Behavioral Dentistry Second Year

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DENTAL-RELATED
ANXIETIES AND FEARS
Dr. Mohamed Salah Khalil (Ph.D-Neuropsychology)
Associate Professor-Consultant Clinical Psychologist
Coordinator of Postgraduate Clinical Psychology Program
5/12/20131 DR. MOHAMED SALAH KHALL
?PHOBIAWHAT IS DENTAL
• The distinction between dental anxiety, dental fear, and
dental phobia.
• DENTAL ANXIETY is a reaction to an UNKNOWN danger. Most
people experience some degree of dental anxiety especially if
they’re about to have something done which they’ve never
experienced before.
• DENTAL FEAR is a reaction to a known danger (“I know what
the dentist is going to do, --I’m scared!!”), which involves a
fight-or-flight response when confronted with the threatening
stimulus.

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• DENTAL PHOBIA is basically the same as fear, only much
stronger. The fight-or-flight response occurs when just
thinking about or being reminded of the threatening
situation.
• Someone with a dental phobia will avoid dental care at all
costs until either a physical problem or the psychological
burden of the phobia becomes overwhelming.
• Two types of dental anxiety: exogenous (from the outside)
and endogenous (from the inside). Exogenous dental anxiety
is defined as anxiety due to traumatic dental experiences.
Endogenous dental anxiety is thought to have originated from
other anxiety disorders.
?PHOBIAWHAT IS DENTAL
MEASRING DENTAL PHOBIA
• Modified Dental Anxiety Scale (MDAS)
• 1. If you had to go to the dentist tomorrow for a check-up, how would you
feel about it?
– a. I would look forward to it as a reasonably enjoyable experience.
– b. I wouldn't care one way or the other.
– c. I would be a little uneasy about it.
– d. I would be afraid that it would be unpleasant and painful.
– 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?
– a. Relaxed.
– b. A little uneasy.
– c. Tense.
– d. Anxious.
– e. So anxious that I sometimes break out in a sweat or almost feel physically
sick.

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Causes of Dental Anxiety and Phobia
• Bad experiences: (MOST of dental phobias)
• Pain
• Feelings of helplessness and loss of control
• Embarrassment
• A history of abuse
• Uncaring dentist.
• Humiliation.
• Vicarious learning
• Preparedness
• Post-Traumatic Stress.
• CONCEPT OF: Posttraumatic Dental-care Anxiety
(PTDA),
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BEHAVIOURAL AND CIGNITIVE
BEHAVIOURAL TECHNIQUES
•THE TERM BEHAVIOUR MODIFICATION
EMERGES FROM EARLY WORK BY
SKINNER(1953).
•The concept is based on establishment of
competent behavioral engineering skills to bring
about change in child
Behavior.

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TECHNIQUES
1.DESENSITIZATION
2.TELL ,SHOW ,DO
3.MODELLING
4.DISTRACTION
5.-CONTINGENCY MANAGEMENT
6. SHAPING
7.VISUALIZATION
8.PROGRESSIVE RELAXATION
• Systematic Desensitization
Involves the gradual presentation of the feared stimulus
while at the same time replacing the anxiety with more calm
and relaxed conditions.
There are three steps in the self-administered systematic
desensitization procedure:
1. Relaxation;
2. Constructing an anxiety hierarchy;
3. Pairing relaxation with the situations described in
your anxiety hierarchy.

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Visualisation
Combines elements of relaxation and then
distraction by imagining a pleasant situation.
• Therapist describes the procedure
• Patient selects image of place to use
STEPS:
• Progressive relaxation
• Imagine chosen scene
• Create detailed multi sensory image
• Can be taped and replayed
• Practice as homework
5/12/20139 DR. MOHAMED SALAH KHALIL
• Tell - Show - Do Technique
1. Use words that the child can understand.
2. Avoid fear-inducing words.
3. Introduce the simplest procedures first.
4. Must be continuous

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Positive reinforcement
• Description: In the process of establishing
desirable patient behavior, it is essential to give
appropriate feedback.
• Positive reinforcement is an effective technique to
reward desired behaviors and, thus, strengthen the
recurrence of those behaviors. Social reinforcers
include positive voice modulation, facial
expression, verbal praise, and appropriate
physical demonstrations of affection by all
members of the dental team. Nonsocial
reinforcers include
Positive Reinforcement
Identify target behavior.
Select an appropriate reward
Reward the target behavior promptly and consistently
when it occurs.
Ignore undesirable

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-MANAGEMENTCONTINGENCY
• Method of modifying the behavior of
• Children by presentation or withdrawal of
reinforces
1. BEHAVIOR SHAPING : Is the procedure which slowly develops
behavior by reinforcing a successive approximation of the desired
behavior until the desired behavior comes into being

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Distraction
• Description: Distraction is the technique of
diverting the patient’s attention from what may
be perceived as an unpleasant procedure. Giving
the patient a short break during a stressful
procedure can be an effective use of distraction
prior to considering more advanced behavior
guidance techniques.
• Objectives: The objectives of distraction are to:
• 1. Decrease the perception of unpleasantness;
• 2. Avert negative or avoidance behavior.
COGNITIVE FACTORS
1. Give the patient A SENSE
OF CONTROL
2. Acknowledge

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Voice Control
• It is applied when the child’s behavior has caused
ongoing treatment to stop.
• The technique involves the use of sudden, loud and
firm commands as aversive stimuli to suppress the
disruptive behavior.
• Should be followed by positive reinforcement
Different types of relaxation
Progressive muscle
relaxation.
12 muscle group relaxation.
8 muscle group relaxation.
4 muscle group relaxation.
Release only relaxation.
Breathing relaxation.
Cue controlled
relaxation.
Holding the breath.
Rhythmic breathing.
Counting breaths.
5/12/201318 DR. MOHAMED SALAH KHALIL

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Goals in relaxation
• A coping mechanism to help patients gain
a sense of mastery over their internal
world
• Aim is to facilitate engagement with
activities of everyday living and exposure
tasks.
• Not an intrinsic therapeutic activity.
5/12/201319 DR. MOHAMED SALAH KHALIL
12 muscle group relaxation
These are:
• Lower arms.
• Upper arms.
• Lower legs.
• Thighs.
• Stomach.
• Upper chest and
back.
• Shoulders.
• Back of the neck.
• Lips.
• Eyes.
• Eye brows.
• Upper forehead and
scalp.
5/12/201320 DR. MOHAMED SALAH KHALIL

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Eight muscle group relaxation
1. Whole arms.
2. Whole legs.
3. Stomach.
4. Upper chest and back.
5. Shoulders.
6. Back of the neck.
7. Face.
8. Forehead and scalp.
5/12/201321 DR. MOHAMED SALAH KHALIL
4 muscle group relaxation.
1. Whole arms.
2. Upper chest and back.
3. Shoulders and neck.
4. Face.
• The patient is asked to identify tension and
then focus on relaxing that tension.
5/12/201322 DR. MOHAMED SALAH KHALIL