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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 1462-1465  

Skills, knowledge, and implementation of techniques for behavioral guidance in adults with a fear of dentistry


1 Senior Resident, Department of Dentistry, All India Institute of Medical Sciences, Patna, Bihar, India
2 Department of Periodontics, Dental Officer, ECHS Polyclinic, Ministry of Defence, Hajipur, Vaishali, Bihar, India
3 Dental Officer, ECHS Polyclinic station HQ, Gopalpur, Cantonment, Odisha, India
4 Senior lecturer, Dept of Periodontics, Buddha Institute of dental sciences and hospital, Patna, Bihar, India
5 Department of Dentistry, Medeor International Hospital, Al Ain, United Arab Emirates
6 PG Student, Department Of Oral Pathology, Buddha Institute Of Dental Sciences and Hospital, Patna, Bihar, India
7 Associate professor, Department of Dentistry, Sri Shankaracharya Medical College, Bhilai, Durg, Chhattisgarh, India

Date of Submission26-Mar-2021
Date of Decision11-Apr-2021
Date of Acceptance09-May-2021
Date of Web Publication10-Nov-2021

Correspondence Address:
Dipti Gopalakrishnan
Department of Dentistry, Medeor International Hospital, Al Ain
United Arab Emirates
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.jpbs_253_21

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   Abstract 


Background: Dental fear and anxiety (DFA) is considered the main reason of dental negligence which can lead to detrimental oral health as well as overall health including psychological well-being and quality of life in an individual. Aims: The present trial was aimed to assess the skill and knowledge of dentists in managing DFA in adult subjects, to evaluate the available strategies used in treating such subjects, and to find the need for further education. Materials and Methods: The present study was an original survey and questionnaire trial, which was distributed to the 82 dentists. The collected data were subjected to statistical evaluation and the results were formulated. Results: Educating and motivating subjects was found to be effective by 62.19% (n = 51) of dentists followed by successive approximation, and muscle relaxation was considered highly ineffective by one responder (1.21%). Music and reduced waiting time in the clinic appeared to be the most effective strategy as responded by 56.09% (n = 46) of dentists. Attempting treatment in various visits than a single seems to be a highly ineffective technique by 4 dentists (4.87%). Conclusion: Within its limitation, the study showed that the application of various behavior modification techniques can be effective in alleviating DFA in adult patients.

Keywords: Adult patients, behavior modification techniques, dental anxiety, dental fear, practitioners


How to cite this article:
Barbi W, Raj V, Askari M, Toshi T, Gopalakrishnan D, Kumari K, Rangari P. Skills, knowledge, and implementation of techniques for behavioral guidance in adults with a fear of dentistry. J Pharm Bioall Sci 2021;13, Suppl S2:1462-5

How to cite this URL:
Barbi W, Raj V, Askari M, Toshi T, Gopalakrishnan D, Kumari K, Rangari P. Skills, knowledge, and implementation of techniques for behavioral guidance in adults with a fear of dentistry. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Aug 10];13, Suppl S2:1462-5. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1462/330043




   Introduction Top


Various techniques of behavior guidance including empathy, communication, listening, and/or flexibility are applied regularly in pediatric dentistry to provide effective dental care by alleviating the dental fear and anxiety (DFA) from the children seeking dental treatment. These also help in maintaining the trust and develop a positive attitude toward dentistry and oral health care.[1]

Such techniques should also be applied in adult subjects with few modifications if required as DFA is also prevalent in the adult population seeking dental care. DFA is also considered the main reason for dental negligence which can lead to detrimental oral health as well as overall health including psychological well-being and quality of life in an individual. DFA results from anxiety and the ill experiences faced or heard. Delayed dental treatment owing to FDA also puts an additional financial burden on adult subjects.[2]

DFA are not only limited to the subjects with previous negative experience but also instill fear in subjects with no previous experience. Unlike pediatric subjects, adults do not express their anxiety and fear freely in the dental office and make no expressions and signs of fear masking actual responses. This makes it difficult for dental practitioners to motivate and counsel such adult subjects.[3]

Hence, it should be a regular practice for dental practitioners to reinforce behavior modification techniques and coping skills to all the subjects seeking dental care. These techniques should aim at providing positive reinforcements to avoid fear and anxiety in adults seeking dental treatment. Behavior modification techniques utilize the psychology principles, leading to effective treatment by dentists and great acceptance by subjects.[4]

Although these techniques proved to be effective in both adults and children, dentistry focus solely on pediatric subjects for behavior modification. Recently, modification in adults is largely pharmacological, which has associated risks and is accepted less than nonpharmacologic means by controlling subjects and interfering with their coping. These techniques in adults should be based on trust, thus benefitting both patient and dental care provider.[5]

The present trial was aimed to assess the skill and knowledge of dentists in managing DFA in adult subjects, to evaluate the available strategies used in treating such subjects, and to find the need for further education.


   Materials and Methods Top


The present nonexperimental cross-sectional trial was aimed to assess the skill and knowledge of dentists in managing DFA in adult subjects, to evaluate the available strategies used in treating such subjects, and to find the need for further education. The present study utilized the random sampling method.

The study included the dentists with a valid degree of BDS or higher and was registered with the Dental Council of India. The dentists having practiced for 1 year or more were only included. The dentists treating majorly adult subjects were enrolled to participate in the study. The pediatric dentists and the dentists relying on the pharmacological management of the fear and anxiety were excluded from the study. The population of the included dentists was heterogeneous as all the dentists were seeing a different number of patients. The final study population consisted of 82 dentists.

The study was based on a survey and questionnaire, which were adopted from the international model of Dentists skills with fearful patients: Education and treatment.[6] As the present study was an original survey and questionnaire trial, ethical forum clearance was taken. The survey was distributed to the dentists with the definition of behavior modification on the top of the survey form, with a purpose of not to educate the dentists but to provide clarity. The 82 dentists included belonged to the specialties of general dentistry, orthodontists, periodontics, endodontics, oral pathology, oral radiology, public health dentists, and prosthodontics. Pediatric dentists, students, interns, and retired dentists were excluded. The dentists who did not give consent and refused to participate were also not included.

The collected data were subjected to statistical evaluation and the results were formulated.


   Results Top


The present nonexperimental cross-sectional trial was aimed to assess the skill and knowledge of dentists in managing DFA in adult subjects, to evaluate the available strategies used in treating such subjects, and to find the need for further education. The survey questionnaires were available to the dentists for 2 weeks and excluded were those who did not respond within 2 weeks. The study sample had 82 subjects, which were 23 females and 59 males with 79.26% (n = 65) having the practice of 10 years or more, 14.63% (n = 12) had the practice of 6–10 years, and 7.31% (n = 6) with the dental practice of 2–4 years. 40.24% (n = 33) of the participating dentists were BDS dentists and 59.75% (n = 49) were MDS practitioners.

The present study also assessed the awareness of the participating dentist toward the various existing techniques for behavior modification in the subjects with DFA. The results are described in [Table 1]. Maximum subjects were aware of education/motivation technique with 93.9% (n = 77) dentists aware of it followed by signaling known to 90.24% (n = 74) dentists, and minimum awareness was regarding muscle relaxationtechnique with 40.24% (n = 33) subjects were aware of it. The respective awareness for behavior shaping, distraction, successive approximation, and diaphragm breathing was seen in 80.48% (n = 66), 85.36% (n = 70), 73.17% (n = 60), and 65.85% (n = 54) of dentists.
Table 1: Awareness of participant dentists towards various behavior modification techniques

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The study also assessed if any of the techniques were appropriate to use in the dental office to reduce DFA in subjects visiting the dental office. Furthermore, the study evaluated the effectiveness of various strategies employed by dentists in-office to reduce the fear in dental patients. The results are summarized in [Table 2]. Maximum dentists responded that educating and motivating subjects is a highly effective method of reducing DFA as responded by 62.19% (n = 51) of dentists and the successive approximation, and muscle relaxation was considered highly ineffective by 1.21% (n=1) responder. Muscle relaxation was considered ineffective by 12.19% of dentists (n = 10). Furthermore, among evaluated in-office techniques, music and reduced waiting time in the clinic were found most effective strategy as responded by 56.09% (n = 46) dentists. Attempting treatment in various visits than a single visit seems to be a highly ineffective technique by 4 dentists (4.87%) as shown in [Table 2].
Table 2: Effectiveness of different techniques and in-office strategies in reducing dental fear and anxiety perceived by study participants

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The study also assessed, if the participant dentists were interested and thought that the proper learning of these techniques can be effective in implementing them in routine practice and also their thinking regarding the suitable health-care professional to provide such training was evaluated [Table 3]. 36.58% (n = 30) of dentists recommend taking training in educating the patients to implement it effectively in the routine practice. Least desirable technique by dentists was diaphragm breathing, as responded by 28.04% (n = 23) dentists, and was also considered highly ineffective by 4 dentists (4.87%). Furthermore, a high percentage of dentists recommended training by the qualified dentist by 74.39% (n = 61) of subjects and only 52.43% (n = 43) preferred training by motivational speakers. 47.56% (n = 39) of dentists found motivational speakers not suitable for training.
Table 3: Behavior modification by participants towards technique and trainer

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   Discussion Top


The present nonexperimental cross-sectional trial was aimed to assess the skill and knowledge of dentists in managing DFA in adult subjects, to evaluate the available strategies used in treating such subjects, and to find the need for further education. Maximum subjects were aware of education/motivation technique with 93.9% (n = 77) dentists aware about it followed by signaling known to 90.24% (n = 74) dentists and minimum awareness was seen regarding muscle relaxation technique with 40.24% (n = 33) were aware of it. The respective awareness for behavior shaping, distraction, successive approximation, and diaphragm breathing was seen in 80.48% (n = 66), 85.36% (n = 70), 73.17% (n = 60), and 65.85% (n = 54) of dentists. Similar results were reported by Farhat-McHayleh et al.,[7] and Sharath et al.,[8] in 2009 where similar responses were seen.

Maximum subjects were aware of education/motivation technique with 93.9% (n = 77) dentists aware of it followed by signaling known to 90.24% (n = 74) dentists, and minimum awareness was regarding muscle relaxation technique with 40.24% (n = 33) subjects were aware of it. Muscle relaxation was considered ineffective by 12.19% of dentists (n = 10). Also, among in-office techniques; music and reduced waiting time in the clinic were appeared to be the most effective strategy as responded by 56.09% (n = 46) dentists. Attempting treatment in various visits than a single visit seems to be a highly ineffective technique by 4 dentists (4.87%). These were consistent with the findings of Newton and Buck[9] in 2000 and Ogle and Hertz[10] in 2012 where these techniques were effective in reducing anxiety and fear in dental subjects.

36.58% (n = 30) of dentists recommend taking training in educating the patients to implement it effectively in the routine practice. Least desirable technique by dentists was diaphragm breathing, as responded by 28.04% (n = 23) dentists, and was also considered highly ineffective by 4 dentists (4.87%). 47.56% (n = 39) of dentists found motivational speakers not suitable for training. Hill et al.,[11] in 2008 and Ogletree BT and Oren[12] in 2001 have findings similar to the present study, where the authors suggested training and modification techniques showing similar results.


   Conclusion Top


Within its limitation, the study showed that the application of various behavior modification techniques can be effective in alleviating DFA in adult patients. These should be implemented in all adult subjects. However, training should be provided in dental schools regarding the same. The study had few limitations including smaller participant size and all the dentists resided in the same geographical area. Hence, more such studies are required to reach a definitive conclusion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: A literature review. Clin Cosmet Investig Dent 2016;8:35-50.  Back to cited text no. 1
    
2.
Dahlander A, Soares F, Grindefjord M, Dahllöf G. Factors associated with dental fear and anxiety in children aged 7 to 9 years. Dent J (Basel) 2019;7:68.  Back to cited text no. 2
    
3.
Gao X, Hamzah SH, Yiu CK, McGrath C, King NM. Dental fear and anxiety in children and adolescents: a qualitative study using YouTube. J Med Internet Res 2013;15:29.  Back to cited text no. 3
    
4.
Strøm K, Rønneberg A, Skaare AB, Espelid I, Willumsen T. Dentists' use of behavioral management techniques and their attitudes towards treating pediatric patients with dental anxiety. Eur Arch Paediatr Dent 2015;16:349-55.  Back to cited text no. 4
    
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Radhakrishna S, Srinivasan I, Setty J, Krishna M, Melwani A, Hegde K. Comparison of three behavior modification techniques for management of anxious children aged 4-8 years. J Dent Anesth Pain Med 2019;19:29-36.  Back to cited text no. 5
    
6.
Brahm CO, Lundgren J, Carlsson SG, Nilsson P, Hultqvist J, Hagglin C. Dentists' skills with fearful patients: education and treatment. Eur J Oral Sci 2013;121:283-91.  Back to cited text no. 6
    
7.
Farhat-McHayleh N, Harfouche A, Souaid P. Techniques for managing behavior in pediatric dentistry: A comparative study of live modeling and tell-show-do based on children's heart rates during treatment. J Can Dent Assoc 2009;75:283.  Back to cited text no. 7
    
8.
Sharath A, Rekka P, Muthu MS, Rathna Prabhu V, Sivakumar N. Children's behavior pattern and behavior management techniques used in a structured postgraduate dental program. J Indian Soc Pedod Prev Dent 2009;27:22-6.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Newton JT, Buck DJ. Anxiety and pain measures in dentistry: A guide to their quality and application. J Am Dent Assoc 2000;131:1449-57.  Back to cited text no. 9
    
10.
Ogle OE, Hertz MB. Anxiety control in the dental patient. Dent Clin North Am 2012;56:1-16.  Back to cited text no. 10
    
11.
Hill KB, Hainsworth JM, Burke FJ, Fairbrother KJ. Evaluation of dentists' perceived needs regarding the treatment of the anxious patient. Br Dent J 2008;204:13;442-3.  Back to cited text no. 11
    
12.
Ogletree BT, Oren T. Application of ABA principles to general communication instruction. Focus Autism Other Dev Dis 2001;16:102-9.  Back to cited text no. 12
    



 
 
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