THE MANAGEMENT OF FEAR & ANXIETY IN THE PEDIATRIC DENTAL PATIENT

Fear
It is a response to an object or situation, real & imaginary that indicates harm or, an unpleasant emotion of effect consisting of psychophysiological changes in response to realistic threat or danger to one’s own existence The physiological response is that of flight or fight

The development of fear

primary emotion acquired soon after birth, with no awareness of the stimulus producing fear with age, there is an awareness of fear-producing stimuli leading to flight/fight response

The value of fear
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Fear is a protective mechanism for selfpreservation Protects the individual from harm & selfdestruction Can be utilized to keep the child away from dangerous situations of either a social or a physical nature Should be channeled toward dangers that really exist, & away from non-dangerous situations

Types of fear
1.Innate fear 2.Acquired fear
Objective fear  Subjective fear

Objective fears
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those that are produced by direct stimulation of the sense organs generally not of parental origin responsive to stimuli that are felt, seen, heard, smelled or tasted, & are of a disagreeable/unpleasant nature may be associative in nature

Subjective fears

those that are based on feelings & attitudes that have been suggested to the child by others about him without the child’s having had the experience personally may be acquired by imitation of fear displayed by parents or from friends, playmates, reading materials, radio, TV etc more difficult to overcome & eradicate

Fears of the preschooler

fear of separation from parent or of abandonment fear of not having satisfied the parent fear of falling, of noise, of strangers

Fears of the early schooler

fear of the dark/staying alone fear of supernatural powers like ghosts & witches, of imaginary objects & of situations such as war

Fears of the late schooler
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fear of fear of fear of fear of fear of fear of

bodily injury (by age 9) failure not being liked competition punishment crowds, heights etc.

Fears of the adolescent

Fear of rejection Fear of performance

Anxiety
Anxiety is apprehension, tension or uneasiness which stems from the anticipation of danger, the source of which is largely unknown or unrecognized
Anxiety = ‘fear spread thin’

Types of anxiety
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A-Trait - free-floating A-State – specific; arises most acutely at a particular moment in association with a particular event or environment - Spielberger, 1966

Fear vs anxiety
Fear

Anxiety

Factors determining child’s reaction to fear & anxiety

the degree of fear the ability to cope with fear the motivation to cope with fear

Expressions of fear & anxiety
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flight aggressiveness crying evasiveness apathy & withdrawal regression vomiting or stomachaches trying to suppress & hide the fear

Causes of fear of the dental office
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separation from parents unknown situation presence of strangers possibility of bodily harm attitude of parents or other children to avoid the dentist parental threat as punishment for bad behaviour

PHOBIA
It is a special kind of fear that is out of proportion to the situation, which cannot be explained or reasoned away, is beyond voluntary control & which leads to an avoidance of the feared situation e.g., the dental surgery Phobos – a Greek god who could strike fear into one’s enemies

Types of phobia

Blanophobia – fear of the injection needle