Jeffrey Smith

January 16 2016

Independent Research

Period 2

Synthesis Final

Chteau de Chinon is a small french town with a population of 2,196, it is considered one

of Frances many medical deserts. In 2008 Jacobus Van Nierop opened a dental practice and

terrorized and patients with cruel treatment and over sedation until his arrest four years later. The

field of Dentistry has practitioners like Nierop that fuel the negative image of dental care. 25

percent of the US population suffers from dental fear (Gawel 1). While there are different levels

of severity, fear has an impact regardless. Minor fear may lead to stress or concern about the

visit, but individuals that suffer from severe from moderate to severe dental fear follow a pattern.

Studies conducted regarding patient behavior have shown to be consistent with the notion of a

vicious cycle of dental fear whereby the delaying of dental visits is related to increased dental

problems (Armfield 30). The various degrees of fear are accompanied by different treatments.

The treatments vary depending on the age of the patient. The treatment for children is generally

less severe and revolves around memory, one method includes using positive images to help

children reconstruct their memory of dental treatment (Newton 9). Treatment for adults relies on

control, one widely used technique to do is the stop signal (Newton 11). Techniques such as

the stop sign help relax the patient and provide a sense of control. People across the world suffer

from dental fear and the causes are similar. King Abdulaziz University in Saudi Arabia

conducted an experiment to determine the factors that

 contribute to dental fear in young boys. The factors were similar to those identified in an

experiment conducted in the Baltic States ten years earlier. To help reduce the number of

individuals that suffer from dental fear, dentists and parents should focus on personal fears and

past trauma.

Dental fear has a wide range of causes, and each patient may have different concerns

based on past experiences. For example, an individual may be hesitant to skydive because they

are afraid of heights. Patients that suffer from other fears may be wary of receiving dental care.

The most common fears that contribute dental fear stem from a sense of discomfort and pain.

Treatment evokes other fears, such as being trapped, getting an injection, seeing blood, or

having your personal space invaded (Clay 6). People become apprehensive when they know

pain in emminent and the fears of injections and blood usually have connotations of pain and

discomfort. The invasive nature of dental care can intensify the fear of tight spaces or the fear of

being trapped. Without treatment the patient may have high levels of anxiety and avoid

appointments, but if individual fears are treated the severity of the fear may be lessened or the

patient may no longer suffer from the fear. The main method of treatment is therapy. Cognitive

Behavioral Therapy has been proven to be successful at reducing dental fear of high severity.

Researchers at Kings College London tested the impact of Cognitive Behavioral Therapy on 140

subjects with varying levels of fear. Of all the subjects four fifths (79%) went on to have dental

treatment without the need for sedation (Cognitive Behavior Therapy 6). Therapies for other

fears are structured similarly. Psychologist Darcy Cox utilizes Self Injection Anxiety Therapy to

treat the fear of injections. A trial conducted by Cox helped 70 percent of the subjects develop

the ability to self inject (Dittmann 14). Anxiety is prevalent in nearly all patients, and it affects

people differently. For some the anxiety is too much to handle and they intentionally miss
appointments. Generally, a dentist appointment is not the most enjoyable experience. It can be

filled with unnerving noises and scoldings. Before an appointment it is common for patients to

have feelings of nervousness, tenseness, and exaggerated concerns over things that are not too

important (Raciene 20). Patients often times blame certain aspects of treatment like the scraping

of teeth by a metal tool or the dental drill. Anxiety and other personal fear cause problems for the

dental practice as well. The dentist and hygienists must plan accordingly to ensure the patient

receives quality care and is safe. No two patients are alike. The unique life experiences of each

patient pose a problem because the dentist needs to provide treatment in a manner that

accommodates the individuals concerns. If the dentist urgently needs information about the

patient there is a short survey called the Milgroms single-item scale. The survey can be used as

screening instruments by busy dentists (McMaster 8). For a more indepth look into the patient's

history, the dentist can use the Dental Anxiety Scale and Dental Fear Survey. The tests aim to

assess avoidant behavior, fear, and psychological response (McMaster 7). A dentist may have

past medical records, but only the patient is able to convey his concerns and fears.

Past trauma of all types greatly contributes to the existence and severity of dental fear.

The trauma can occur at any age and have a profound impact on the individual. Past traumatic

dental experience can create a lasting impact on the individuals attitude towards the dentist and

quality of care. For certain patients their perceptions of uncontrollability, unpredictability, and

dangerousness associated with dental visits may have been influenced by the examination

process (Armfield 29). The lack of care and poor quality of treatment can lead the patient to

believe that all experiences at the dentist will be scarring. Painful sounds can be associated with

the dentist. The most unnerving sounds people typically think of include the high pitch whirring

drills and scraping of metal tools against teeth. A Japanese research team conducted an
experiment to observe brain waves response to dental sounds. When the sounds played parts of

the brain called the left and right superior temporal gyri responded more than when they heard

neutral sounds indicating the high anxiety levels present (Sound Sparks Dental Fear 7).

Children are especially vulnerable to traumatic experiences. Their world is filled with unknowns

and some of those are seen as scary. A childs behavior can act as an indicator for whether they

may be susceptible to dental fear or future traumatic experiences. Shyness and other antisocial

behaviors can lead to emotional problems later as a child (Klingberg 241). The large variety of

issues complicates the prevention of such conditions from developing later in life . Other

problems in children also contributes to the susceptibility of children including sleeping

problems, attention problems, and aggressive behavior (Krikken 1). Traumatic experience has

the potential to worsen the preexisting behavioral issues. PTSD and sexual abuse can cause the

onset of dental fear. The intense fear the individual suffers from can lead to avoidance and poor

oral health. Post traumatic stress disorder can be acquired in various ways, but all causes deal

with a scarring event. Combat experience, car accidents, and sudden shocking events are all

causes of PTSD. The wide variety of stressors can complicate treatment by introducing an

unknown variable to the dentist. A victim of PTSD may be apprehensive because it breaks

down the entire system, leaving the patient in survival mode and chronically hypervigilant

(Swarthout-roan 55). During the weakened period the mental state of the victim is compromised

and the individual may have limited functions or no ability to function until the episode

passes.Victims of PTSD and childhood sexual abuse can experience flashbacks when exposed to

specific stimuli associated with their traumatic experience. The flashbacks can cause the loss of

focus, nausea, and unresponsiveness (Santos 8). Sexual abuse at a young age sets up negative

connotations with certain actions or areas of the body. The mouth and face are often times
common sites of sexual abuse. There is a strong connection with oral penetration suffered during

childhood sexual abuse and high levels of dental fear (Swarthout- roan 54). Different variations

of counseling exist for childhood sexual abuse and PTSD, but in both cases the damage can be

minimized but the individual will always live with the trauma.

Dental fear is an issue millions of people around the world suffer from. Fear does not

discriminate, people in Saudi Arabia and the United States suffer from the same fear. It is

prevalent among wealthy individuals and those of lower socioeconomic level. No matter who

suffers from dental fear, it has a significant impact on oral health and mental well being. The

various causes including personal fears and past traumatic experience complicate treatment and

lead to poor oral health. No one has to enjoy the dentist, but no one should have dread the

appointments. Rather than continuing the vicious cycle, more attention should be placed on the

treatment. If psychologists and dentists focus on the two main causes, then the number of fearful

patients would lower substantially. Cognitive Behavioral Therapy and other similar therapies

have been tested and show success rates upwards of 70 percent. Dental schools should place

more focus on the development of dental fear and what precautions need to be taken to lower the

anxiety of the patient. Practices should take into account the results of tests like the Dental

Anxiety Scale and Dental Fear Survey and alter the treatment to avoid specific stimuli. If dental

practices and schools alter the methods taught and used, there may be less dental horror stories

like in Chteau de Chinon, France.

Works Cited

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