The Fearful Dental Patient

Dr. Arthur Weiner has been on faculty at the Tufts University School of Dental Medicine since 1968, where he has taught courses on pain control, anxiety management, panic disorders, and behavioral dentistry. He is currently director of the Behavior Science II course at Tufts and a national spokesperson for the Academy General Dentistry on fear and patient management. Dr. Weiner is a guest lecturer at several regional and national conferences. He has also spoken in the past in Australia and France and has published extensively on the subject of fear and anxiety management in numerous journals including Dental Clinics of North America and Acta Scandinavia Psychiatrica.

Foreword xi Preface xv

Acknowledgments xvii

About the Author xix

Contributor List xxi

1 The basic principles of fear, anxiety, and phobia: past and present 3
Arthur A. Weiner

Introduction 3

Major etiological models to explain anxiety 6

Behavioral indicators of anxiety 7

Nature of dental anxiety 9

Echelons of expression 9

Timing of dental anxiety 11

Severity 13

Differentiating psychological (exogenous) anxiety from medical (endogenous) anxiety 13

Natural history of endogenous anxiety 14

Phobias 20

Causes of phobias 21

Summary 24

Note 25

References 25

2 Determinants associated with creating fearful dental patients 29
Arthur A. Weiner

Introduction 29

Prevalence of dental fear 30

Direct conditioning 31

The approach–avoidance conflict theory 32

Exploring the literature cataloging the common fi ndings of each of the determinants of dental fear 33

Patient control 38

Gender, age, socioeconomic, life status determinants of dental fear 39

Practitioners' determinants of dental fear 45

Oral health, quality of life, and the impact of dental anxiety 52

Summary 54

References 54

3 Factors affecting the psychological collection and identification of the fearful dental patient 61
Arthur A. Weiner

Introduction 61

Prerequisite components for enhanced communication skills 62

Establishing a positive patient–dentist relationship 66

Two-way communication 68

Accommodating patient–dentist priority differences 69

The initial patient–dentist consultation 70

Practitioner's verbal inquiry and collection of past and present history 74

Summary 85

References 86

4 Chairside management of the fearful dental patient: behavioral modalities and methods 89
Arthur A. Weiner

Introduction 90

The concept of the dental practitioner as a "facilitator of change" 90

Step-by-step chairside model for fear amelioration in the frightened dental patient 99

Chairside management resulting from patient's consultation and determinants of fears elicited 114

Doctor–patient relationship and its role in reducing anxiety and gaining treatment acceptance (this section by Samuel Shames) 116

Alternative behavior modification and treatment modalities 119

References 124

5 The pharmacological basis of pain and anxiety control 127
Morton Rosenberg and Michael Thompson

Introduction 127

Local anesthesia 128

Summary 135

References 135

6 Hypnosis in dentistry 139
Michael A. Gow

Introduction 139

What is hypnosis? 140

The hypnosis session 145

Hypnosis in dentistry—"hypnodontics" 154

"Informal" hypnotic techniques in day-to-day dental practice 161

An anchoring technique for child dental patients—"the high five anchor" 164

Conclusions 165

Suggested hypnosis societies, training pathways, and contacts for dentists 166

References 166

7 Management of complicated, high-risk patients with psychiatric comorbidities 173
Kelly M. Wawrzyniak and Ronald J. Kulich

Introduction 173

Overview: behavioral science and the complicated patient 173

Posttraumatic stress disorder 174

Major depressive disorder and related mood disorders 178

Chronic pain disorder and related somatoform disorders 180

Schizophrenia 184

Personality disorders 186

Substance use disorders 189

Eating disorders 191

General management recommendations 191

References 193

8 Understanding and managing the fearful and anxious child 197
Laura Camacho-Castro

Introduction 197

What is new in behavior management? 198

Birth to two years old 202

Two years old 203

Three to six years old—the preschool age 203

Six to twelve years old 204

The teenage years—adolescence 205

When does fear or anxiety first develop in children? 205

Basic behavior management techniques 206

Should the parent remain in the operatory? 209

Pharmacological management of behavior problems 210

Suggested Reading 212

References 213

9 The geriatric patient: psychophysiological factors associated with aging and dental anxiety 215
Arthur A. Weiner and Kathryn Ragalis

Introduction 215

Understanding the changes associated with aging 216

Managing the risk factors associated with aging 228

Summary 233

References 234

10 Fear and anxiety management for the special needs patient 241
Linda M. Maytan and Gina M. Terenzi

Introduction 241

Let us meet and evaluate your patients 243

Sensory perception modalities for treatment and communication 249

Alternative modalities for anxiety management 254

Case management presentation 259

References 262

Index 265