Description
As long as individuals have practiced the art and science of dentistry, fear and anxiety have been associated with dental treatment. Managing this fear and anxiety has been one of the most troublesome problems that the dental practitioner, as well as the profession at large, has had to face. In years past, dental professionals could afford largely to ignore the problem of dental anxiety. Practices could fl ourish based on technical virtuosity, while a fearful or anxious patient might be regarded as a burden rather than as a basis for concern.
In the past three decades or so, the advent of the fi eld of behavioral medicine in psychology has brought with it a fresh perspective on a variety of emotional, psychological, and mental disorders, including those of personality, eating, depressive, somatoform, as well as anxiety/panic and posttraumatic stress, and their associated effects on dental care and its behavioral management. As a result of the great infl uence these disorders have, either individually or combined, on whether or not an individual will receive care, the dental profession has begun to devote increasing attention and involvement focusing on the potential effects and concerns that accompany these disorders. In particular, attention has been directed to those with fear, anxiety, and phobia, which are so often are associated with negative and aversive behavior in a dental patient. In recent years, issues of dentist – patient interaction and patient management have received considerable attention in the dental curriculum, and, at the same time, an increasing number of dental and behavioral clinicians and researchers have directed their efforts toward developing programs designed to increase knowledge and shed new light on this vexing problem of dental fear and anxiety. However, despite this increased attention, the problem of fear and anxiety remains as prevalent today as it did years ago. This is due in general to the lack of understanding of the basic principles of fear, anxiety, and phobias, and the various other disorders that often act in combination to initiate those negative behavioral manifestations that hinder the dental practitioner from successfully treating this segment of the population. In today ’ s complex society, it is diffi cult to separate and treat only the physical needs of the patient while ignoring the emotional ones. Being a good dentist in today ’ s world means not only producing a fine, accurate restoration; it must also include the understanding that a patient ’ s behavior is crucial to the outcome of treatment. In dental school curricula, courses in the behavioral sciences are now required in order for these institutions to obtain full and complete accreditation, demonstrating the clear importance of this subject to the practice of dentistry. To this end, the practitioner must acquire as much knowledge and understanding as possible of these emotions, feelings, and behaviors and the combined role they play in all stage of dental care.
Since no text can completely cover all the complex psycho – physiological aspects of dental care, nor refer to all those dedicated clinicians and their contributions toward this phase of care, this text has been designed to present basic knowledge acquired through my own years of both private practice and academic research/teaching. It is also combined with the knowledge gained by other distinguished clinicians and academies through their individual and group experiences and studies, necessary to the successful understanding and behavioral management of the dentally anxious and fearful patient. Multiple approaches for various situations are demonstrated, which are practical, and, in many cases, simple, and can be utilized not only by the busy general practitioner, but by dental students, specialists, hygienists, and their staff. We hope the reader will be better able to make a correct assessment of a patient ’ s combined psychological, emotional, and dental needs and to apply that information, and, if needed, the necessary behavioral and psychopharmacological techniques, to lead to the provision of optimal dental treatment. We hope this text, combined with continuous education courses, will act as an instrument to stimulate further and more detailed studies of this phenomenon of dental fear, at all levels of the dental profession.
Arthur A. Weiner, DMD