Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

management of the anxious patients in dental office

1,825 views

Published on

management of the anxious patients in dental office

Published in: Health & Medicine
  • Be the first to comment

management of the anxious patients in dental office

  1. 1. Management of the anxious patients Assist.Prof.Dr.Alper KAYA RAK College of Dental Sciences RAK Medical & Health Sciences University
  2. 2. Stress  A physical, chemical or emotional factor that causes bodily or mental tension and may be a factor in disease causation  Factors that tend to alter an existent equilibrium  Cause of ¾ Medical Emergencies in Dentistry
  3. 3. Stages of Stress Response Stage 1: One of the 5 senses sends stimuli to the brain .
  4. 4. Stages of Stress Response Stage 2: Brain analyzes it as a ‘Threat’ or ‘No Threat’
  5. 5. Stages of Stress Response Stage 3: Body aroused until threat is over .
  6. 6. Stages of Stress Response Stage 4: Body returns to homeostasis (calm) once threat is gone.
  7. 7. Scope of the Problem • Dental Fear • Dental Anxiety • Dental Phobia
  8. 8. Scope of the Problem Dental Fear • Fear is a natural, adaptive reaction and is supposed to protect us against danger. • Our response to the feeling of fear consist of three parts; a physiologic, a cognitive and a behavioral component.
  9. 9. Scope of the Problem Dental Fear • The physiologic component consists of an activation of the sympathetic nerve system with an increased adrenalin-level, which can lead to sweating, increased heart beating and stomach problems. • The cognitive component involves negative thinking, like “this is dangerous – I might die – I need to get away”,
  10. 10. Scope of the Problem Dental Fear • The behavioral part of the response will involve trying to fight the situation or getting away from it. • The fear is nevertheless controllable and the person is capable of coping and thinking rationally.
  11. 11. Scope of the Problem Dental Anxiety • The anxiety response is almost identical to the fear response, both having a physiologic, a cognitive and a behavioral component. • The main difference is the nature of the stimulus which will trigger the reaction, and how powerful the reaction is to the given threat.
  12. 12. Scope of the Problem Dental Anxiety • The anxious patient will still know that the anxiety is an irrational and greatly exaggerated reaction, and will often, despite of the anxiety, actually come to the dental clinic
  13. 13. Scope of the Problem Dental Phobia • Phobia is a well-defined illness, and there are very specific criteria of what is defined as odontophobia
  14. 14. Scope of the Problem Dental Phobia • Odontophobic persons will usually not go to a dental clinic at all, or at the most only when they have an unbearable tooth ache. • Often they cease brushing their teeth, because looking at the teeth is a constant reminder of not going to the dentist –a feeling which gives them great discomfort.
  15. 15. Scope of the Problem Dental Phobia • Not going to the dentist often gives an increased treatment need, and hence their anxiety and shame increase even more. • Often they evolve a social phobia as well, because of their bad tooth condition or –function, and their phobia affects their everyday life to a great degree.
  16. 16. Anxiety  Release of epinephrine, nor-epinephrine  ⇧ HeartRate  ⇧ Blood Flow  ⇧ Respiration  Vasodilatation in the periphery (arms and legs)  ⇧ Serum Glucose Level
  17. 17. Signs of Acute Anxiety  Cold, sweaty palms or forehead  Flushing of face  Altered facial expression such as bulging eyebrows  Dry mouth orincrease in salivation  Bruxism or clenching of teeth  Increased need to urinate  Unnaturally stiff posture
  18. 18. Signs of Acute Anxiety  Inability to sit still  Trembling or tremors  Fiddling with items in his/her hands  White-knuckle syndrome  Tapping feet or fingers  Crying out or moaning  Hyperventilation, syncope, nausea or vomiting  Increased respiration, blood pressure, and heart rate
  19. 19. First Consultation  Get to know the patient  Try to be friend him/her  Medical History  Discuss likes and dislikes, acknowledge feelings Empathy  Understand him/her well-it’s a long term affair...
  20. 20. Medical History  Written, signed and verbal  Categorization as per ASA PS Score  Check vitals
  21. 21. Communication  Let them talk  Be a good listener  Show interest in their conversation  At an eye level  Away from the equipment
  22. 22. Iatrosedative Technique  “Making the patient calm by the dentist’s behavior, attitude, and communicative stance “  A dentist can use to achieve this include making efforts to avoid pain, giving the patient control and keeping the patient informed of what the dentist is planning to do, and what sensations the patient may experience
  23. 23. Iatrosedative Technique  The dentist should have some flexibility in the choice of language, speed and attitude in order to adapt the communication to the individual patient.  Full clarity about the expectations and demands placed on the patient at any time, is also necessary and helpful for the patient
  24. 24. AnxiousPatient  Short morning appointment followed by a good morning breakfast  Pre-medication with Lorazepam 1mg (check interaction with other drugs) night before sleep followed by 90 minutes prior to procedure • No driving • Need to be accompanied by friend/relative etc.  Extremely short or no waiting time in the waiting area
  25. 25. Diagnosis and Treatment Plan Try to find the cause of the problem and discuss with patient rather than just trying to pick up that handpiece Make a preventive programme for the patient Make a comprehensive treatment plan in phases Emergency Stabilization Maintenance Definitive
  26. 26. During the treatment  Duration, only as much as patient can tolerate  Making sure patient feels he/sheis in command  Better to have a short and simple procedure first to gain patient’s confidence  Pain free Topical gel Local anesthesia; Buffered, warm, slow, 30G needle
  27. 27. Vocal Sedation “I will be careful.” “You may feel a slight sting.” “I will make the area numb so that it is comfortable for both, you and me.” “I will apply this strawberry surface anesthetic first and youwill hardly feel anything.” “I am slowly putting some solution inside so that you will not feel a thing.”
  28. 28. Vocal Sedation • Avoid “needle”, “hurt”, “sharp” • Talk to them as you go through the procedure. • It will make them feel more relaxed and compliant. • Don’t forget smiling
  29. 29. Post Treatment  Clear verbal and writteninstructions  Pain control medications  Phone number of the treating doctor (to call in case of emergency)  Protocol for referral if needed

×