Importance Of Early Education In Preventing Dental Anxiety

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What would you rather avoid? An appointment with a dentist or a neurologist? Out of 10 people who I asked today, 7 people preferred to visit with a neurologist instead of the dentist. Neurologists work with your brain, the more vulnerable organ. Yet, people seem to either knowingly or unknowingly avoid going to the dentist because of their dental anxieties.

What is a Dental anxiety? Dental anxiety is defined as ‘an excessive dread of anything being done to the teeth. It results any dental surgery, no matter how minor the treatment is, to may be postponed or procrastinated.’ It is a form of an anticipatory anxiety that is created from the fear of an anticipated unknown danger that may or may not harm the person. A more severe case would be classified as a “dental phobia.” People with dental phobia are in a literal extreme dental fear that was triggered by a presence or anticipation of dental object or situation. It can cause intense panic and more. This has become problematic. Delaying necessary dental treatment for an indefinite period due to dental anxiety is commonly seen to aggravate not only the dental diseases but also the systemic and the social health. However, dental anxiety is an anticipatory disease. This means that the anticipation of fear and trauma can possibly be prevented and reduced. I believe that a good education and positive early exposure to oral hygiene and dental treatment is a possible solution to this critical yet underrated issue.

I will explain in more about dental anxiety, its relationship with health, potential causes to dental anxiety and how education can solve this problem.

According to American Adult Dental Survey, it is estimated that 36% of the American population has dental anxiety or dental fear and 12% suffers from extreme dental fear. This explains the phenomenon that people are commonly scared of dentists. The concept is too generalized that people are naturally accepting that dentists are intimidating. As mentioned earlier, this is identified to be problematic because people have been putting themselves at risk of grave diseases by avoiding dental care. Researches done in Germany by Dr.Thom discovered that patients with dental anxiety had dental decays in need of treatments and those with dental phobia had even higher prevalence. This correlation has a validity, because there are many evidences proving that unattended dental care puts people in risk of dental cavities and development of systemic diseases such as heart attacks, diabetes, infective endocarditis, cancer and more.

According to Dr. David Locker, half of dental anxious patients reported that their dental anxiety or fear started in childhood. This brought up the importance of identifying the causes of dental fear in childhood to prevent development of ignorance in oral cares.

Fearful anticipation against dentistry is caused by indirect effects from significant others and the media. When the parents are scared of the dentists, their dental anxieties are inherited to their children too. Locker presented that 56% of children who reported to have dental anxiety had a parent or sibling who also suffered the same. These children acquired the anxiety from observing the behavior of those around them. People would either share their own or others’ stories or unconsciously present their fear. Thus, the children would develop anticipated fear against dentistry. This anticipated fear was shown to even increase the pain that they remembered from previous visits. Dr.Gerry Kent from University of Sheffield, UK, found closer association between remembered and expected pain than between remembered and experienced pain. It means that the pain that people anticipated from what others taught them makes them remember the experience to have been more painful than what they actually perceived.

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Moreover, the portrayal of dentistry in the media have influenced the manifestation of dental anxiety. Dentists have been portrayed to provide pain and to be unreliable. Jennifer Aniston from the movie Horrible Bosses, plays a nymphomaniacal dentist who always harasses everyone. Ed Helms from the movie The Hangover plays as a dentist who pulls out his own teeth when drunk, indirectly portraying dentists to be crazy. Dentists are even antagonized in the children’s movie, Finding Nemo. The dentist captures the young Nemo and other fishes in his aquarium. Dentists are commonly picked as villains in children’s cartoons, such as Knightbrace, dental-obsessive villain from Kids Next Door, Dr.Bender from Odd Fairy God Parents and countlessly more. According to psychological researches done in University of Michigan, children around the age of 7, not only develop the categorization of good and bad but also easily imitate what they see from the television. Thus, these negative images may be the caused the children to label dentists as bad and develop fearful anticipation towards dentistry.

This image needs to be fixed to limit potential development of dental anxiety. If the portrayals of dentists are changed into a more positive and helpful roles, the general public will be less likely to have high levels of resistance against dentistry. As the children’s exposure to media are especially increasing in the modern age of developed communications, changes in the messages from media to provide a proper early education about dentistry and their importance is very critical to overcome the negative perception towards dentistry.

Another potential causes to dental anxiety were analyzed to be the direct learning from traumatic experiences. Dentistry has commonly been engraved as a trauma to many people. Researchers found that children’s dental anxiety and fear increased as they had experienced more of extractions. The trauma encouraged the children to label dental objects such as injection, dentist, dental chair, gowns and even more with pain and fear. For example, I have visited Camino Nuevo Charter school for Early childhood in Westlake LA to provide free dental screening for kids. The screening process was just looking into their mouth with mirror and light. Before the screening session, my colleague and I visited each class to familiarize our presence to the kids and provide a short introduction about how to keep the mouth healthy. It was very interesting to witness an interesting phenomenon. Children with history of frequent dental checkups loved being with the dental professionals. They found it fun and voluntarily opened their mouth even though it wasn’t asked for. On the other hand, children with either history of extractions and fillings or unhealthy oral health did not want to be there. Some cried in fear as soon as they saw us in gowns, even though we already have met and even exchanged a high five. This experience correlated to the research findings by Dr. Berge, in which children who had experienced more check-up visits before their first-ever curative treatment reported low levels of dental fear. This means that they had longer history of non-invasive or non-surgical treatments before experiencing a painful treatment to relate pain with dentists.

So, I believe that the best and most easily measurable educational method would be increasing frequency of dental visits. Non-surgical checkup visits with dentists or dental hygienists provides the children and the parents with personal monitoring of oral health and educations in good oral hygiene maintenance. They are usually guided with how to brush and floss teeth, nutritional counseling and even tobacco cessation. The dental hygienists’ goals in pediatric appointments are not only to treat and educate but also to gain rapport and provide a dental home setting. The increased verbal explanations and reassurances by the dental staffs have been proven to reduce the level of dental anxieties. The children are able to be familiarized with the dental setting and be desensitized of anticipatory fear with positive experiences when having visited dental clinics. Moreover, increased visit frequencies help the parents to be more knowledgeable and aware and have less repulsion against dental care. When the parents are comfortable with dental cares, the children will not only be given better home dental care and educations but also not vicariously develop dental anxiety. This means that early and frequent exposure to dentistry have been proven to prevent dental anxiety from developing.

Lastly, good dental education is critical to increase self-awareness in oral health for people to self-diagnose better. It was mentioned earlier that traumas causing dental anxieties are due to painful treatments like extraction. The anticipated fear makes people to not see the dentists until they are in pain. However, the pain indicates that the dental diseases have already progressed to the point where treatments are required. If people were more aware in their oral health and more comfortable reaching out to dentists, then rates of need for extractions and teeth restorations would decrease. This would then also reduce the rate of surgical treatments that potentially causes traumatic experiences, limiting any potential dental anxiety development. When the patients visit for routine check-ups, they are educated with ways to prevent dental diseases and are exposed with more knowledges that allow them to self-diagnose if they are in risk of developing periodontal problems.

Educational methods to promote self-dental cares are available, but I believe that educational methods need to focus more on improving the image of dentistry especially for the children. Changes in portrayal of dentists in the media and more availability in public density education would desensitize people’s dental anxiety. There still is a long way to go to completely flip the negative portrayal of dentistry, but education focused on the children of the present would surely will result improvements in the prevalence of dental anxieties and the images.  

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