Understanding of Dental Phobia

8/13/2019 Understanding of Dental Phobia

1/39

An Understanding ofDental Phobia

A ThesisPresented to

the Chancellor's Scholars COWlcil ofThe University ofNorth Carolina at Pembroke

In Partial Fulfillmentof the Requirements for Completion of

the Chancellor's Scholars Program

byTonya M. JasinskiDecember 9, 1997

Faculty Advisor's Approval ffiW i s ~Date WM \.W 0 1 IQq 1

Co..:\-


2/39

nUnderstanding 1Running head: DENTAL PHOBIA

n Understanding ofDental PhobiaTonyaM. Jasinski

University ofNorth Carolina at Pembroke


3/39

2n Understandingn Understanding ofDental Phobia

Dental phobia, a phobic disorder, is a problem that affects a large number ofindividuals in the United States (Irish, Ginsburg, Clarke, 1994). Phobic disordersare experienced by 77 out of 1,000 people in the general population. A person issaid to have a phobic disorder when he or she attempts to avoid an object, situation,or activity. The object, situation, or activity is avoided because of the enduring,irrational fear that accompanies the situation (Tearnan TeIch, 1984).

Before a phobia can be defmed, it is important to distinguish between theideas of anxiety and fear. Anxiety, fear, and phobias are strongly related, in that thethree concepts may lead to one another. Anxiety involves apprehension and arousal

regarding a future situation. Fear usually occurs as a result of exposure to situationsthat are either real or imagined. Reactions to these situations are often considerednormal. t is common for children to be afraid of things such as darkness, animals,and dentists. A phobia is a form of fear that cannot be controlled voluntarily.Phobias create feelings that are out ofproportion to the actual situation. Usingreasoning to overcome phobias becomes difficult, ifnot impossible. As a result,individuals usually resort to avoidance of the situation that has become feared(King, Hamilton, Ollendick, 1988).


4/39

nUnderstanding 3Tearnan and TeIch 1984) described three groups of phobias: specific, formerly

called simple, social, and agoraphobia. The main focus of this paper will concernspecific phobias. Phobias that are classified as specific allow individuals moreopportunities to dodge their fears because these particular phobias are moreconfmed within boundaries. Examples of specific phobias include fear ofelevatorsand heights. If a person lives in New York City, versus Pembroke, it would beharder to avoid a fear ofelevators or heights. This is because of the many tallbuildings present in New York City.

Specific phobias can be acquired at any age. Tearnan and TeIch 1984),however, found that most commonly, these phobias start at young ages. The age

tends to differ according to the different types of specific phobias. By age 24, manypeople with specific phobias will seek help.

Exact origins for the three categories of phobias among individuals have notbeen found. A variety of theories has been put forth that may account for thedevelopment of specific phobias. These are direct conditioning, vicariousconditioning, and receiving negative information from others. Vicariousconditioning and receiving negative information are examples of indirectconditioning Tearnan TeIch, 1984).


5/39

An Understanding 4Tearnan and TeIch (1984) found that direct conditioning was believed to e the

origin of the fear in the majority of the individuals they asked. People who couldnot remember the cause of their fears made up the second largest group. Indirectconditioning was reported as the cause by only a small number of the individuals.

Information about the family, childhood, and personality factors of peoplewith specific phobias is sparse. n one study, Tearnan and Teich (1984) found thatmany individuals with specific phobias reported that modeling by family membersdid not constitute the origin of their phobias. n another study, dependentpersonality showed a strong relationship with phobias.

BiologicaJ factors also have an influence on the development of specific

phobias. Only a small amount of research, however, has been conducted in thisarea. One study (Tearnan Teich, 1984) has connected hereditary factors withfears such as those that are animal related. Other examples include fears of fire,bridges, mountains, oceans, and heights. These examples may be accounted forwhat is known as the preparedness hypothesis. More discussion about thepreparedness hypothesis w ll be covered in another section of this paper.

According to Mackintosh (1983), conditioning occurs when a change in aperson s behavior takes place as a result of a relationship formed between certainevents. Classical conditioning, introduced by Ivan Pavlov, was one of the f Tst


6/39

An Understandingbehavioral theories about the origin o phobias (Tearnan TeIch 1984). Clasconditioning occurs when an unconditioned stimulus (DCS) is paired with a nstimulus. The neutral stimulus becomes a conditioned stimulus (CS) and takessimilar characteristics to those o the UCS. Thus, i the UCS originally elicitedso will the CS.

The most familiar study o classical conditioning is the case o little Albfive-year-old. In this experiment carried out by Watson and Rayner, a loud noiwas paired with a white rat. When the noise was no longer present, after severpairing incidents occurred, little Albert became afraid o the white rat. The whwas previous1y an unfeared object unti1 it was paired with a 10ud noise. C1assic

conditioning can also involve generalization, as shown in little Albert s case. Tsuch as a Santa Clause beard and a white fur coat created effects similar to thothe original stimulus, the white rat (cited in Tearnan TeIch 1984).

Mowrer believed the classical conditioning theory needed to be expandesince the theory did not explain why fears lingered even after the UCS wasremoved. Mowrer s two-factor theory holds that the origin o fears involves twsteps. The first step is the fear caused by pairing a neutral stimulus with an UCwhich results in direct conditioning. The second step is the avoidance o the festimulus. In other words, the two-factor theory is the combination o classical


7/39

nUnderstanding 6operant conditioning. Step one serves as classical conditioning, and step two isoperant conditioning Teaman e l c ~ 1984).

Mowrer believed that fear continues even after the ues is removed. The fearcontinues because an individual has a tendency to avoid a stimulus that creates fear.This avoidance constitutes negative reinforcement. Avoidance learning is a majorcategory of instrumental operant) conditioning. Experiments have been conductedTeaman TeIch, 1984) regarding avoidance behavior. Light, a neutral stimulus,was paired with shock among laboratory animals. Animals showed avoidancebehavior toward the stimulus after the pairing was repeated several times.

Tearnan and TeIch 1984) believe there is a problem with viewing

conditioning as a cause ofphobias. Repeating studies on humans such as the studycarried out with little Albert often poses ethical difficulties. Another problem ofconditioning deals with the difficulty involved in analogue studies betweenlaboratory animals and humans. The causes of fear tend to be different betweenlaboratory experiments and the real life experiences ofhumans. In phobiasituations, individuals have reported that they became fearful of something afteronly one occurrence of a situation. One study supports this observation. In thisstudy, a drug that caused short-term paralysis was given to the participants. A tonewas sounded during the same time that the rug was administered. The participants


8/39

nUnderstanding 7felt such intense fear that it took only one pairing of the UCS and neutral stimulusto elicit n enduring fear Liebennan, 1993). In most conditioning situations,however, a fear becomes evident after more than one pairing, which presents stillanother problem of claiming conditioning as a sole cause of specific phobias.

Operant conditioning is another theory that helps explain the cause ofspecific phobias. Operant conditioning involves being reinforced rewarded) orpunished for a behavior Oltmanns, Neale, Davison, 1982). This type ofconditioning, also known as instrumental conditioning, involves important researchoriginated by B. F. Skinner. A behavior is reinforced if the stimulus increases thelikelihood that a certain behavior wil occur in the future. Conversely, if a reductionof a behavior occurs, then the behavior change is due to a punishing stimulus.Williams 1973) believes that negative reinforcement occurs when a situation isavoided to reduce the amount of fear. A person learns to avoid a situation so that heor she feels no fear.

Williams believes that escape usually is learned first, and avoidance islearned afterwards. With escape, a person learns how to get away from the dangeror the feared situation. With avoidance, a person learns how to stay away from thedanger or feared situation.


9/39

nUnderstanding 8Another theory that helps explain the origin of specific phobias is the

psychoanalytic theory. Sigmund Freud, also known as the father ofpsychoanalysis,believed that our defense against fear is avoidance Elliot, 1994). He also believedthe psychoanalytic therapy ofphobias should involve methods to unveil and reviewthe phobia. Freud felt it was important for individuals to bring their fears out intothe open and talk about them Oltmanns et al., 1982).

Freud believed that two defense mechanisms are used when phobias createanxious feelings. These two defense mechanisms are repression and displacement.Repression involves an individual blocking anxious feelings from consciousness.Displacement involves a person viewing feelings of anxiety as a result of a more

reasonable situation Mavissakalian Barlow, 1981). For example, a child whofeared his or her father might displace the fear and instead fear large dogs. The dogscould be avoided more easily than the father. Defenses created to shield anxietycome from the ego Arlow Brenner, 1964).

Freud was convinced that phobia is a symptom derived from neuroticanxiety. Neurotic anxiety comes from drives, wishes, and desires which Freud feltwere related to sexuality and aggression. Freud believed these drives, wishes, anddesires are unconscious conflicts buried inside of a person. To remove a phobia,


10/39

An Understanding 9Freud suggested that a person would have to become aware of the anxiety as well asof its source (Mavissakalian Barlow, 1981).

The preparedness hypothesis, indirect conditioning, and the cognitive-behavioral approach are other theories that have also been considered to explain thedevelopment of specific phobias. The preparedness hypothesis, proposed bySeligman, is the belief that humans have an innate tendency to become fearful ofthings that were dangerous to humans ancestors. The preparedness hypothesisincludes fears of things such as snakes, heights, storms, illnesses, and injuries(Tearnan TeIch, 1984).

Vicarious learning and modeling are examples of indirect conditioning. Much

of our learning throughout life comes from vicarious learning and modeling. ayoung boy sees his friend become afraid of snakes because of a snake bite, then theyoung boy will probably become fearful of snakes, also. A strong possibility existsthat vicarious conditioning is very common in phobias. More research, however, isneeded in this area before the possibility can be confirmed(Tearnan TeIch, 1984).

Cognitions can also pl y role in the development of specific fears.Receiving negative information from others about an experience can cause fear. Forexample, if a person is warned continuously about the dangers of a particular


11/39

nUnderstanding 10situation or object from his or her parents, and if those warnings are reinforced bystories about the same situation or object heard from other people, fear can becreated cognitively. A person can become afraid without having ever experiencedthe object or situation directly or having seen someone else become afraid(Teaman TeIch, 1984).

In the cognitive-behavioral approach, a person decides to become afraid ofsomething using a limited amount of information about an object or situation. Thisis also known as overgeneralizing. More research is needed in examining thecognitive-behavioral approach as an explanation for the development of specificphobias (Tearnan Telch, 1984).

Dental phobias fall into the category of blood and injury phobias, which are atype of specific phobia (Mavissakalian Barlow, 1981). Irish, Ginsburg, andClarke (1994) reported that 25 to 4 million Americans do not go to the dentistbecause they are afraid. Harrison, Carlsson, and Berggren (1985) believe thatpeople who are afraid usually go to the dentist because they are experiencing a greatdeal ofpain. Fear appears to be the main reason that the person avoided previous,preventative dental care. The etiology of dental phobia is strongly related to negativeexperiences in the past. People can also become fearful by receiving negativeinformation vicariously (Glassman Peltier, 1993).


12/39

nUnderstandingClassical conditioning comes into effect in the development of a dental phobia

when a negative response is paired with a particular stimulus(Glassman Peltier, 1993). A good example of classical conditioning in this case iswhen the sound of the drill (CS) is paired with a painful or uncomfortable feelingcaused by the drill (DCS). The patient responds by making a noise or a complaint,which is the unconditioned response (DCR). The UCR is the patient s indicationthat he or she will most likely want to escape similar stimuli in the future. Theactual avoidance of future instances makes up the conditioned response (CR). Also,fear is reinforced when dental procedures are performed while the patient isexperiencing more than a level of low anxiety. As a result, fear win reappear duringfuture dental procedures (Glassman Peltier, 1993). Freud used the term untamedmemories to refer to clear images of bad experiences that people recall. Traumaticdental experiences have been viewed as the most common etiologic element ofdental phobia (Mass, 1995).

Dental phobias may also develop because many people are afraid ofpain.Needles, dental handpieces (drills), tooth extractions, and nerve removals (rootcanals) are some of the things that create fear among dental phobics. Threat of harmand lack of control are also things that cause fear and anxiety in dental patients.Mass (1995) believes that individuals who have experienced traumatic dental


13/39

nUnderstanding 12procedures may not be able to trust dentists in general. Mistrust, in this case, alsoleads to anxiety and fear.

Vicarious conditioning can also be a determinant in dental phobia. Freud'suntamed memories can appear when people hear horror stories from others aboutdental appointments. For example, a person could hear from a friend how much ithurt to have a tooth pulled. If the person sees that the friend has a swollen jaw thenhe or she would probably be convinced that the friend was being truthful. Peoplecan capture untamed memories from their personal perception ofwhat a dentalexperience would be like. Negative information about dentists and dentalprocedures shared by authority figures, such as parents, is another example of the

vicarious conditioning ofdental fears (Mass, 1995).Dental phobia is a problem because those who are afraid will most often

avoid much needed dental care. Some dental phobics feel their fears constituteabnormal behavior. These individuals, therefore, tend to misattribute the anxietycaused by dental procedures as the cause of their fear (Glassman Peltier, 1993).People with dental phobia sometimes refuse to examine their beliefs in order tosearch for the true cause of their fear. A person will become comfortable withdental procedures only ifhis or her fear has been resolved (Mass, 1995).


14/39

nUnderstanding 3Statement ofPurpose

Dental phobia is definitely a problem because it affects such a large portionof the population 25 to 40 million Americans). I found in a review of literaturee.g., Mass, 1995) that a good patient/dentist relationship is needed in order for

dental phobics to experience successful and comfortable dental appointments.Before a good patient/dentist relationship can exist, the dentist should be aware ofthe needs possessed y dental phobics. n other words, a dentist should have somekind of training and experience with dental visits involving dental phobics. Thus,the flIst purpose ofmy research was to fmd out how many dental schools offer suchtraining to dental students.

Because dental phobia is a problem, my second goal was to fmd out moreabout its etiology. In a review of the literature, I found that more research is neededon several possible factors that could contribute to the development ofdentalphobia. These factors include the age of onset of a phobia, and family, childhood,and personality characteristics of phobics. Thus, the second purpose ofmy researchwas to explore the personality characteristics of dental phobics.


15/39

nUnderstanding 14Study 1

MethodParticipants. In order to fmd out what kind of training is provided to dental

students for situations involving dental phobics, I surveyed each of the 53 dentalschools in the United States. I obtained a list of all of the dental schools and theiraddresses from the American Dental Association see Appendix A). Of the 53dental schools, 48 schools responded, which corresponds to a return rate.

Materials. ach dental school received an envelope with the followingmaterials enclosed: a cover letter, a 3-question survey, and a stamped envelope. Inthe cover letter, rstated the purpose of the survey see Appendix B). The stampedenvelope was provided to the dental schools for returning the surveys.

Procedure. After obtaining approval from the Institutional Review Board IRB)at the University ofNorth Carolina-Pembroke UNC-P), I sent materials to eachdental school. In the cover letter, several items were addressed, such as my thesisassignment and the purpose of the enclosed survey. I stated I was interested in thetraining requirements for dentists. I informed the schools that group data from thesurveys would be used in my thesis and that responses from individual schoolswould not be identified. I did, however, ask the recipients to attach the names oftheir schools to their surveys so that follow-up letters could be sent ifnecessary. I


16/39


17/39

An Understanding 6Discussion

Most of the courses listed by the dental schools that answered yes to the frrstquestion in the survey did not pertain to the patient/dentist relationship or dentalphobia. For example, some of the courses listed were Dental Ethics, Dental PublicHealth, Introduction to Dentistry, Pediatric Dentistry, and Gerontology and GeriatricDentistry. (A complete list of courses can be found in Appendix D.) Furthennore,the percentage of schools that do not require psychology-related coursesmay seem low (29%), but it is important to keep in mind that this percentage isbased on a large sample of the dental schools in the United States. Training in theareas of the patient/dentist relationship and dental phobia, therefore, is not provided

by a significant proportion of dental schools in the United States to future dentists.This proportion is especially significant when we take the number ofdental schoolgraduates into consideration. fone school does not provide this type of training toits students, and the school has approximately 85 graduates per year, 85 dentistseach year begin to practice without the training needed to deal with dental phobics.This is a concern which should be resolved in the future.

In conclusion, ll dental schools in the United States do not provide training totheir students in the area of dental phobia Because of the absence of t is training, itwould be difficult for future dentists to become aware of the needs possessed by


18/39

nUnderstanding 17dental phobics. In order for these needs to be r e o g n i z e ~ a future dentist shouldhave some kind o training and experience with dental phobics. This is criticalbecause the patient/dentist relationship is considered an important factor in thetreatment o dental phobics.

Study 2Method

Participants. In order to explore the personality characteristics o dentalphobics, I completed a 2-part study which utilized students enrolled in Introductionto Psychology classes at UNC-P. The IRB at UNC-P reviewed a proposal o myresearch purpose and method. After the review process, my research was approvedby the IRB.

In the frrst part o Study 2, 73 male students and 121 female studentscompleted a dental fear scale. A consent form attached to this scale reminded thestudents that they were not required to complete the questionnaire. The studentswere given the option o leaving their telephone numbers i they wereinterested in the possibility o being contacted later for a second part o the study.The students were told that research credit would be awarded for the second partsee Appendix E for consent form .


19/39

An Understanding 18In the second part of Study 2, three personality questionnaires were completed

by 29 of the Introduction to Psychology students. A consent form was also attachedto these questionnaires to remind students that their participation was voluntary.The consent form also noted that research credit would be awarded for completingthe questionnaires. In order to remain anonymous and still receive research credit,the students were instructed to leave the last four digits of their social securitynumber and the day and time of their Introduction to Psychology class on theconsent form see Appendix F).

The 29 students who participated in the second part of this study were chosenon the basis of their scores on the dental fear scale. Those in the low-scoring group

scored a 4 5 or 6 on the dental fear scale N-15). Those in the high-scoring groupscored 13, 14, or 15-20 on the dental fear scale N=14).

Procedure and Materials. In the frrst part of Study 2, the Corah Dental AnxietyScale CDAS; 1969; cited in Krochak u b ~ 1993) was distributed to studentsin six of the Introduction to Psychology classes at UNC-P. The CDAS, whichincludes four questions, assesses the level of anxiety one has about going to thedentist. Scores from this questionnaire range from 4 to 20. High anxiety ischaracterized by a score of 3 or 14. A phobia is represented by a score of 5 to 20


20/39

An Understanding 19Irish, Ginsburg, Clarke, 1994). The CDAS was used in order to detect students

whose scores indicated a possible phobia or feelings ofhigh anxiety phobicAnxious group). The CDAS also made it possible to select students with lowerscores 4,5, or 6, for example) in which feelings ofhigh anxiety or phobicavoidance were not represented. These students constituted a normal control group.

In part two ofStudy 2, three questionnaires were used to assess variouspersonality characteristics. The frrst questionnaire was the Barnes-VulcanoRationality Test BVRT) developed by Barnes and Vulcano l 9 8 2 ~ cited in Weiten,1994). The BVRT, which contains 44 items, is designed to assess the degree towhich individuals exercise the following: negative self-talk, irrationa1 assumptions,and catastrophic thinking. High scores on the BVRT indicate rational thinkingwhereas low scores represent irrational thinking. I hypothesized that, in comparisonto the control group, the phobic-anxious participants would score low on the BVRT.These low scores would indicate the presence of irrational thinking.

The second questionnaire, the Social Avoidance and Distress Scale SAD), wasdeveloped by Watson and Friend l 9 6 9 ~ cited in Weiten, 1994). The SAD, whichcontains 28 items, measures avoidance and distress that may occur in socialinteractions. High scores on this scale represent an unwillingness to engage in


21/39

An Understanding 20particular social activities, such as participating in a group discussion. Ihypothesized that, in comparison to the control group, phobic-anxious participantswould score high on the SAD scale. These high scores would suggest anunwillingness to participate in certain social activities.

The third questionnaire, the Desirability ofControl Scale (DC), was developedby Burger and Cooper (1979; cited in Weiten, 1994). The DC, which contains 20items, assesses an individual s need for control. A person who scores high on theD scale would indicate a desire to control other individuals and situations in orderto create more control in his or her own life. I hypothesized that, in comparison tothe control group, phobic-anxious participants would score high on the D scale.These high scores would represent a desire for control in certain situations.Results

Five percent of the students scored between 5 and 20 on the CDAS ,indicating a possible phobia. Five percent of the students scored 3 or 14,suggesting high anxiety. Differences between male and female scores in the CDASalso emerged. I used a t-test to test the difference between male and female scoreson the CDAS. Because I did not have an a priori hypothesis concerning the results,the test was two-tailed. The t-test indicated significant results. Overall, the resultsrevealed that females M 9.07, SD = 3.47) scored significantly higher than males


22/39

nUnderstanding 21M = 7.74, SD = 2.92) on the dental fear scale, 1 192) = 2.87, P .005.

Separate one-tailed t-tests comparing the scores ofphobic-anxious participantsand normal control participants on the BVRT, SAD, and DC scales wereconducted. Phobic-anxious participants M = 139.71, SD = 18.13) did not differfrom the control participants M = 145.80, SD = 13.70) on the BVRT scale,1 27) = 1.02, P .16. The scores of the phobic-anxious participantsM = 6.07, SD = 4.91) did not differ from the scores of the normal control

participants M = 6.13, SD = 7.49) on the SAD scale, 1 27) = .03, p .49. Phobicanxious participants M = 99.93, SD = 10.77) did not differ from the normalcontrol participants e = 100.67, SO = 11.27) on the DC scale, 1 27) = .18, P .43.Discussion

The results from Part 1 of Study 2 revealed that women scored significantlyhigher than men on the CDAS. The significant scoring difference could mean oneof two things. First of all it may very well be that women are more afraid of goingto the dentist than men. If this is true, dentists need to be aware of the needs andfears held by women. A competing explanation, however, is also possible. t couldbe that women are more likely to report being afraid ofgoing to the dentist thanmen are. If this is indeed the case, dentists should pay closer attention to males incase they are truly afraid of their dental visit. Measuring galvanic skin response


23/39

An Understanding 22(GSR) s one way to fmd out ifmales are likely to hide their feelings of anxietywhile completing self-reports, such as the CDAS. After males complete self-reports,a video could be shown to these participants. The video could show an individualhaving his or her teeth cleaned by a dentist. A control video should also be shown tothese participants. The SR a physiological measure of emotional responses, canbe used while viewing both videos. The GSR measures observed during the dentalvideo can be compared to those measures taken during the control video. Bycomparing these measures, any anxiety exhibited by males could be detected. TheGSR may be a more accurate indication ofmales anxiety as compared to selfreports.

In Part 2 ofStudy 2 phobic-anxious participants and normal controlparticipants did not differ on measures ofpersonality variables. I predicted that, incomparison to the normal control participants, the phobic-anxious participantswould score lower on the BVRT scale, and higher on the SAD and DC scales. Thet-tests I performed, however, did not yield these results. One possible explanationfor the lack of significant results in Part 2 has to do with the size ofmy sample, as Iwas unable to gather data from 20 phobic-anxious participants and 20 normalcontrol participants as I intended. This argument s particularly compelling n thecase of the BVRT as the results indicated a strong trend towards significance. Thus,


24/39

nUnderstanding 23it may be possible, with a larger sample, to find that phobic-anxious individuals doindulge in negative self-talk, irrational assumptions, or catastrophic thinking. Thisfinding, if true, would be consistent with the theory developed by Ellis. Ellisbelieved that psychological distress, such as anxiety and depression, is generated byirrational beliefs or assumptions that individuals hold Kendall Hammen, 1995).Therefore, further exploration of this possibility could yield productive andbeneficial results.

ConclusionUnfortunately, many dental schools in the United States do not require, as part

of their curriculum, training in the area of the patient/dentist relationship. This

training could be advantageous to future dentists, as they will most likely encounterexperiences involving dental phobics during their dental career. Such training couldbring forth positive results, such as more pleasant dental visits for both the dentalphobic and the dentist. Stress can also be reduced for both the patient and thedentist.

Ten percent of the Introduction to Psychology students at UNC-P scoredbetween 3 and 20 on the CDAS, denoting feelings ofhigh anxiety or phobia.These results suggest that dental phobia is not an uncommon problem in collegeaged individuals.


25/39

An Understanding 24A significant difference between male and female scores on the CDAS was

discovered. Females scores were substantially higher than male scores. This rmdingraises a variety of concerns and questions that need to be addressed. Females couldactually be more afraid of going to the dentist than males. this is so dentistsshould brace themselves for a large number of females with feelings of high anxietyor phobia. Dentists should be prepared to spend some extra time with the femalepatients. Dentists can use this extra time to detect any feelings ofhigh anxiety thatfemale patients may display. fmany males are truly reluctant to report feelings ofanxiety dentists should also expend extra time with this population. During thistime dentists can attentively observe their male patients in order to detect anyinconsistencies between verbal and nonverbal language. For example the patientcould tell the dentist that he is not afraid but the patient could be exhibiting anxiousbehaviors such as sweating and shaky hands. Dentists should be aware ofbothpossibilities relating to male and female patients in order to ensure the mostcomfortable dental visit for patients that are afraid of dentists and/or dentalprocedures. The significant difference found between male and female scores on theCDAS calls for further investigation. Further investigation in this area can generateexplanations as to why a difference exists between males and females.


26/39

An Understanding 25References

Arlow, J. A., Brenner, C (1964). Psychoanalytic concepts and thestructural theory. ew York: International Universities Press.

Elliott, A. (1994). Psychoanalytic theory: An introduction. Cambridge, MA:Blackwell.

Glassman, P., Peltier, B. (1993). Treatment of high and low fearindividuals. Journal of the California Dental Association, 21 (3),35-40.

Harrison, 1 A., Carlsson, S. G., Berggren, U. (1985). Research on clinicalprocess and outcome methodology: Psychophysiology, systematic desensitizationand dental fear. Journal ofBehavior Therapy and Experimental Psychiatry, 16 (3),201-209.

Irish, L. E., Ginsburg, G M., Clarke, 1 H. (1994). Basic dental-anxietymanagement. General Dentistry, 42 (3), 252-255.

Kendall, P. C., Hammen, C. (1995). Abnormal Psychology. Boston:Houghton Mifflin.

King, N. J., Hamilton, D. I., Ollendick, T H. (1988). Children's phobias:A behavioural perspective. ew York: John Wiley Sons.

Krochak, M., Rubin, J. G (1993). An overview of the treatment ofanxious and phobic dental patients. Compendium, 14 (5),604-614.


27/39

An Understanding 26Lieberman, D. A. (1993). Learning: Behavior and cognition. Pacific Grove,

CA: Brooks/Cole.Mackintosh, N. J. (1983). Conditioning and associative learning. ew York:

Oxford University Press.Mass, R. (1995). The Iatrogenic interview in the effective management of the

fearful dental patient. Compendium, 16 (2), 152-162.Mavissakalian, M., Barlow, D. H. (Eds. . (1981). Phobia: Psychological

and pharmacological treatment. New York: The Guilford Press.Milgrom, P., Weinstein, P. (1993). Dental fears in general practice: New

guidelines for assessment and treatment. Tnternational Dental Journal, 43(Suppl. 1), 288-293.

Oltmanns, T. F., Neale, J. M., Davison, G. C. (1982). Case studies inabnormal psychology. New York: John Wiley Sons.

Tearnan, B. H., TeIch, M. J. (1984). Phobic disorders. n H. E. AdamsP. B. Sutker (Eds. ), Comprehensive handbook ofpsycbopathology (pp. 163-197).New York: Plenum Press.

Weiten, W. (1994). Personal explorations workbook for Weiten and Lloyd spsychology applied to modem life: Adjustment in the 90s. Pacific Grove, CA:Brooks/Cole.


28/39

nUnderstanding 27Williams, J L 1973). Operant learning: Procedures for changing behavior.

Monterey, CA: Brooks/Cole.


29/39

nUnderstanding 28Appendix A

University ofAlabamaSchool ofDentistry1919 Seventh Avenue, S.Birmingham, L 35294Dr. Victor 1 Matukas, DeanLorna Linda UniversitySchool ofDentistryLorna Linda, C 92350Dr. Charles 1 Goodacre, DeanUniversity ofCalifornia at Los AngelesSchool ofDentistryLos Angeles, C 90095-1668Dr. Jay A Gershen, Acting DeanUniversity of Southern CaliforniaSchool ofDentistry, RM203University Park - MC 0641Los Angeles, C 90089-0641Dr. Howard M. Landesman, DeanUniversity ofCalifornia, SFSchool ofDentistry513 Parnassus Avenue, S-630San Francisco, C 94143Dr. Charles Bertolami, DeanUniversity of the PacificSchool ofDentistry2155 Webster StreetSan Francisco, C 94115Dr. Arthur A. Dugoni, Dean

University ofColorado Med. Ctr.School ofDentistry4200 East 9th Avenue, Box A095Denver, CO 80262Dr. Robert E. Averbach, DeanThe University ofConnecticutSchool ofDental Medicine263 Farmington AvenueFarmington, CT 06032Dr. James E. Kennedy, DeanHoward UniversityCollege ofDentistry6 W' Street, N.W.Washington, DC 20059Dr. Charles Sanders, Acting DeanUniversity ofFloridaCollege ofDentistryP.O. Box 100405Gainesville, FL 32610-0405Dr. Frank A. Catalanotto, DeanMedical College ofGeorgiaSchool ofDentistry1459 Laney Walker Blvd.Augusta, GA 30912-0200Dr. David R. Myers, DeanSouthern lllinois UniversitySchool ofDent. Med.-Building 2732800 College Avenue-Room 2300Alton, IL 62002Dr. Patrick Ferrillo, Jr., DeanAppendix continues)


30/39

University of illinois at ChicagoCollege ofDentistry801 South Paulina StreetChicago, IL 60612Dr. Allen W Anderson, DeanNorthwestern University Dental Sch240 East Huron StreetChicago, IL 60611Dr. Michael A. Heuer, DeanIndiana UniversitySchool ofDentistry1121 West Michigan StreetIndianapolis, IN 46202Dr. George Stookey, Acting DeanThe University of IowaCollege ofDentistry Dental BuildingIowa City, IA 52242Dr. David Johnsen, DeanUniversity ofKentuckyCollege ofDentistry800 Rose Street-Med. Ctr.Lexington, KY 40536-0084Dr. David A. Nash, DeanUniversity ofLouisvilleSchool ofDentistryHealth Sciences CenterLouisville, KY 40292Dr. Rowland A. Hutchinson, Dean

n Understanding 29Louisiana State UniversitySchool ofDentistry1100 Florida Avenue, Building 101New Orleans, LA 70119Dr. Eric J. Hovland, DeanUniversity ofMarylandBaltimore College ofDental Surgery666 West Baltimore StreetBaltimore, MD 21201Dr. Richard R. Ranney, DeanBoston University-Henry M. GoldmanSchool ofGraduate Dentistry100 East Newton StreetBoston, M 02118Dr. Spencer N. Frankl, DeanHarvard School ofDental Medicine188 Longwood AvenueBoston, M 02115Dr. R. Bruce Donoff, DeanTufts UniversitySchool ofDental Medicine1 Kneeland StreetBoston, M 02111Dr. Lonnie H. Norris, Dean

The University ofMichiganSchool ofDentistry1234 Dental Buildingnn Arbor, MI 48109-1078

Dr. William E. Kotowicz, Acting DeanAppendix continues)


31/39

University ofDetroit MercySchool ofDentistry2985 East Jefferson AvenueDetroit, MI 48207Dr. Bruce Graham, DeanUniversity ofMinnesotaSchool ofDentistry515 S.E. Delaware StreetMinneapolis, MN 55455Dr. Michael J. Till, Interim eanThe University ofMississippiSchool ofDentistry-Med. Ctr.2500 North State StreetJackson, MS 39216-4505Dr. J. Perry McGinnis, DeanUniversity ofMissouri, Kansas CitySchool ofDentistry650 East 25t StreetKansas City, MO 64108Dr. Michael J Reed, DeanUniversity ofNebraska Med. Ctr.College ofDentistry40t Holdrege StreetsLincoln, NE 68583-0740Dr. Stephen H. Leeper, DeanCreighton UniversitySchool ofDentistry2500 California StreetOmaha, NE 68178Dr. Wayne W Barkmeier, Dean

n Understanding 30University ofMedicine DentistryNew Jersey Dental School110 Bergen StreetNewark, NJ 07103-2425Dr. Robert A. Saporito, Acting DeanState University ofNew York, BuffaloSchool ofDent. Med., Farber Hall3435 Main StreetBuffalo, NY 14214Dr. Louis Goldberg, DeanColumbia UniversitySchool ofDental Oral Surgery630 West 168 hStreetNew York, NY 10032Dr. Allan J. Fonnicola, DeanNew York UniversityCollege ofDentistry345 East 24th StreetNew York, NY 10010Dr. Edward G Kaufinan, DeanState Univ. ofNew York, Stony BrookSchool ofDent. Med., Rockland HallStony Brook, NY 11794-8700Dr. Burton Pollack, Dean

University ofNorth CarolinaSchool ofDentistry104 Brauer Hall, 211 HChapel Hill, NC 27514Dr. John W Stamm, Dean(Appendix continues)


32/39

Case Western Reserve UniversitySchool of Dentistry2123 Abington RoadCleveland,OH 44106Dr Lawrence 1 Goldblatt, DeanThe Ohio State UniversityCollege of Dentistry305 West 12th AvenueColumbus,OH 43210Dr. Henry W. Fields, Jr., DeanUniv. of Oklahoma, Hlth. Sci. Ctr.College of DentistryP.O. Box 26901Oklahoma City, OK 73190Dr. Russell J. Stratton, DeanThe Oregon Health Science UniversitySchool of Dentistry-Sam Jackson Pk.611 S.W. Campus DrivePortland, OR 97201Dr Henry J. Van Hassel, DeanTemple University School of Dentistry3223 North Broad StreetPhiladelphia, P A 19140Dr Martin F Tansy, Dean

University of PennsylvaniaSchool of Dental Medicine4001 West Spruce StreetPhiladelphia, P A 19104Dr. Raymond Fonseca, Dean

An Understanding 31University ofPittsburghSchool of Dental Medicine3501 Terrace StreetPittsburgh, PA 15261Dr. Jon B. Suzuki, DeanMedical University of South CarolinaCollege of Dental Medicine171 Ashley AvenueCharleston, SC 29425Dr. Richard De Champlain, DeanUniversity of TennesseeCollege of Dentistry875 Union AvenueMemphis, TN 38163Dr William F Slagle, DeanMeharry Medical CollegeSchool of Dentistry1005 18th Avenue, N.Nashville, TN 37208Dr. Fred C Fielder, DeanTexas A M UniversityBaylor College of DentistryP.O. Box 660677Dallas, TX 75266-0677Dr. Richard N. Buchanan, DeanThe University of TexasHealth Science Center-Dental Branch6516 John Freeman AvenueHouston, TX 77030Dr. Ronald Johnson, DeanAppendix continues)


33/39

nUnderstanding 32The University ofTexasHealth Science Center-Dental School7703 Floyd Curl DriveSan Antonio TX 78284-7914Dr. Kenneth L. Kalkwarf DeanV irginia Commonwealth UniversityMCV-School ofDentistryP.O. Box 566Richmond V 23298Dr. Lindsay M. Hunt Jr. DeanUniversity ofWashingtonSchool ofDentistryHealth Science Building SC-62Seattle WA 98195Dr. Paul B. Robertson DeanWest Virginia UniversitySchool ofDentistryThe Medical CenterMorgantown WV 26506Dr. Robert N. Moore DeanMarquette UniversitySchool ofDentistry604 North 16t StreetMilwaukee WI 53233Dr. Thomas Rypel Acting Dean


34/39

An Understanding 33AppendixB

Dear Sir or Madam:I am a senior and psychology major at the University ofNorth Carolina atPembroke. I am also a Chancellor's Scholar here at UNC Pembroke. I am workingon a thesis for the Chancellor's Scholars Program. My topic for the thesis includesan interest in the training requirements for dentists.As part ofmy thesis, I am conducting a survey which is included. The intention ofthis survey is to provide some information about the training requirements fordentists. Ifyou could spend just a couple ofminutes completing the enclosedsurvey, your time and effort would be greatly appreciated. After you havecompleted the survey, please return it in the stamped envelope provided.Group data from the surveys will be used in my thesis. Therefore, responses fromindividual schools will not be identified. I am, however, asking for the names ofinstitutions. The names of institutions will be used only if follow-up letters becomenecessary.Thank you very much for your time.Sincerely,

Tonya M. JasinskiChancellor's Scholar, University ofNorth Carolina at Pembroke

Elizabeth B. Denny, Ph.D.Assistant Professor, University ofNorth Carolina at Pembroke


35/39

nUnderstanding 34Appendix C

Name of Institution:

1 Are any psychology-related courses required for dental students? For example,Abnonnal Behavior)

If yes, please list the courses.

Ifno, are any offered to dental students?

2. Are any seminars, etc. related to psychological aspects of the dentist/patientrelationship required of your dental students?

yes, please describe briefly.

If no, are any offered to dental students?

3. Approximate number of graduates per year:


36/39

ppendixDDental Public HealthDental EthicsDental Practice Management I, II, III, and IVSpecial Patient CareBehavioral, Geriatric, Special Care DentistryBehavioral DentistryBehavioral Science I andHealth PromotionslPreventive DentistryHealth PromotionslNorrnal BehaviorHealth Promotions/Abnormal BehaviorGerontology: Aging PhenomenonPsychological Aspects ofDentistryCommunication LaboratoryHuman Development and HealthGeriatric DentistryPain and Anxiety ControlThe Edentulous Patient

n Understanding 35

Stress ManagementIntroduction to the PatientHuman Behavior in DentistryClinical EthicsBehavioral ManagementBehavioral Medicine I and IIPsychopathologyAnxiety, Pain, and EmergencyIntroduction to MedicineIntroductory PsychologyInterpersonal RelationsBehavior ModificationDevelopmental PsychologyPersonalityClinical DentistryProfessional and Social IssuesAppendix continues)


37/39

nUnderstanding 36Simulated Patient ExperienceIntroduction to DentistryCorrelated SciencesOral Diagnosis/Oral Medicine I and IIGrowth Development and AgingIntroduction to Clinical StudiesTreatment Planning I and IIPediatric DentistryCariology and Preventive DentistryComplete DenturesDental Health EducationClinical Extramural ExperienceAdvanced PeriodontologySeniorD U

Senior Seminar in ProsthodonticsAdvanced Concepts in DentistryPatient ManagementBehavioral Growth and Development


38/39

An Understanding 37AppendixE

This questionnaire assesses your feelings about going to the dentist. You are notrequired to participate in this questionnaire. However by signing your name to thisconsent form you will be volunteering to do so. A second part to thisquestionnaire for which you can receive research credit will be available at a laterdate. If you are willing to participate in the second part please leave your telephonenumber in the space provided below. Thank you for your time and effort.Signature_________________________________DateTelephone number _Best times to call


39/39

An Understanding 38AppendixF

These questionnaires assess your personal reactions to a variety of situations.You are not required to participate in this study. However, by including the lastfour digits of your social security number on this consent fonD. you will bevolunteering to do so. Although all individual responses will be kept confidential,do not put your name on the consent fonn or on any of the questionnaires. Pleaseleave the day and time of your Introduction to Psychology class in the spaceprovided below so that you may receive research credit.

If you should have any questions, you can see Tonya Jasinski during thefollowing times and location: MWF 12:30-1 :20 in Room 308 (Education

Building). You can also direct any questions to Dr. Denny in Room 323 (EducationBuilding). Dr. Denny s office hours are posted on her door.

When you have completed these questionnaires, please return them to theenvelope on Dr. Denny s office door. Thank: you very much for your time andeffort.Social Security Number (last four digits) _DateDay and Time of Introduction to Psychology Class _

Documents

Understanding of Dental Phobia