Handling Dental Anxiety Through Endodontic Treatment

When the need for endodontic treatment is present, some patients can experience huge amounts of stress and fear related to those treatments, frequently evoking dental phobia. Dental anxiety often occurs as a normal reaction to a perceived threat or hazard, causing states of apprehension. For those with dental phobia, intense, unrecognizable amounts of fear are caused by the dread of dental visits and treatments. Patients with dental anxiety or dental phobia require a special amount of consideration when receiving endodontic treatment. Today, we’ll be looking at the prevalence of dental anxiety and why people often fear the dentist. Well also discuss what endodontists can do to help reduce these fears before and during treatment. 

Dental Anxiety, Dental Phobia, and Its Origins

Dental anxiety and dental phobias create vicious cycles of fear, avoidance, and feelings of shame and guilt in regard to dental health. In more psychological concerns, dental anxiety often results from some form of conditioning, either direct or indirect: 

  • Direct conditioning associates dental treatment with a negative or traumatic experience. Older adults most often experience a negative or traumatic experience, a direct conditioning form that directly increases dental anxiety and dental phobias. 
  • Indirect conditions often come from negative visual images, second-hand information, and bad behavior from a previous dental experience. Most often, information passed on through sources such as parents or friends is considered the most relevant form of indirect conditioning for children and young adults.

One of the most common ideas that influence dental anxiety and dental phobia is anticipated pain. Younger patients in these cases can experience higher levels of pain in comparison to older patients due to this issue of anticipated versus experienced pain. This also results in higher levels of pain sensitivity, greater vulnerability to negative emotions, and other traits that can worsen the effects of these mental health conditions. The physical reactions in dental anxiety and dental phobia often result in an increase in stress levels, a higher heart rate, and higher blood pressure before and during the appointment. The combination of both psychological and physical effects of these conditions often results in avoidance, leading to postponing appointments and necessary treatment. For endodontists, complex endodontic cases can increase over time and lead to necrotic, infected teeth and gums. 

How Endodontists Help Manage Dental Anxiety

Endodontists faced with patients who have some form of dental anxiety or severe dental phobia often tailor their treatments to their patient’s needs. The patients, especially if they’re new patients, will need to first be evaluated for their medical history using clinical assessment tools, such as multiple-choice questions. In cases where dental anxiety is present, some beginning forms of management can help provide some forms of intervention during appointments, including: 

  • Rapport Building: Providing qualifications about experiences and establishing a friendly relationship can help ease symptoms of dental anxiety and help relax patients further. 
  • Systematic Desensitization: In some scenarios, specifically in cooperation with therapists, working on desensitizing the experience through exposure to a stressful situation can potentially help reduce the effects of dental anxiety. 
  • Relaxation Therapy: Audio and visual tools such as music, videos, and virtual reality headsets can be effective in reducing stress, providing distractions during treatment.  
  • Providing Sense of Control: Allowing patients to have a sense of control during the procedures can help reassure them during moments of fear or panic. 
  • Increasing Information on Procedures/Experience: In cases where the fear stems from a lack of information, giving descriptive measures for the procedures at hand can help increase dental visit attendance and provide a good psychological intervention. 

In cases where these non-invasive interventions don’t work, medicated interventions can work to allow patients the opportunity to gain their procedure without direct experience with their dental anxiety or dental phobia. Medication interventions can include: 

  • Oral Conscious Sedation: In combination with certain medications, the medications such as propofol and midazolam can work to provide a completely relaxed state for the procedure. 
  • Nitrous Oxide: Also called laughing gas, nitrous oxide can provide relief from the psychological effects of dental anxiety or dental phobia while leaving the patient conscious. 
  • General Anesthesia: Other medications such as oxycodone and hydromorphone are used to provide general anesthesia instead of sedation to help perform endodontic procedures. 
  • Anxiolytics: Some medications, such as benzodiazepines, can provide relief from anxiety symptoms during treatments. In some cases, these drugs are administered through IV sedation. 

All of these treatments highly depend on the endodontic practice, but overall, both nonmedicated and medicated interventions can increase dental attendance and reduce symptoms. Because these well-recognized problems exist for both patients and endodontists, tackling dental anxiety and dental phobia matters because of the long-lasting effects they can have on oral health. 

A Problem With Multiple Solutions

Each patient with some form of dental anxiety or dental phobia will require some form of individualized treatment to combat this long-term issue. Due to the nature of this form of fear, it often results in a cycle of dental fear, neglect, and poor dental health as a result. These tremendous cycles often cause more complex endodontic issues to appear and can lead to worsening situations for the patient due to the habit of avoidance and personal neglect. For endodontists, battling these issues involves a multi-step approach. 

Understanding the patient’s fears and phobias associated with their field can help expand on that patient’s personal dental care, giving opportunities for growth in the field. However, in cases where those circumstances cannot be resolved, interactions with local therapists, primary physicians, and other specialists can help address dental anxiety more head-on. The combination of therapeutic care and endodontic care can help provide comprehensive care for the patient, giving that patient extended resources to address their fears and ultimately help them receive better dental health. To truly combat the issues of dental fear and phobias, it takes the cooperation of both the patient and dentists in these regards, and for endodontists, maintaining a compassionate disposition is what will help patients keep coming back to their appointments.

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