Pain, fear and anxiety

SLO:
1. Discuss how pain, fear, anxiety
influences patients OH care.
2. Understand the pain behaviour and
strategies for controlling it.
3. Understand natural causes and
factors causing fear and anxiety
(F&A)
4. Identify methods of reducing F&A
among pts during dental tx.

Pain: a symptom thats commonly experienced in clinical practice
-physiological change eg delivery
-Injury and dz
-Healing activity eg injx, surgery

Dz model of pain(biological model)
An unpleasant experience wic primarily ass with tissue damage or is
described in terms of tissue damage or both- no pain would be
expected when there is no injury, and every injury shud result in pain.

A complex phenomenon involving:
-neurology
-physiology
-psychology
-Social and cultural factors

Pain threshold and pain expression:
Amount of stimuli nedded to produce initial sensation of discomfort or pain appear to be same for everyone.
But! The way and individual responds to it depends on psychosocial and cultural variables
-cultural
-personal hx
-personality
-emotional
-cognitive








Pain, fear and anxiety


Measuring pain:








Pain control strategies
Sensory
discrimitive

Affective motivational
To change perception and intervention of and
indvdual towards their sensory input
Cognitive evaluation
To change ptss experience and
expectations towards tx
Surgery
medication

Distraction
Placebo effect
Enhancing control
Hypnosis
Reduce stress

Fear:
Emotional response to an immediately present and identifiable perceived threat (known danger)
Eg fearful of having tooth extracted

-Epid of dental fear:
Children: 3-21% depend on age
Adult: 5-30% (Locker, 1989)
Adult in Malaysia: 9% (Jaafar et al.)
-it is reported that F have > fear than M
An inherited timidity in F
F encouraged to display, M encouraged to hide.
-Reduces threshold of fear Magnifies the pain

-Fear of dental situation
-Any types in dental clinic:
Innate fear: Objective fear: Subjective fear:
- w/o any stimuli @ prev
experiences
-Depends on vulnerability of
the individual
-hx of traumatic dental
experiences @ prev
unpleasant experience from
dentist

-unfavourable family attitude and
transmission of these may also result in fear
-Display emotion in parentss face creates
more impression> verbal suggestions.

Fear evoke dental stimuli:
-Most fear events in clinic can be ranked as:
Anesthesia administration using injx
Xn
Sound of drill

Fc causing dental fear:
-An interaction of factors occurs in existence of dental fear eg:
1. Fear of pain and its anticipation
2. A lack of trust
3. Fear of loss of control
4. Fear of intrusion
5. Fear of unknown
Indirect
measurement
Self report Behavioural
Physiological
Heart rate
Respiratory rate
Blood pressure
The McGill pain
questionnaire
Visual analogue scale

Irritability
Anger
Restlessness

Pain, fear and anxiety



Anxiety: (worry) *A




-Causes of A:
Uncertainty Previous learning Biological diff
Fear of unknown is anxiety-
provoking
In the dental clinic, new pts A can
be due to uncertainty they feel
about what awaits them after
initial 1
st
appointment check up

D/t:
: prev learning experiences of
trauma during the 1
st
visit
: the learning involved in the
dental anxiety may have been
indirect, depending upon the
experiences of other ppl
Higher Maternal A higher child A
level shows ve behaviour in
dental clinic

Some ppl are more predisposed to
becme more anxious @ learn abt A
responses more than other d/t the
innate biological mechanism.


-IDENTIFYING F&A:
Art of observation

Self report measure

Physiology

Behavioural

Shaking hands
presumption of A (cold
and sweaty palms)
Sit at the edge of the
chair
Eyes roaming around
Unnaturally stiff posture
Nervously playwith
handkerchief @ tissue
White-knuckle syndrome
Diaphoresis (sweating) of
palms/forehead

Dental anxiety Qs (Corah
1969)
Dental fear survey
(Kleinknecht et al 1973)

Heart rate
Galvanic skin response
Palmar sweat activity

Tendency to freeze
Scream
Run away
Tense muscles
Irritability
Anger

-Anxiety rating scale
The scale gives 5 options graded 0-4
0-relaxed
1-uneasy
2- feeling scared but coorperative
3- feeling scared but uncoorperative
4- feeling very scared, uncoorperative,
requires physical restraint.








is said to be general apprehension @ uneasiness in anticipation that smt unpleasant & undesirable is going
to happen in wic the source of perceived threat is ill defined, ambiguous and not immediately present.
Eg. Anxious regarding visiting the dentist

Pain, fear and anxiety


-Manx of anxious pts:
1. Dentist pts communication
Verbal communication Non-verbal communication
1. Friendly and pleasant
2. Address pts by name
3. Sitting and speaking at the eye level
4. Dentist need to access their own
communication skills
5. Interview pts to build rapport, educate and
assess A level
6. Involvement of dental team emotional
support
1. Body language
2. Smiling
3. Eye contact
4. Showing concern
5. Expression of feeling w/o speaking


2. Desensitization (tell-show-do)
3. Modelling
4. Hypnosis
5. Biofeedback
6. Anaesthesia