The Psychology of Treating Child Patients

1. Brandy A. Lopez The Psychology of Treating Child Patients

2. Project Design • Child patient and dental staff observation • Dental staff survey • College student survey

3. Introduction In the United States it was found that 23% of 895 5-11 year olds showed dental anxiety. Dental anxiety occurs via 3 pathways: Direct conditioning Modeling Maternal Dental Anxiety Information/Instruction

4. Non-Physical Behavioral Management American Academy of Pediatric Dentistry: voice control, distraction and social learning theory

6. Physical Behavior Management American Academy of Pediatric Dentistry: Papoose board Sedation 35%

7. Results: Dental Staff Survey • Majority consensus • The behavior of the parent/guardian that brings the child affects the behavior of the child. • Social learning theory (tell-show-do technique) is a vital element in acquiring child cooperation. • It is possible to diagnose the level of dental anxiety of a patient within the first few minutes of meeting with dental caregiver. • Having the television on relaxes the patient.

9. Results: College Student Survey • 55.12% of college students have low dental anxiety • 21.97% of college students have moderate dental anxiety • 18.32% of college students have high dental anxiety • Greatest anxiety triggers: • Waiting for the dentist to begin drilling on the patient’s teeth • Root canal treatment • Not being numb enough for the treatment procedure

10. References 1 Miligrom P, Mancl L, King B, Weinstein P. Origins of childhood fear. Behav Res Ther 1995; 33: 313-329. 2 Klingberg G, Berggren U, Carlsson SG, Noren JG. Child dental fear: cause-related factors and clinical effects. Eur J Oral Sci1995;103: 405- 412. 3 Klingberg G, Berggren U. Dental problem behaviors in children of parents with severe dental fear. Swed Dent J 1992; 16: 27-32. 4 American Academy of Pediatric Dentistry. Guidelines 2001-02. Chicago, IL: AAPD, 2002. 5 Bandura A. Social Learning Theory. Morristown, NJ: General Learning Press, 1971.

11. Discussion: Are you afraid of the dentist? 1. If you had to go to the dentist tomorrow for a check-up, how would you feel about it? 16.3% a. I would look forward to it as a reasonably enjoyable experience. 41.9% b. I wouldn't care one way or the other. 32.6% c. I would be a little uneasy about it. 4.7% d. I would be afraid that it would be unpleasant and painful. 4.7% 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? 39.5% a. Relaxed. 25.6% b. A little uneasy. 16.3% c. Tense. 16.3% d. Anxious. 2.3% e. So anxious that I sometimes break out in a sweat or almost feel physically sick. 3. When you are in the dentist's chair waiting while the dentist gets the drill ready to begin working on your teeth, how do you feel? 23.3% a. Relaxed. 34.9% b. A little uneasy. 16.3% c. Tense. 20.9% d. Anxious. 4.7% e. So anxious that I sometimes break out in a sweat or almost feel physically sick. 4. Imagine you are in the dentist's chair to have your teeth cleaned. While you are waiting and the dentist or hygienist is getting out the instruments which will be used to scrape your teeth around the gums, how do you feel? 32.6% a. Relaxed. 34.9% b. A little uneasy. 14.0% c. Tense. 18.6% d. Anxious. 0% e. So anxious that I sometimes break out in a sweat or almost feel physically sick.

12. Key to Scoring the Dental Anxiety Scale: a = 1, b = 2, c = 3, d = 4, e = 5 Total possible = 20 Anxiety rating: • 9 - 12 = moderate anxiety but have specific stressors that should be discussed and • managed • 13 - 14 = high anxiety • 15 - 20 = severe anxiety (or phobia).