2. Stressa physical, chemical, or emotional factor thatcauses bodily or mental tension and may be afactor in disease causationfactors that tend to alter an existent equilibriumCause of 3/4 Medical Emergencies in Dentistry
3. Stages of Stress Response Hans Selye Stage 1: One of the Five senses sends stimuli to the brain Stage 2: Brain analyzes it as a ‘Threat’ or ‘No Threat’ Stage 3: Body aroused until threat is over Stage 4: Body returns to homeostasis (calm) once threat is gone.
4. Anxiety:StressRelease of epinephrine, nor-epinephrine Heart Rate Blood Flow Respiration Vasodilatation in the periphery (arms and legs) Serum Glucose Level
5. Signs of Acute AnxietyCold, sweaty palms or foreheadFlushing of faceAltered facial expression such as bulgingeyebrowsDry mouth or increase in salivationBruxism or clenching of teethIncreased need to urinateUnnaturally stiﬀ posture
6. Acute AnxietyInability to sit stillTrembling or tremorsFiddling with items in his or her hands“White-knuckle” syndromeTapping feet or ﬁngersCrying out or moaningHyperventilation, syncope, nausea, or vomitingIncreased respiration, blood pressure, and heartrate
7. Stress Reduction in Dentistry Pre-Treatment Peri-Treatment Post-Treatment Medical History Iatrosedation Written Instructions ASA PS Relaxation TechAnxiety Reduction Music, Aroma, Analgesics MDAS MassageProper Rest / Diet Transportation Hypnosis Follow-up Telephone Medication Acupuncture Short Morning Local Anaesthetic Referral, if needed Appointment followed by Topical
8. First ConsultationGet to know the patientTry to befriend him/herThorough Medical History Written Verbal (Re-enforced)Discuss likes and dislikes, acknowledge feelingsEmpathyUnderstand him/her well - it’s a long term aﬀair...
9. Medical HistoryWritten, signed and verbalCategorization as per ASA PS Score ASA I A normal healthy patient ASA II A patient with mild systemic disease ASA III A patient with severe systemic disease ASA IV A patient with severe systemic disease that is a constant threat to lifeCheck vitals
10. CommunicationLet them talkBe a good listenerShow interest in their conversationAt an eye levelAway from the equipment
11. ExaminationDo a thorough check-up including; examination of Extra-oral: TMJ, Lymph Nodes, abnormalities (A gentle palpation of the area ensuring that you care.) Intra-oral: Soft Tissues Occlusion Periodontal Tissues Teeth
12. Diagnosis and Treatment PlanTry to ﬁnd the cause of the problem and discuss withpatient rather than just trying to pick up that handpiece...Make a preventive programme for the patientMake a comprehensive treatment plan in phases Emergency Stabilization Maintenance Deﬁnitive
13. Modiﬁed Dental Anxiety Scale MDASHelps us to recognize the level of anxiety inpatientsPlan treatment accordingly
14. Anxious PatientShort Morning Appointment followed by a goodmorning breakfastPre-medication with Lorazepam 1mg (checkinteraction with other drugs) night before sleepfollowed by 90 minutes prior to procedure No driving Need to be accompanied by friend/relative/ escortExtremely short or no waiting time in the waitingarea
15. During the treatmentDuration, only as much as patient can tolerateMaking sure patient feels he/she is in commandBetter to have a short and simple procedure ﬁrstto gain patient’s conﬁdencePain free Topical Gel Local Anaesthetics with 30G needle, slow, warmIatrosedation
16. IatrosedationVocalMusic Relaxation TechniquesAroma Deep BreathingMassage Guided ImageryHypnosis Progressive RelaxationAcupuncture
17. Vocal Sedation“I will be careful.”“You may feel a slight sting.”“I will make the area numb so that it is comfortablefor both, you and me.”“I will apply this strawberry surface anesthetic ﬁrstand you will hardly feel anything.”“I am slowly putting some solution inside so thatyou will not feel a thing.”
18. Vocal SedationAvoid “needle”, “hurt”, “sharp”Talk to them as you go through the procedure.It will make them feel more relaxed and compliant.
19. Post TreatmentClear verbal and written instructionsPain control medicationsPhone number of the treating doctor (to call incase of emergency)Protocol for referral if needed
20. Friend for life...Relationship between a patient and a dentist is theone that is made for life.Helping people in making their quality of life,better...You treat patients well, and they will treat you well.Respect is a 2 way street. You get what you give...
21. MDAS ScaleCAN YOU TELL US HOW ANXIOUS YOU GET, IF AT ALL, WITH YOUR DENTAL VISIT? PLEASE INDICATE BY INSERTING ‘X’ IN THE APPROPRIATE BOX
22. 1. If you went to your Dentist for TREATMENT TOMORROW, how would you feel? Not Slightly Fairly Very Extremely Anxious Anxious Anxious Anxious Anxious ! ! ! ! !2. If you were sitting in the WAITING ROOM (waiting for treatment), how would you feel? Not Slightly Fairly Very Extremely Anxious Anxious Anxious Anxious Anxious ! ! ! ! !
23. 3. If you were about to have a TOOTH DRILLED, how would you feel? Not Slightly Fairly Very Extremely Anxious ☐ Anxious ☐ Anxious ☐ Anxious ☐ Anxious ☐ 4. If you were about to have your TEETH SCALED AND POLISHED, how would you feel? Not Slightly Fairly Very Extremely Anxious ☐ Anxious ☐ Anxious ☐ Anxious ☐ Anxious ☐ 5. If you were about to have a LOCAL ANAESTHETIC INJECTION in your gum, above an upper back tooth, how would you feel? Not Slightly Fairly Very Extremely Anxious ☐ Anxious ☐ Anxious ☐ Anxious ☐ Anxious ☐
24. Instructions for scoringThe Modiﬁed Dental Anxiety Scale. Each item scored asfollows:Not anxious = 1Slightly anxious = 2Fairly anxious = 3Very anxious = 4Extremely anxious = 5Total score is a sum of all ﬁve items, range 5 to 25: Cutoﬀ is 19 or above which indicates a highly dentallyanxious patient, possibly dentally phobic.