Anxious or Phobic Dental Patients

The Corah Anxiety Scale17

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The Corah Anxiety Scale17

The Corah Anxiety Scale

  1. If you had to go to the dentist tomorrow, how would you feel about it?

    1. I would look forward to it as a reasonably enjoyable experience.

    2. I wouldn’t care one way or the other.

    3. I would be a little uneasy about it.

    4. I would be afraid that it would be unpleasant and painful.

    5. I would be frightened at what the dentist might do.

  1. When you are waiting in the dentist office for your turn in the chair how do you feel?

    1. relaxed

    2. a little uneasy

    3. tense

    4. anxious

    5. so anxious I sometimes break out in a sweat or almost feel physically sick.

  1. When you are in the dentist chair waiting while he gets the drill ready to begin working on your teeth, how do you feel?

    1. relaxed

    2. a little uneasy

    3. tense

    4. anxious

    5. So anxious I sometimes break out in a sweat or almost feel physically sick.

  1. You are in the dentist chair to have your teeth cleaned, while you are waiting the dentist is getting out the instruments he will use to scrape your teeth around the gums, how do you feel?

    1. relaxed

    2. a little uneasy

    3. tense

    4. anxious

    5. So anxious I sometimes break out in a sweat or almost feel physically sick.

This survey can easily be tailored to each dental office. Use the responses from such a survey to identify what the patient is most afraid of and address it at the first meeting.

Since the signs of fear can present in many ways, it is important to focus your full attention on the patient. The anxious patient will sometimes exhibit signs of fear that are verbal, behavioral, or somatic (physical).

Verbal signs: include self reports such as: "I never did like the dentist," or "I hit the last dentist who tried to give me a shot"; also "When will it be over," "I usually need extra novocaine," or "I faint at the sight of a drill."

Behavioral signs: the patient jumps as the chair back is lowered; physically closed nonverbal communication like arms crossed, legs crossed; gripping armrests; sits in operators chair instead of patient chair upon entering the operatory; muscular tension; avoidance of eye contact; fidgeting; fainting; or lack of cooperation.

Somatic signs: high pulse rate, sweating, irregular breathing, pupillary dilation.

Some experts maintain that the best indicator of a patient's true anxiety level is a combination of the patient's self-report and their records of dental care. The oral examination may reveal extensive restoration and signs of long spans in between dental visits. A patient may not admit to being anxious but there are many signs that the dental staff can look for that aide in diagnosing a patient with dental fear. During the initial exam it is important to look for advanced carious lesions, extensive periodontal disease with abundant calculus, or extensive fixed prosthetics. Each of these issues indicate that the patient has not received routine dental care.

Another issue many patients with dental fears report is a past allergic response to dental anesthetic. These patients should be questioned more in depth about the details surrounding the perceived allergic experience. Sometimes the reaction is actually an uncomfortable state caused by a combination of the patient's anxiety and epinephrine. If the patient truly feels that he or she is allergic to the anesthetic, they can be referred to an allergist. If the patient is in agreement, exposure to a small amount of anesthetic (such as a little topical on the lip or buccal mucosa) may be applied so you and the patient can observe any symptoms. If the patient comes to the realization that the "allergic reaction" is simply a combination of the anxiety and the feeling of being numb, with the patient’s permission, increase the dosage in small increments so he/she can become accustomed to the anesthesia without adding the anxiety of a dental procedure. If you wish to attempt this procedure, be cautious of putting the patient on the defensive as it may lead the patient to feel that the dentist is not concerned with their problem.

There are many reasons people experience dental anxiety. The most often reported reasons are: fear of injections, anticipating pain during treatment, and expectations of post-operative discomfort.

Uncertainty. Most people are somewhat apprehensive during a new experience. Uncertainty about what is going to happen and tension with being in new surroundings increases anxiety.

Previous experiences. Past bad experiences in a dental or medical setting usually leave vivid emotional memories that can be triggered by just being in the dental office. Patients who have experienced the following are typically more sensitive to the dental experience and report increased dental anxiety: patients who have had trauma or injury to their face; patients who have been treated in an emergency room or were recently hospitalized; and individuals who had bad immunization experiences.

Vulnerability and Loss of Control. While dental staff may believe that dental chairs are designed with comfort in mind, patients with dental fear feel vulnerable when reclined in the dental chair. They also express concern that they will be unable to communicate discomfort once the dentist begins work.

Invasion. Dentistry can be invasive and the mouth is often considered a private area of a person's body. Some patients report that dental treatment makes them feel "violated".

Isolation. Some patients have reported that they feel isolated during a procedure because the dentist carries on a conversation with the assistant without including them.

Embarrassment and Shame. Patients have reported fear that the dentist will reprimand them for the poor state of their dental health. A patient may imagine that the dentist and his or her staff will mock them for the shape, color, or size of their teeth. These patients have a poor self-image and are often ashamed to open their mouths, sure of criticism.

Second-Hand Information. Stories from friends or family members about painful dental experiences and uncomfortable situations portrayed in the media may make an impression on a patient and cause undue anxiety.

Concern About Finances. Dental treatment can be expensive. Even if the patient is covered by insurance, they may be concerned that all the cost will not be included in their plan.

Asphyxiation. Patients with asthma or emphysema are usually very concerned with maintaining an open airway. Stress during a procedure can cause the neck muscles to constrict which can be a source of anxiety.

Emotional State and Self-Esteem. Stress in the life of the patient (even if totally unrelated to dentistry) can affect their tolerance and sensitivity to pain and fear.

Sterile Procedures. Patients, with or without dental fears, are very concerned about the cleanliness of the office and of the instruments. Recent attention has been given in the media to proper sterile techniques. Though meant to educate the public of the necessity of proper sterile technique, some of the shows have used graphic representations that make a dramatic impression on and instill unnecessary fear in patients.

    Other Patients have also reported fear of:

    • disfigurement from the loss of a tooth, cut tongue or lip,

    • loss of feeling,

    • receiving "bad news,"

    • dentist superiority or patient inferiority,

    • betrayal by past assurances of painless procedures that were painful,

    • radiation exposure, and

    • mercury poisoning.

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