The Psychology of Treating Child Patients

Brandy A. Lopez

Project Design

Child patient and dental staff observation

Dental staff survey

College student survey

Introduction

In the United States it was found that 23% of 895 5-11 year olds showed dental anxiety.

Dental anxiety occurs via 3 pathways:Direct conditioningModeling

Maternal Dental AnxietyInformation/Instruction

Non-Physical Behavioral Management

American Academy of Pediatric Dentistry: voice control, distraction and social learning theory

Dental Terminology Word Substitutes

Rubber dam Rubber raincoat

Rubber dam clamp Tooth button

Rubber dam frame Coat rack

Sealant Tooth paint

Topical Fluoride Gel Cavity Fighter

Air syringe Wind gun

Water syringe Water gun

Suction Vacuum cleaner

Alginate Pudding

Study Models Statues

High Speed Whistle

Low Speed Motorcycle

Physical Behavior Management

American Academy of Pediatric Dentistry:

Papoose board

Sedation35%

Results:Dental Staff Survey

Majority consensusThe behavior of the parent/guardian that brings the child

affects the behavior of the child.

Social learning theory (tell-show-do technique) is a vital element in acquiring child cooperation.

It is possible to diagnose the level of dental anxiety of a patient within the first few minutes of meeting with dental caregiver.

Having the television on relaxes the patient.

Low D

enta

l Anxie

ty

Moder

ate D

enta

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High Den

tal A

nxiety

Don't

Know0

10

20

30

40

50

60

70

Norman Corah's Dental Anxiety Scale:

SLU College Students

NC Part 1

NC Part 2

NC Average

Surv

ey A

nsw

er P

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Results: College Student Survey

55.12% of college students have low dental anxiety

21.97% of college students have moderate dental anxiety

18.32% of college students have high dental anxiety

Greatest anxiety triggers: Waiting for the dentist to begin drilling on the patient’s

teethRoot canal treatmentNot being numb enough for the treatment procedure

References

1 Miligrom P, Mancl L, King B, Weinstein P. Origins of childhood fear. Behav Res Ther 1995; 33: 313-329.2 Klingberg G, Berggren U, Carlsson SG, Noren JG. Child dental fear: cause-related factors and clinical effects. Eur J Oral Sci 1995; 103: 405- 412. 3 Klingberg G, Berggren U. Dental problem behaviors in children of parents with severe dental fear. Swed Dent J 1992; 16: 27-32.4 American Academy of Pediatric Dentistry. Guidelines 2001-02. Chicago, IL: AAPD, 2002.5 Bandura A. Social Learning Theory. Morristown, NJ: General Learning Press, 1971.

Discussion: Are you afraid of the dentist?

1. If you had to go to the dentist tomorrow for a check-up, how would you feel about it? 16.3% a. I would look forward to it as a reasonably enjoyable experience. 41.9% b. I wouldn't care one way or the other. 32.6% c. I would be a little uneasy about it. 4.7% d. I would be afraid that it would be unpleasant and painful. 4.7% e. I would be very frightened of what the dentist would do. 2. When you are waiting in the dentist's office for your turn in the chair, how do you feel?  39.5% a. Relaxed. 25.6% b. A little uneasy. 16.3% c. Tense. 16.3% d. Anxious. 2.3% e. So anxious that I sometimes break out in a sweat or almost feel physically sick. 3. When you are in the dentist's chair waiting while the dentist gets the drill ready to begin working on your teeth, how do you feel?  23.3% a. Relaxed. 34.9% b. A little uneasy. 16.3% c. Tense. 20.9% d. Anxious. 4.7% e. So anxious that I sometimes break out in a sweat or almost feel physically sick. 4. Imagine you are in the dentist's chair to have your teeth cleaned. While you are waiting and the dentist or hygienist is getting out the instruments which will be used to scrape your teeth around the gums, how do you feel?  32.6% a. Relaxed. 34.9% b. A little uneasy. 14.0% c. Tense. 18.6% d. Anxious. 0% e. So anxious that I sometimes break out in a sweat or almost feel physically sick.

Key to Scoring the Dental Anxiety Scale:

a = 1, b = 2, c = 3, d = 4, e = 5 Total possible = 20

Anxiety rating: 9 - 12 = moderate anxiety but have specific

stressors that should be discussed and managed 13 - 14 = high anxiety 15 - 20 = severe anxiety (or phobia).