Low levels of dental anxiety can arise from a loss of control and helplessness as a patient. Dentists should provide preparatory information about procedures that need to be done but also include their patients in decision-making. This is very important in one’s dental career because it allows patients to express their right in accepting or refusing treatment. Patient autonomy is one of the key medical principles; dental professionals should abide by and follow .
One way a dentist could achieve this is by agreeing on a hand signal . The patient can stop the dentist at any time during a procedure so they can take a break or rinse their mouth. A patient doesn’t have to signal the dentist to stop a procedure once they feel pain. Having a successful dentist-patient relationship, would give the patient an enhanced sense of control and in the long-run, patients would have more confidence in dentists who have the ability to communicate care and compassion.
INDIVIDUALS WITH MODERATE LEVELS OF DENTAL FEAR:
ANAESTHESIA Dentists evaluate what treatment is required to decide is anaesthetics are needed. Anaesthesia would be an appropriate option to patients with moderate levels of dental fear . Information about different types of anaesthesia should be provided . A local anaesthetic is used during minor procedures where a small area of the body is numbed and you remain fully conscious. This means there will be no sensation in the injected area but the patient will just feel some vibration and pressure. Dentists use thin needles and inject the solution slowly to reduce discomfort and make sure the mouth is numb. If a patient can still feel some sensations, a dentist can wait a few minutes until the solution has taken affect or inject more solution. A general anaesthetic is used for more serious operations where the patient is completely unconscious and unaware of the procedure. After the anaesthetic is given, the injection fades and the sensation is similar to ‘pins and needles’.
INDIVIDUALS WITH HIGH LEVELS OF DENTAL FEAR:
Patients with high levels of dental fear are often referred to dental phobic patients and are more likely to be receiving sedation or attend cognitive behavioural therapy sessions. This is because these individuals delay treatment for so long to the point they are in severe pain and have compromised their oral health. This means they have a higher tolerance of pain than other patients who visit the dentist on a regular basis. However it could be argued that sedation too extreme to use and it is not as effective as cognitive therapy sessions because it would increase feelings of helplessness and loss of control . However Ian McHenry, a specialist doctor, disagrees with this statement. He believes sedation is completely reasonable to use, if a patient wants to be pain-free they can have this option.
COGNITIVE BEHAVIOURAL THERAPY SESSIONS Cognitive behavioural therapy (CBT) is a short-term treatment typically involving six to 10 sessions. It allows one to control their anxiety levels, stop negative thoughts and develop coping and problem-solving skills . An individual can identify their negative thoughts and challenge them with the pros and cons and change their perception of the situation by replacing them with positive more accurate thoughts. A study done by King’s College London, suggested that Cognitive Behavioural therapy sessions had increased dental attendance, reduced dental anxiety and offered effective technique for patients to receive treatment without sedation.
After an average of five sessions, most of the patients could be treated by a dentist without being sedated. Overall, sedation doesn’t help overcome dental fear in the long run but only makes dental phobic patents feel relaxed for a short period of time. However Cognitive therapy sessions are no always available, and the sessions mostly focus on depression and general anxiety as opposed to dental anxiety. Therefore there needs to e a close collaboration with the dental team and Cognitive behavioural therapists so theses sessions can be widely available in the future.
PUBLIC HEALTH INTERVENTIONS: Every £1 spent on giving a patient preventative dental treatment can save at least £8 in intervention. If people have better oral hygiene it will mean they will not be self-conscious about the appearance of their teeth and will be more likely to encounter less invasive treatment so therefore have less traumatic experiences to remember. EDUCATION
Education is an important factor to consider when focusing on dental fear. Patients, who have a high risk of oral disease, are more likely to be living in areas with a lower level of education and are from low-income families. These patients suffer poorer oral health, have more caries in their teeth and therefore need greater treatment. This means many people living in the UK do not visit dentists regularly and are unaware of how to maintain good oral health.
One way the Government could spend on NHS Dentistry is by increasing awareness and to educate people on the implications of bad oral hygiene and persuade people to visit dentists regularly. Patients have to gather accurate information to help judge the truth of their fears, as ‘knowledge can be a powerful weapon against fear’ . A possible suggestion is by organising events such as visiting schools where a charity fundraiser can achieve this with the theme as ‘dental health’ or even advertising. Dentists could also teach students of a young age how to brush their teeth and floss. Another way money can be well spent is to fluoridate water supplies.
WATER FLUORIDATION An example of a public health intervention is water fluoridation. Water Fluoridation is a controversial topic that holds a wide range of views . Fluoride is an element that strengthens the tooth enamel and therefore reduces the risk of caries. Caries is a scientific word for tooth decay, a process involving bacteria in dental plaque metabolising the carbohydrates in the food to produce acid that demineralises the tooth, and eventually leading to cavity formation, which requires complex and quite painful treatment such as fillings and extractions . If tooth decay can be prevented, the cost of NHS dealing with patients would be reduced. At present only certain areas of the UK are fluoridated including parts of the West Midlands, Newcastle and Southampton.
This means that only 10% of the population have fluoridated water, but why is that the case? Many people are against the idea of having fluoridated water because fluoride is poisonous to humans and needs to be controlled. However, the optimum levels of fluoride are only 1 part per million of water – low enough not to cause any side effects. The idea of water fluoridation to some people seems like a mass medication for the whole population, and in theory it shouldn’t be carried out in practice, as every individual requires different and personalised treatment to meet their dental needs. Moreover, too much fluoride can cause fluorosis in developing teeth (sometimes called ‘mottled teeth’), which are white stains that appear on the surface of teeth.
Some people believe it is a breach of their human rights of choice, as the community’s water supplies will contain fluoride despite their possible disagreement with it. Despite this controversy, fluoride is included in many of our daily products that we use to maintain a good level of oral hygiene – toothpastes, mouthwashes and tablets. By advocating this form of public health intervention, in the long run it would definitely stop people from developing a fear towards dentistry as more people will have a better oral hygiene and therefore will not have as many dental problems in the future, making sure vesting the dentist is a pleasurable experience. However it does not combat the problem of reducing or curing people who already have this dental fear from the beginning. TECHNOLOGY:
WAND It delivers anaesthesia in a slow manner and makes the injection painless .
NUCALM TREATMENT It’s perfectly safe as no needles or invasive methods are used during the relaxation treatment. This form of treatment helps dental phobic patients with a high level of dental anxiety to relax their body during a procedure . First the patient chews on GABA tablets. These tablets counterattack the effects of the release of adrenaline that causes the anxiety. Special micro-current patches are placed behind each ear, which send waves to the receptors in the brain for the GABA tablets to take affect. The patient also wears blackout glasses, earphones to listen to soothing music. It mirrors the 1st stages of sleep and it makes visiting the dentist a much more pleasurable experience. After being used on over 13,000 patients in the UK and US, 98% said they would use NuCalm again for dental treatment and 97% would recommend it to a friend or relative .
DVD GLASSES Patients are able to watch films during their dental appointments. This will help them keep their mind off the treatment and become more relaxed. Patients can also bring their own preference for a DVD’s to watch making them feel more at home. This is an example of a distractions technique.
DENTAL LASERS – DIAGNODENT These devices reduce pain, treatment time, the risk of infection and improves healing and accuracy. The Diagnodent uses laser technology and detects early signs of decay meaning there will be a lower risk of decay spreading and damaging the teeth. It is a useful diagnostic tool that is cost-effective, non-invasive and not painful or uncomfortable. It would help patients with higher levels of anxiety because there will be less need for advanced treatment because it reduces the risk of advanced condition. If a condition gets worse, more complex and painful treatment would be needed, for example needles and drills could be used and therefore it would be more expensive.
CT SCANNERS This allows the dentist to plan the best possible treatment for their patient. CT scans provide detailed and accurate images of the teeth and gums. It ensures that an implant is in the exact right place and therefore it reduces treatment time, so more time can be spent giving the patient preventative care advice in how to maintain good oral hygiene. Patients also gain a comprehensive overview of what the treatment entails.
MICROSCOPE This gives acute vision for dentists. This allows dentists to see micro cracks and be able to remove affected tooth structures while preserving a healthy tooth structure.