The Odyssey of Dental Anxiety: From Prehistory to the Present. A Narrative Review

Abstract

Dental anxiety (DA) can be considered as a universal phenomenon with a high prevalence worldwide; DA and pain are also the main causes for medical emergencies in the dental office, so their prevention is an essential part of patient safety and overall quality of care. Being DA and its consequences closely related to the fight-or-flight reaction, it seems reasonable to argue that the odyssey of DA began way back in the distant past, and has since probably evolved in parallel with the development of fight-or-flight reactions, implicit memory and knowledge, and ultimately consciousness. Basic emotions are related to survival functions in an inseparable psychosomatic unity that enable an immediate response to critical situations rather than generating knowledge, which is why many anxious patients are unaware of the cause of their anxiety. Archeological findings suggest that humans have been surprisingly skillful and knowledgeable since prehistory. Neanderthals used medicinal plants; and relics of dental tools bear witness to a kind of Neolithic proto-dentistry. In the two millennia BC, Egyptian and Greek physicians used both plants (such as papaver somniferum) and incubation (a forerunner of modern hypnosis, e.g., in the sleep temples dedicated to Asclepius) in the attempt to provide some form of therapy and painless surgery, whereas modern scientific medicine strongly understated the role of subjectivity and mind-body approaches until recently. DA has a wide range of causes and its management is far from being a matter of identifying the ideal sedative drug. A patient's proper management must include assessing his/her dental anxiety, ensuring good communications, and providing information (iatrosedation), effective local anesthesia, hypnosis, and/or a wise use of sedative drugs where necessary. Any weak link in this chain can cause avoidable suffering, mistrust, and emergencies, as well as having lifelong psychological consequences. Iatrosedation and hypnosis are no less relevant than drugs and should be considered as primary tools for the management of DA. Unlike pharmacological sedation, they allow to help patients cope with the dental procedure and also overcome their anxiety: achieving the latter may enable them to face future dental care autonomously, whereas pharmacological sedation can only afford a transient respite.

Audio-Visual Distraction Effect on Heart Rate in Children during Dental Treatment, A Randomized Clinical Trial

“…Its main consequence is avoiding the dental visit resulting in bad oral healthcare and escalation of dental disease. Thus it is important for all dental practitioners to consider dental anxiety not only during the dental visit, but also after, to assure that the patient leaving the clinic is satisfied emotionally and motivated for the next visit (Facco & Zanette, 2017).…”

Non-pharmacological methods of fighting dental anxiety

“…Basic behavioural methods include: verbal and non-verbal communication (Tell-Show-Do -TSD), voice control, positive reinforcement, parent's presence/absence in the practice, modelling, and systematic desensitization [7]. The use of behavioural techniques allows dealing with dentophobic patients in the correct way, yet not many dental practitioners use these techniques [8].…”

“…It also reduces the patient's fear related to the use of a needle necessary in traditional forms of anaesthesia [42]. Sometimes, the relaxation level is so high that it is possible to perform the surgery without anaesthesia [8]. Hypnosis may also be helpful in controlling the patient's gag reflex, and may be successfully used in paediatric dentistry [24,43].…”

A case series analysing patients with dental anxiety: a patient-centred model based on psychological profiling

“…An increasing number of patients are undergoing day-case dental procedures or surgeries, and in some cases they may experience significant emotional upset for either consultation or dental therapy. Patients are often required to cooperate for a long time and stay in a coerced position: this may affect their psychological state and induce discomfort, fear, anxiety, and pain 1 . When patients can arduously cooperate during treatments, an appropriate analgesia should be achieved and a satisfactory anxiolysis should be accomplished.…”