furthermore, dental patients are usually "alert" or "not ill," thus in full perception of all that is happening. This situation contributes to acquisition of dental anxiety.

## **3.1. Influence of dental anxiety on dental attendance and oral health status**

It has been observed that individuals with dental anxiety tend to fail to keep appointments, avoid attending to a dentist for dental care or complying with prescribed treatment [35]. This tendency cuts across all individuals regardless of their socioeconomic status or geographical location. Dental anxiety is also associated with poor dental health conditions [36]. Research shows that anxious patients possess poor oral health when compared to nonanxious counterparts in terms of decayed, missing, and filled teeth [37]. Moreover, poor oral health conditions negatively impact individuals' quality of life [38, 39]. Generally, dental anxious patients have been viewed as unreliable and of poor economic risk [26].

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

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

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 management goals.

## *3.2.1. Provider perspective*

• 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

• For patients whose anxiety is induced by a needle, computer-controlled local anesthesia can be used; or electronic dental anesthesia, wherein anesthesia is achieved based on "gate-control theory of pain," with no use of a needle. This method, though, is expensive

• Adults could also be referred for group therapy with specialist psychologist and behavioral

A patient will calm down, hence be receptive of oral health information provided for his/her own benefit. Furthermore, the patient will allow receiving the required treatment. Ultimately, the patient will be positively motivated, on a long-term basis and thus acquire positive atti-

This will assist service provider to be at peace, hence facilitate accurate provision of the required treatment. The whole scenario will, eventually, minimize occupational stress.

Generally, dental procedures take a couple of minutes to accomplish, and therefore require a patient to be calm and cooperative in the dental chair. Unfortunately, this is not always the case, since some patients are apprehensive probably because most procedures are either believed or are actually associated with some degree of pain to the patient. Furthermore, dental patients are usually "alert" or "not ill," thus in full perception of all that is happening. This situation

It has been observed that individuals with dental anxiety tend to fail to keep appointments, avoid attending to a dentist for dental care or complying with prescribed treatment [35]. This tendency cuts across all individuals regardless of their socioeconomic status or geographical location. Dental anxiety is also associated with poor dental health conditions [36]. Research shows that anxious patients possess poor oral health when compared to nonanxious counterparts in terms of decayed, missing, and filled teeth [37]. Moreover, poor oral health conditions negatively impact individuals' quality of life [38, 39]. Generally, dental anxious patients have

**3. Dental anxiety and its consequences to oral health-care attendance** 

**3.1. Influence of dental anxiety on dental attendance and oral health status**

relaxation therapy methods.

40 Anxiety Disorders - From Childhood to Adulthood

and requires special training.

therapist.

*2.4.3. Benefits to patients*

tudes toward dentistry.

**and delivery**

*2.4.4. Benefits to practitioner*

contributes to acquisition of dental anxiety.

been viewed as unreliable and of poor economic risk [26].

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

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

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].

are of paramount importance. Therefore, the provider and dental team at large should strive to intentionally acquire these characteristics, which will lead to having positive behavior toward

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

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

43

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**).

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

patients, particularly to be understanding to anxious ones.

This is a sole responsibility of the dental team [48].

*3.3.3. Modification of dental clinic environment*

by courtesy of Dr. Gustav Rwekaza).

*3.3.2. Modification of patient characters*
