Fear and anxiety are defined as unpleasant emotions in response to threats. Fear is a response to realistic dangers while anxiety is a response to unknown dangers. Development of fears changes with age from unknown stimuli as infants to social fears as adolescents. Symptoms of fear include increased heart rate and tense muscles. Chronic fear can lead to issues like tiredness and avoidance. Assessment tools for dental fear include questionnaires and scales measuring facial expressions or selected points on an anxiety thermometer. Management of dental fear involves prevention strategies, behavioral treatments, and pharmacologic approaches depending on the level of fear.

2. FEAR AND ANXIETY

3. Fear is defined as an unpleasant emotion or effect consisting of
psycho-physiological changes in response to a realistic threat or
danger to one’s own existence. (Shobha Tandon).
DEFINITIONS

4. • Fear is one of the primary emotions acquired soon after birth.
• The infant, however, is unaware of the nature of the stimulus
producing fear.
• As the child grows and his mental capacity increases, he starts
becoming aware of fear producing stimuli and can adjust to the
isolated experience by resorting to fight if he cannot solve the problem.

5. UPTO AGE 2
o Fear of unknown
o Intense or sudden stimulation of the sense organs than pain
o Noise and vibration of the dental drill and pressure exerted
o sudden and unexpected movements
o Bright lights
DEVELOPMENT OF FEARS

6. Preschool children (2-5years)
oFear of separation from parent
ofear of not having the parent
ogradual decline in the earliest fears such as fear of falling, of
noise and of strangers ?
ofear during this time is the fear of bodily injury

7. Early schooler
oFear of the dark, of staying alone
oFear of supernatural powers
oyoungster at this age is less demanding, more conforming, develops a
marked curiosity about his environment
o6-7 years, at this age most children succeed in coping with dental
treatment

8. The late schooler
oFear of failure
oFear of not being liked
oFear of competition, punishment
oFear of crowds, heights

9. Adolescent:
oFear of social rejection, fear of performance.
oThey are concerned about their appearance. This interest
in cosmetic effect can be used by the dentist as motivation
for seeking dental attention

10. TYPES OF FEAR
GENERAL FEAR
• Active or “Real” fear (objective fear)
• Imagined fear (Subjective fear)
DENTAL FEAR
• Fear of pain
• Fear of loss of control
• Fear of the unknown
• Fear of intrusion
• Fear of betrayal

11. “Real” fear (objective fear)
• Objective fears are those produced by direct physical stimulation of the
sense organs and are generally not of parental origin.
• Objective fears are responses to stimuli that are felt, seen, heard, smelled
or tasted, and are of a disagreeable or unpleasant nature.
• A child who has had previous contact with a dentist and has been managed
so poorly that undue and unnecessary pain has been inflicted necessarily
develops a fear of future dental treatment.

12. Subjective Fear or “Imagined Fear”
• Subjective fears are those based on feelings and attitudes that have been
suggested to the child by others about him without the child’s having had
the experience personally.
• The young inexperienced child, hearing of some unpleasant or pain-
producing situation undergone by apparent or others, soon develops a fear
of that experience.

13. SYMPTOMS OF INTENSE FEAR
• An unpleasant feeling of terror
• An urge to cry or hide
• Pounding of the heart
• Tense muscles
• Dryness of the throat and mouth
• Nauseous feeling
• Urge to urinate (very common in
children)
• Irritability
• Anger
• Weakness
• Sense of unreality

14. CHRONIC FEAR LEADS TO:
• Tiredness
• Difficulty in sleeping and bad dreams
• Restlessness
• Loss of appetite
• Aggression
• Avoidance of tension producing situation

15. PHYSIOLOGICAL SIGNS OF FEAR
• Pale sweaty skin
• Hair standing on end
• Dilation of pupils
• Rapid breathing
• Increased heart rate
• Rising blood pressure
• Increased blood flow through muscles
• Contraction of bladder and rectum.

16. BIOCHEMICAL CHANGES
• Secretion of adrenaline and nor adrenaline
• Increased serum content (Shannon and Isbell, 1963)
• Decrease in circulating blood eosinophils as stress fullness
increased (Ship and white, 1960)
• Increase in free fatty acids and corticosteroids in plasma.

17. FEAR ASSESMENT
Venham picture test (VPT)
The child is presented 8 pairs of pictures of children exhibiting
various emotions and is asked to choose the child that best reflects
his own emotions.
Scores can thus range from 0 to 8

18. Anxiety : Often defined as a state of unpleasant feeling
combined with an associated feeling of impending doom or
danger from with in rather than from without (Shobha
Tandon)
ANXIETY

19. Types
• Trait anxiety is a lifelong pattern of anxiety as a temperament
feature
• State anxiety is a situationally bound state of anxiety that does
not persist beyond provoking situation
• Free floating anxiety is persistently anxious mood in which
cause is unknown
• Situational anxiety seen only in specific situations
• General anxiety is chronic pervasive feeling of anxiousness
whatever the external circumstances

20. • The most common methods employed for measuring anxiety in
patients undergoing dental procedures are:
• Biochemical estimation of plasma catecholamine levels and
corticosteroid levels.
• Using questionnaires before the procedure.
• The skin conduction test, pulse Rate and Blood Pressure.

21. ANXIETY RATING SCALE
PICTORIAL AND RESPONSE CARD
The scale evaluates the child’s fear in the dental set up in different situations
such as:
⁻ Appointment with the dentist
⁻ Waiting for his turn in the dentist’s office
⁻ Dental procedures
The scale give 5 options graded 0 to 4 from relaxed to panic behaviour

22. ANXIETY THERMOMETER
The image of a thermometer where the respondent selects a point
on the thermometer to rate anxiety, where no anxiety, and 10 =
extreme anxiety

23. FACIAL IMAGE SCALE
• Facial image scale (FIS) has a row of five faces ranging from very happy to
very unhappy.
• Children are asked to point at which face they felt most like at the moment.
• The face is scored by giving a value of one for the most positive face and
five for the most negative face.
• Faces four and five indicate high dental anxiety.

24. Fear Anxiety
1. It is a reaction to a
known danger
It is reaction to an
unknown danger (Rubin,
Slovin, Krochak, 1988)
2. An objective source of
danger is present
No objective source of
danger is present
3. It is a primary emotion
acquired soon after birth
It is a learned process and
develops later than fear
4. Fear is realistic Anxiety depends on the
ability to imagine
5. It emanates from the
consciousness
Seated in the sub
conscious
Egs:- fear is the emotion
that a person would
experience when
confronting a large snake
in the woods.
Anxiety is the emotion that
a person would experience
when confronting a large
snake in the zoo.

25. • The role of parents
• Parental presence
• Parent counseling
• Instructions to parent
• Role of pedodontist
MANAGEMENT OF DENTAL FEAR
AND ANXIETY

26. Primary prevention Secondary
prevention
Tertiary behavioral
treatment
strategies
Pharmacologic
management
strategies
Based on environment Behavioral treatment
of
fearful children
Behavioral treatment
of
anxious children
Behavioral treatment
of
uncooperative/handica
pped children
• Pre-appointment
approaches
• A safe, controlled
environment
• Sense of control to
the child
• Introduction of the
child to the dental
office
• Communication
• Euphemisms
• Time-structuring
• Distraction
• Guided imagery
• Behavior
modification
• Parent in the
operatory
• Desensitization
• Modeling
• Tell show do
• Combined
behavioural
Treatments
• Nitrous oxide
sedation
• Oral sedation
• Rectal sedation
• Parenteral sedation
• Aversive techniques
• General anesthesia