Anxious or Phobic Dental Patients

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he office staff can only do so much to alleviate a patient's fears. The dental professional's biggest responsibility is to provide caring, quality dental work with a minimum of operative and post-operative pain. The dental professional cannot be expected to produce perfect pain control for someone who is emotionally charged up and unwilling to assume responsibility for his or her fears.

It is important to remember that the reasons for patient’s fears can be very different, so it is imperative that the dentist approach each patient anew and individualize each treatment plan, using the techniques in this manual as a guide.

The patient must take some of the responsibilities for treatment as well. The patient should be provided literature detailing effective relaxation techniques, learning distraction techniques, and becoming assertive enough in the dental operatory to tell the dentist when something bothers them. Most important, the patient must be open to developing trust is the dental staff.

The office staff who is willing to take the extra time and effort to assist the anxious or phobic patient will have:

  • more patients

  • more referrals

  • satisfaction from helping another person

  • reduction of office and personal stress

  • less time spent in the operatory

    There are several behavioral, non-pharmacologic techniques available for reducing a patient's anxiety or fear of dental treatment. If relaxation techniques and compassionate dentistry is used in conjunction with local anesthesia, many patients can easily be treated with no additional medication necessary. Satisfied anxious patients can become regular, referring members of any dental practice. All it takes is a caring dentist as well as dental staff willing to take a little extra time to treat not only the patient’s teeth, but also the psychological fears that have kept anxious patients from seeking routine dental care.


This test contains 25 questions. Please mark only one best answer to the following questions on the one page answer sheet.

  1. Dental fear affects _____ of the United States population.

    1. 30%

    2. 40%

    3. 80%

    4. 100%

  2. An emotional state in which the patient exhibits an excessive, persistent, and exaggerated fear response is:

    1. anxiety

    2. schizophrenia

    3. phobia

    4. PMS

  3. The somatic signs of fear include:

    1. high pulse rate

    2. flushing

    3. sweating

    4. irregular breathing

    5. all of the above

  4. Some of the more common reasons for dental fear are:

    1. fear of injections

    2. anticipating pain during treatment

    3. expectations of post-operative discomfort

    4. all of the above

  5. The patient who is most afraid of asphyxiation is one who has:

    1. asthma

    2. AIDS

    3. high blood pressure

    4. dermatitis

  6. Patients with low self-esteem will expect the worst in any situation, including dentistry.

    1. True

    2. False

  1. Children usually model parent's behavior. Assessment of the parent’s anxiety level can often indicate the amount of anxiety in their children.

    1. True

    2. False

  2. It can be assumed that a parent consents to any type of treatment for their children without a signed consent form.

    1. True

    2. False

  3. Some of the most popular methods of fear control used by dentists today (according to a 1991 survey) includes:

    1. make sure anesthetic has taken effect before beginning treatment

    2. be friendly to the patient

    3. pay attention to what the patient says

    4. assure patient that you will do all you can to not cause pain

    5. all of the above

  4. Where is the ideal place for the first interview with a patient to cause the least amount of anxiety?

    1. The waiting room

    2. The operatory

    3. A quiet, comfortable, confidence building room, like the dentist's private office

    4. Who needs an interview? Just get down to business!

  5. Allowing the patient to use a hand signal to stop treatment is a good way to give the patient a sense of control.

    1. True

    2. False

  6. Some of the methods of creating a relaxed ambiance in the office include:

    1. soothing music

    2. visual distraction

    3. smooth working relationship between staff

    4. all of the above

  7. Ignoring a patient's signals of anxiety and discomfort can cause further trauma.

    1. True

    2. False

  8. During a stressful situation, the adrenal cortex produces:

    1. epinephrine

    2. steroids

    3. saliva

    4. blood glucose

    5. all of the above

  9. During a stressful situation, the adrenal medulla produces:

    1. epinephrine

    2. steroids

    3. saliva

    4. blood glucose

    5. all of the above

  10. The relaxation response deactivates the sympathetic division of the autonomic nervous system to decrease:

    1. epinephrine production

    2. blood pressure

    3. blood glucose levels

    4. all of the above

  11. The Gate Control Theory postulates that:

    1. pain is purely a physiological reaction

    2. there is a correlation between the emotions and the degree of response to a pain stimuli

    3. pain can be prevented completely by mind control without the use of anesthetics or medication

    4. there is no value in teaching patient relaxation techniques, emotions have no effect on pain

  12. The Iatrosedative Technique relies on

    1. the patient’s own ability to cope with stress.

    2. medication.

    3. the Dentist’s promises and actions to protect the patient from what is perceived dangerous.

    4. the coincidence of acceptable anesthesia and a relaxed patient.

  13. The Dental Fears Control Program is recommended:

    1. for all patients, before the initial consultation.

    2. for some patients, after treatment is completed.

    3. for patients the dentist determines are too anxious for treatment.

    4. for all patients following emergency dental treatment.

    5. for all patients, any time during their treatment.

  14. In the Dental Fears control program, the patient is exposed to “systematic desensitization” consisting of:

    1. root canal therapy with no anesthetics.

    2. tapes of periodontal surgery and extractions.

    3. reading a description of a dental scene of increasing stress levels while the patient imagines the scene and then practices a relaxation exercise until the fear reaction disappears.

    4. oral medications.

  15. Ten to twenty deep slow breaths gives the patient more time to think about the fact that they are in good hands and that the treatment is for their benefit.

    1. True

    2. False

  16. An ideal modeling tape should include:

    1. a Dentist explaining the procedure including the sounds and feelings associated with it.

    2. successful completion of the dental procedure with dentist praising cooperative behavior.

    3. the patient raising their hand for a rest stop

    4. all of the above

  17. The moderately or mildly anxious patient may not need a structured anxiety reduction program, but different aspects may be helpful in overcoming their fears.

    1. True

    2. False

  18. University Dental Fears Clinics are staffed by:

    1. dentists

    2. psychologists

    3. researchers

    4. fearful patients

    5. a and b

  19. The dental professional cannot be expected to produce perfect pain control for someone who is emotionally charged up and unwilling to assume responsibility for their fears

    1. True

    2. False

(End of Test)
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