Int Dent J. 1982 Mar;32(1):44-55.
Anxiety: its management during the treatment of the adolescent dental patient.
Donaldson D.
Abstract
Surveys indicate that the adolescent, in particular, suffers from acute anxiety in relation to dentistry. This anxiety is promoted by the general opinion they form of dentists and dentistry through portrayal by their peers and the media. In addition, their own attitude to dentistry, both positive and negative, is influenced to a large extent by the dentist himself. This patient-dentist relationship is, therefore, especially important when treating the adolescent and this should be emphasized in the dental undergraduate curriculum. Psychological methods can be effective in overcoming anxiety but they may be time-consuming. The technique of rapid induction analgesia, using hypnosis by indirect suggestion, may be the most practical modality in this field. Pharmacological techniques remain the principal method of stress reduction. The oral sedative-hypnotic of choice has progressed from the barbiturates to the benzodiazepines mainly due to the selective action of the latter on the limbic system coupled with their high therapeutic index. The newer benzodiazepines combine a more rapid onset with accelerated recovery. Nitrous oxide remains a safe and predictable agent for sedation but its ability to reinforce post-hypnotic suggestion has not been fully realized in the past. Intravenous sedation has evolved from a general anaesthetic technique to a predictable conscious sedation technique with the benzodiazepines again dominating the field. The advent of newer benzodiazepines with much shorter half-lives will improve their properties further. With the combination of the psychological and pharmacological techniques available, anxiety for the adolescent in dentistry may be overcome.
PMID: 6122648 [PubMed - indexed for MEDLINE]
ASDC J Dent Child. 1994 Jul-Aug;61(4):272-5. Hypnosis as an adjunct to the administration of local anesthetic in pediatric patients. Gokli MA, Wood AJ, Mourino AP, Farrington FH, Best AM. Abstract This study investigates the acceptance of local anesthetic injection, utilizing hypnosis in twenty-nine children, ages four to thirteen years. Each subject was evaluated twice, once utilizing hypnosis before injection, and once without. A double blind research design was used to avoid effects of expectancy. Subjects in the study were videotaped during the procedure. Their behavior was rated independently by two pediatric dentists, using the North Carolina Behavior Rating Scale (NBRS). Transcutaneous pulse oximetry data were also recorded for each subject. The resulting data were evaluated for statistically significant differences between the two methods and for interrater reliability. Results showed no statistically significant differences in oxygen saturation due to hypnosis condition, order of treatment, sex, race, or age. Statistically significant differences were found in pulse rate and behavior, attributable to hypnosis condition and age, but not to sex, race, or order of treatment. Pulse rate decreased with hypnosis, as did crying. The hypnosis condition seemed to be more successful with younger children (four to six years old). PMID: 7989631 [PubMed - indexed for MEDLINE]
Int J Clin Exp Hypn. 2010 Oct;58(4):457-75. Comparison of conventional therapies for dentin hypersensitivity versus medical hypnosis. Eitner S, Bittner C, Wichmann M, Nickenig HJ, Sokol B. Department of Prosthodontics,Friedrich-Alexander University, Erlangen Nuremberg, Erlangen, Germany. stephan.eitner@uk-erlangen.de Abstract This study compared the efficacy of conventional treatments for dentin hypersensitivity (DHS) and hypnotherapy. During a 1-month period at an urban practice in a service area of approximately 22,000 inhabitants, all patients were examined. A total of 102 individuals were included in the evaluation. Values of 186 teeth were analyzed. The comparison of the different treatment methods (desensitizer, fluoridation, and hypnotherapy) did not show significant differences in success rates. However, a noticeable difference was observed in terms of onset and duration of effect. For both desensitizer and hypnotherapy treatments, onset of effect was very rapid. Compared to the other methods studied, hypnotherapy effects had the longest duration. In conclusion, hypnotherapy was as effective as other methods in the treatment of DHS. PMID: 20799124 [PubMed - indexed for MEDLINE]
Fogorv Sz. 2002 Oct;95(5):199-203 Psychic aspects of the overactive gag reflex (gagging) in connection with a clinical case Gaspar J, Fejerdy L, Fabian TK. Semmelweis Egyetem, Fogorvostudomanyi Kar, Fogpotlastani Klinika, Budapest. The overactive gag reflex is one of the etiologic categories of psychosomatic symptoms, which most often arise from environmental stressors. If organic disturbances, anatomic anomalies, or biomechanical inadequacies of existing prostheses are not key causes, the services of trained specialists are needed to help with behavioural management of the problem. Hypnosis can provide the clinician with a set of techniques, which may be used to augment or facilitate a particular course of treatment. In the case report, the patient's history and her overactive gag reflex suggested to use hypnosis therapy. The responsibility of a dentist can be found in his possible recognition of eventually necessary psychotherapy when consulting a patient.
Rev Belge Med Dent. 2003;58(2):99-104 Hypnosis techniques used to diminish anxiety and fear: review of the literature Willemsen R. Service de dermatologie, AZ Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Jette. riawil@pi.be Hypnosis can be a valuable technique in the management of patients who fear medical treatment. Hypnosis leads to a stronger concentration and a more focussed attention, and thus to a better acceptance and greater effectiveness of suggestions. Literature indicates that hypnotherapy can reduce pain and fear in case of dental or medical phobia. After a short review of the existing literature on the topic, the practical aspects of the hypnotic approach are explained.
ASDC J Dent Child. 2000 Jul-Aug;67(4):263-7, 231 The use of imagery suggestions during administration of local anesthetic in pediatric dental patients. Peretz B, Bimstein E. Department of Pediatric Dentistry, Hebrew University, Hadassah School of Dental Medicine, Jerusalem, Israel. The aim of this study was to evaluate the effects of suggestion before and during the administration of local anesthesia to children. These effects were then observed and correlated with social, behavioral and dentally related variables. Eighty children between the ages of three and sixteen years and who required at least one injection of local anesthesia were monitored. Retrospective examinations of their dental records provided the information regarding the behavior and dental treatment histories of the patients. All other data were provided through observation during the dental treatment phase. During the first treatment session, before the injection, each child was asked to select a favorite, pleasant memory or image. Where children had difficulty in identifying an image, one was proposed by the dentist. After an image had been chosen, the patients were asked to concentrate on the image and to visualize it during the procedure. The majority of children had chosen their own images, and significantly visualized the same images throughout the injection procedures. Image selection and visualization had no association with gender, age, the parent's assessment of the child's behavior, previous dental experience, behavior (both past and present) or, management techniques (both past and present). We conclude that imaging techniques may be successfully utilized in the administration of local anesthesia to young children (from three years of age) in an effort to mitigate untoward, pain-related stress.
Eur J Oral Sci. 2002 Aug;110(4):287-95. A 3-year comparison of dental anxiety treatment outcomes: hypnosis, group therapy and individual desensitization vs. no specialist treatment. Moore R, Brodsgaard I, Abrahamsen R. Department of Oral Epidemiology and Pediatric Dentistry, Dental Phobia Research and Treatment Center, Royal Dental College, Aarhus University, Denmark. roding@post8.tele.dk Outcomes of hypnotherapy (HT), group therapy (GT) and individual systematic desensitization (SD) on extreme dental anxiety in adults aged 19-65 yr were compared by regular attendance behaviors, changes in dental anxiety and changes in beliefs about dentists and treatment after 3 yr. Treatment groups were comparable with a static reference control group of 65 anxious patients (Dental Anxiety Scale > or = 15) who were followed for a mean of nearly 6 yr. After 3 yr, 54.5% of HT patients, 69.6% of GT patients and 65.5% of SD patients were maintaining regular dental care habits. This was better than the 46.1% of the reference group, who reported going regularly to the dentist again within the cohort follow-up period, and 38.9% of a control subgroup with observation for 3 yr. Women were better regular attenders than men at 3 yr. Specialist-treated regular attenders were significantly less anxious and had more positive beliefs than regular attenders from reference groups. There were few differences between HT, GT and SD after 3 yr. It was concluded that many patients can, on their own, successfully start and maintain regular dental treatment habits with dentists despite years of avoidance associated with phobic or extreme anxiety. However, it also appears that these patients had less success in reducing dental anxiety and improving beliefs about dentists long-term than did patients who were treated at the specialist clinic with psychological strategies.
J Orofac Pain. 1994 Fall;8(4):397-401. A cognitive-behavioral approach to temporomandibular dysfunction treatment failures: a controlled comparison. Oakley ME, McCreary CP, Clark GT, Holston S, Glover D, Kashima K. Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California, Los Angeles 90024-1762, USA. The effects of cognitive-behavioral treatment for patients with temporomandibular disorders were studied by comparing active treatment to a wait-list control condition. Patients were predominantly women and had been referred to the study after having poor response to dental/physical medicine care. Patients' conditions were evaluated pretreatment and posttreatment based on self-report measures of pain, distress, and jaw function problems. They were examined by a dentist who assessed pain-free opening, muscle palpation pain, and tenderness of the temporomandibular joints. The 5-week cognitive-behavioral treatment included relaxation training, self-monitoring of stressors, and cognitive coping strategies. Treatment had its greatest impact on improving mood, especially anxiety; however, there were some effects on the patients' experiences of pain.
Dent Clin North Am. 1986 Oct;30(4 Suppl):S93-105. Relaxation skills for the patient, dentist, and auxiliaries. Schutt NL, Bernstein DA. The aforementioned stress reduction techniques can be useful for some people, but not all individuals will benefit to the same degree with a similar technique. Those who manifest severe stress symptoms, such as ulcers, hypertension, and migraine headaches, are advised to seek a medical evaluation before attempting relaxation or any other type of stress reduction method. The relaxation skill most beneficial for an individual's own needs might be best sought through a qualified therapist. Those who desire reduction in general tension, or who wish a rejuvenation during the workday, may well benefit from less controlled stress reduction techniques, such as taped instructions, breathing, and imagery methods. A trained therapist can provide the most appropriate relaxation method for an individual's needs. We, as health care providers, can enlighten our patients about methods which can aid them in dealing with anxiety and stress and thus gain better control over the pace of their lives and ours.
Dent Clin North Am. 1988 Oct;32(4):745-61. Hypnosis in the treatment of dental fear and phobia. Forgione AG. Gelb Craniomandibular Pain Center, Tufts University School of Dental Medicine, Boston, Massachusetts. The term hypnosis is currently used to define an area of research and treatment that employs suggestion. Within this area, suggestion refers to the induction of expectancies by implicit or explicit means, usually involving concentration and the expectancy that the suggested results are possible. This use of suggestion differs from the common use of the term suggestion, which is a logical offering for a change in behavior or thought. The long history of hypnosis is testimony to its effectiveness, although there has been controversy as to why it works. Patient selection is important. Further, fear must be distinguished from phobia. Combined with other treatment techniques, such as systematic desensitization, it is a powerful behavior modification method. To prevent accidental delivery of suggestions that may be counterproductive to treatment, the study of hypnosis is important even to those health care professionals who have no intention of employing it in their practice.
Am J Clin Hypn. 1991 Apr;33(4):235-40. Treatment of tongue thrust with hypnosis: two case histories. Golan HP. Boston City Hospital, MA. Tongue thrust is a relatively infrequent habit which can result in disruptive, permanent oral malocclusion, bone changes, and facial disharmony. The use of hypnotic phenomena can augment myofunctional therapy. Temperature control, glove anesthesia, relaxation, and imagery enhance demonstration of the proper way to swallow. The cornerstone of having the patient actually feel the contraction at the insertion of the masseter muscles provides an inner biofeedback which provides a very positive signal that the improper habit is being corrected. Hypnosis can then be used in the manner described to achieve a good clinical result.
ASDC J Dent Child. 1994 Jul-Aug;61(4):272-5. Hypnosis as an adjunct to the administration of local anesthetic in pediatric patients. Gokli MA, Wood AJ, Mourino AP, Farrington FH, Best AM. Abstract This study investigates the acceptance of local anesthetic injection, utilizing hypnosis in twenty-nine children, ages four to thirteen years. Each subject was evaluated twice, once utilizing hypnosis before injection, and once without. A double blind research design was used to avoid effects of expectancy. Subjects in the study were videotaped during the procedure. Their behavior was rated independently by two pediatric dentists, using the North Carolina Behavior Rating Scale (NBRS). Transcutaneous pulse oximetry data were also recorded for each subject. The resulting data were evaluated for statistically significant differences between the two methods and for interrater reliability. Results showed no statistically significant differences in oxygen saturation due to hypnosis condition, order of treatment, sex, race, or age. Statistically significant differences were found in pulse rate and behavior, attributable to hypnosis condition and age, but not to sex, race, or order of treatment. Pulse rate decreased with hypnosis, as did crying. The hypnosis condition seemed to be more successful with younger children (four to six years old). PMID: 7989631 [PubMed - indexed for MEDLINE]
Int J Clin Exp Hypn. 2010 Oct;58(4):457-75. Comparison of conventional therapies for dentin hypersensitivity versus medical hypnosis. Eitner S, Bittner C, Wichmann M, Nickenig HJ, Sokol B. Department of Prosthodontics,Friedrich-Alexander University, Erlangen Nuremberg, Erlangen, Germany. stephan.eitner@uk-erlangen.de Abstract This study compared the efficacy of conventional treatments for dentin hypersensitivity (DHS) and hypnotherapy. During a 1-month period at an urban practice in a service area of approximately 22,000 inhabitants, all patients were examined. A total of 102 individuals were included in the evaluation. Values of 186 teeth were analyzed. The comparison of the different treatment methods (desensitizer, fluoridation, and hypnotherapy) did not show significant differences in success rates. However, a noticeable difference was observed in terms of onset and duration of effect. For both desensitizer and hypnotherapy treatments, onset of effect was very rapid. Compared to the other methods studied, hypnotherapy effects had the longest duration. In conclusion, hypnotherapy was as effective as other methods in the treatment of DHS. PMID: 20799124 [PubMed - indexed for MEDLINE]
Fogorv Sz. 2002 Oct;95(5):199-203 Psychic aspects of the overactive gag reflex (gagging) in connection with a clinical case Gaspar J, Fejerdy L, Fabian TK. Semmelweis Egyetem, Fogorvostudomanyi Kar, Fogpotlastani Klinika, Budapest. The overactive gag reflex is one of the etiologic categories of psychosomatic symptoms, which most often arise from environmental stressors. If organic disturbances, anatomic anomalies, or biomechanical inadequacies of existing prostheses are not key causes, the services of trained specialists are needed to help with behavioural management of the problem. Hypnosis can provide the clinician with a set of techniques, which may be used to augment or facilitate a particular course of treatment. In the case report, the patient's history and her overactive gag reflex suggested to use hypnosis therapy. The responsibility of a dentist can be found in his possible recognition of eventually necessary psychotherapy when consulting a patient.
Rev Belge Med Dent. 2003;58(2):99-104 Hypnosis techniques used to diminish anxiety and fear: review of the literature Willemsen R. Service de dermatologie, AZ Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Jette. riawil@pi.be Hypnosis can be a valuable technique in the management of patients who fear medical treatment. Hypnosis leads to a stronger concentration and a more focussed attention, and thus to a better acceptance and greater effectiveness of suggestions. Literature indicates that hypnotherapy can reduce pain and fear in case of dental or medical phobia. After a short review of the existing literature on the topic, the practical aspects of the hypnotic approach are explained.
ASDC J Dent Child. 2000 Jul-Aug;67(4):263-7, 231 The use of imagery suggestions during administration of local anesthetic in pediatric dental patients. Peretz B, Bimstein E. Department of Pediatric Dentistry, Hebrew University, Hadassah School of Dental Medicine, Jerusalem, Israel. The aim of this study was to evaluate the effects of suggestion before and during the administration of local anesthesia to children. These effects were then observed and correlated with social, behavioral and dentally related variables. Eighty children between the ages of three and sixteen years and who required at least one injection of local anesthesia were monitored. Retrospective examinations of their dental records provided the information regarding the behavior and dental treatment histories of the patients. All other data were provided through observation during the dental treatment phase. During the first treatment session, before the injection, each child was asked to select a favorite, pleasant memory or image. Where children had difficulty in identifying an image, one was proposed by the dentist. After an image had been chosen, the patients were asked to concentrate on the image and to visualize it during the procedure. The majority of children had chosen their own images, and significantly visualized the same images throughout the injection procedures. Image selection and visualization had no association with gender, age, the parent's assessment of the child's behavior, previous dental experience, behavior (both past and present) or, management techniques (both past and present). We conclude that imaging techniques may be successfully utilized in the administration of local anesthesia to young children (from three years of age) in an effort to mitigate untoward, pain-related stress.
Eur J Oral Sci. 2002 Aug;110(4):287-95. A 3-year comparison of dental anxiety treatment outcomes: hypnosis, group therapy and individual desensitization vs. no specialist treatment. Moore R, Brodsgaard I, Abrahamsen R. Department of Oral Epidemiology and Pediatric Dentistry, Dental Phobia Research and Treatment Center, Royal Dental College, Aarhus University, Denmark. roding@post8.tele.dk Outcomes of hypnotherapy (HT), group therapy (GT) and individual systematic desensitization (SD) on extreme dental anxiety in adults aged 19-65 yr were compared by regular attendance behaviors, changes in dental anxiety and changes in beliefs about dentists and treatment after 3 yr. Treatment groups were comparable with a static reference control group of 65 anxious patients (Dental Anxiety Scale > or = 15) who were followed for a mean of nearly 6 yr. After 3 yr, 54.5% of HT patients, 69.6% of GT patients and 65.5% of SD patients were maintaining regular dental care habits. This was better than the 46.1% of the reference group, who reported going regularly to the dentist again within the cohort follow-up period, and 38.9% of a control subgroup with observation for 3 yr. Women were better regular attenders than men at 3 yr. Specialist-treated regular attenders were significantly less anxious and had more positive beliefs than regular attenders from reference groups. There were few differences between HT, GT and SD after 3 yr. It was concluded that many patients can, on their own, successfully start and maintain regular dental treatment habits with dentists despite years of avoidance associated with phobic or extreme anxiety. However, it also appears that these patients had less success in reducing dental anxiety and improving beliefs about dentists long-term than did patients who were treated at the specialist clinic with psychological strategies.
J Orofac Pain. 1994 Fall;8(4):397-401. A cognitive-behavioral approach to temporomandibular dysfunction treatment failures: a controlled comparison. Oakley ME, McCreary CP, Clark GT, Holston S, Glover D, Kashima K. Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California, Los Angeles 90024-1762, USA. The effects of cognitive-behavioral treatment for patients with temporomandibular disorders were studied by comparing active treatment to a wait-list control condition. Patients were predominantly women and had been referred to the study after having poor response to dental/physical medicine care. Patients' conditions were evaluated pretreatment and posttreatment based on self-report measures of pain, distress, and jaw function problems. They were examined by a dentist who assessed pain-free opening, muscle palpation pain, and tenderness of the temporomandibular joints. The 5-week cognitive-behavioral treatment included relaxation training, self-monitoring of stressors, and cognitive coping strategies. Treatment had its greatest impact on improving mood, especially anxiety; however, there were some effects on the patients' experiences of pain.
Dent Clin North Am. 1986 Oct;30(4 Suppl):S93-105. Relaxation skills for the patient, dentist, and auxiliaries. Schutt NL, Bernstein DA. The aforementioned stress reduction techniques can be useful for some people, but not all individuals will benefit to the same degree with a similar technique. Those who manifest severe stress symptoms, such as ulcers, hypertension, and migraine headaches, are advised to seek a medical evaluation before attempting relaxation or any other type of stress reduction method. The relaxation skill most beneficial for an individual's own needs might be best sought through a qualified therapist. Those who desire reduction in general tension, or who wish a rejuvenation during the workday, may well benefit from less controlled stress reduction techniques, such as taped instructions, breathing, and imagery methods. A trained therapist can provide the most appropriate relaxation method for an individual's needs. We, as health care providers, can enlighten our patients about methods which can aid them in dealing with anxiety and stress and thus gain better control over the pace of their lives and ours.
Dent Clin North Am. 1988 Oct;32(4):745-61. Hypnosis in the treatment of dental fear and phobia. Forgione AG. Gelb Craniomandibular Pain Center, Tufts University School of Dental Medicine, Boston, Massachusetts. The term hypnosis is currently used to define an area of research and treatment that employs suggestion. Within this area, suggestion refers to the induction of expectancies by implicit or explicit means, usually involving concentration and the expectancy that the suggested results are possible. This use of suggestion differs from the common use of the term suggestion, which is a logical offering for a change in behavior or thought. The long history of hypnosis is testimony to its effectiveness, although there has been controversy as to why it works. Patient selection is important. Further, fear must be distinguished from phobia. Combined with other treatment techniques, such as systematic desensitization, it is a powerful behavior modification method. To prevent accidental delivery of suggestions that may be counterproductive to treatment, the study of hypnosis is important even to those health care professionals who have no intention of employing it in their practice.
Am J Clin Hypn. 1991 Apr;33(4):235-40. Treatment of tongue thrust with hypnosis: two case histories. Golan HP. Boston City Hospital, MA. Tongue thrust is a relatively infrequent habit which can result in disruptive, permanent oral malocclusion, bone changes, and facial disharmony. The use of hypnotic phenomena can augment myofunctional therapy. Temperature control, glove anesthesia, relaxation, and imagery enhance demonstration of the proper way to swallow. The cornerstone of having the patient actually feel the contraction at the insertion of the masseter muscles provides an inner biofeedback which provides a very positive signal that the improper habit is being corrected. Hypnosis can then be used in the manner described to achieve a good clinical result.
