PSIHOLOGIE MEDICALĂ

LUCRARE PRACTICĂ – 3

Șef de Lucrări Dr. Csibi Sándor

UMF, Etică și Științe Socio-umane
E-mail: csibi.sandor@umftgm.ro
 Prezentarea activităților

LP anterior:
• Schimbarea – primul pas în vindecare.
• Rezistența la schimbare.
• Stagiile schimbării (Prochaska – DiClemente).

LP actual:
• Stresul și anxietatea în cabinetul stomatologic
• Modelul de reducere a stresului în medicina dentară
Stages of Stress Response
General adaptation syndrome (Selye)
• Video: Long Term Effects of Stress on Your Body
Stress curve
Affective responses to stress
 Exercițiu de grup:

• Descrieți cum ar decurge prima întâlnire cu un pacient

care are un nivel de stres/anxietate ridicat și modalitatea
aleasă pentru reducerea stresului!
– Descrierea comportamentului clientului
– Tehnici de comunicare cu clientul + conținutul comunicării
– Tehnici de reducere a stresului/anxietății
Stress Reduction in Dentistry

Pre-Treatment Peri-Treatment Post-Treatment

Medical History Iatrosedation Written Instructions
ASA PS Relaxation Tech Analgesics
Anxiety Reduction Music, Aroma,
MDAS Massage
Proper Rest / Diet Hypnosis Follow-up Telephone
Transportation Acupuncture Referral, if needed
Medication Local Anaesthetic
Short Morning followed by Topical
Appointment
 First Consultation

• Get to know the patient

• Try to befriend him/her
• Thorough Medical History
– Written
– Verbal (Re-enforced)
• Discuss likes and dislikes, acknowledge feelings
• Empathy
• Understand him/her well - it’s a long term affair...
• Video: Communication in Dentistry
 Medical History

• Written, signed and verbal

• Categorization as per ASA PS Score (physical
status classification system for assessing the
fitness of patients before surgery):
– ASA I A normal healthy patient
– ASA II A patient with mild systemic disease
– ASA III A patient with severe systemic disease
– ASA IV A patient with severe systemic disease that is a
constant threat to life
• Check vitals
 Communication

• Let them talk

• Be a good listener
• Show interest in their conversation
• At an eye level
• Away from the equipment
 Examination

• Do a thorough check-up including; examination of

– Extra-oral: TMJ, Lymph Nodes, abnormalities (A
gentle palpation of the area ensuring that you care.)
– Intra-oral: Soft Tissues
– Occlusion
– Periodontal Tissues
– Teeth
 Diagnosis and Treatment Plan

• Try to find the cause of the problem and

discuss with patient rather than just trying to
pick up that handpiece ...
• Make a preventive programme for the patient
• Make a comprehensive treatment plan in
phases
– Emergency
– Stabilization
– Maintenance
– Definitive
 Modified Dental Anxiety Scale MDAS; Humphris et al., 1995)

Can you tell us how anxious you get, if at all, with your dental visit?
Please indicate by inserting ‘X’ in the appropriate box.

1. If you went to your Dentist for TREATMENT TOMORROW, how would you
feel?
□ Not Anxious □ Slightly Anxious □ Fairly Anxious □ Very Anxious □ Extremely Anxious

2. If you were sitting in the WAITING ROOM (waiting for treatment), how
would you feel?
□ Not Anxious □ Slightly Anxious □ Fairly Anxious □ Very Anxious □ Extremely Anxious

3. If you were about to have a TOOTH DRILLED, how would you feel?
□ Not Anxious □ Slightly Anxious □ Fairly Anxious □ Very Anxious □ Extremely Anxious

4. If you were about to have your TEETH SCALED AND POLISHED, how would
you feel?
□ Not Anxious □ Slightly Anxious □ Fairly Anxious □ Very Anxious □ Extremely Anxious

5. If you were about to have a LOCAL ANAESTHETIC INJECTION in your gum,

above an upper back tooth, how would you feel?
□ Not Anxious □ Slightly Anxious □ Fairly Anxious □ Very Anxious □ Extremely Anxious
 Instructions for scoring

• The Modified Dental Anxiety Scale – each item

scored as follows:
– Not anxious = 1
– Slightly anxious = 2
– Fairly anxious = 3
– Very anxious = 4
– Extremely anxious = 5
• Total score is a sum of all five items, range 5 to
25: Cut off is 19 or above which indicates a highly
dentally anxious patient, possibly dentally phobic.
Vă mulțumesc pentru atenție!