pain characteristics and management

what percent of adults feel anxiety before dental treatment?

80%

what percent of adults fear dental treatment?

20%

what percent of adults evade dental treatment?

5%

what is the causal relationship between dental anxiety and missed appointments?

dental anxiety → delayed treatment → poor OH → emergent care

what are the 5 basic fears?

1. pain

2. unknown

3. helplessness/dependency

4. body change/mutilation

5. death

what are some causes of dental anxiety?

1. previous negative experience

2. fear of pain/injections

3. fear of judgment

4. embarrassment

5. fear of findings

6. lack of control

7. dental radiographs

8. sounds of instruments

9. white coat syndrome

what is white coat syndrome?

when a patient exhibits HBP in a medical setting but normal levels otherwise

what are signs of dental anxiety?

1. clenched fists, white knuckles

2. sweating

3. pallor

4. tense, leaning forward

5. fidgeting

6. nail biting, lip biting, licking lips

7. hyper vigilance

8. very quiet or very talkative

9. tachycardia, heart palpitations

10. hypertension

what is tachycardia?

heart rate > 100 bpm

what are symptoms of dental anxiety?

1. dry mouth

2. frequent visits to the bathroom

3. feeling nauseous

4. feeling light headed/faint

5. butterflies, stomach pains

6. hyperventilation, panic attack

7. tremor, hands/voice unsteady

8. irritated with delays/angry

what is pain?

sensation of discomfort a patient feels when something is wrong

what is direct pain?

experienced at the site of injury

what is referred pain?

experienced at a site away from the injury

what is pain perception?

physiological process of transmitting a main message to CNS

what is pain perception NOT?

not how pain is perceived

what is pain reaction?

personal response/reaction to pain

what is pain threshold?

the point where pain becomes uncomfortable/intolerable

what are influences on pain?

1. emotional state

2. fatigue

3. stress

4. age

5. cultural characteristics

6. fear and apprehension

what are methods of pain management?

1. remove the cause

2. pharmacological methods

3. physiological methods

4. psychological methods

5. preventing pain perception

6. prevention pain reaction

what are examples of pharmacological methods?

mild analgesics, strong analgesics, nitrous-oxide-oxygen analgesia

what are analgesics?

pain killers

what are examples of mild analgesics?

ibuprofen, acetaminophen

what are examples of strong analgesics?

valium

what are examples of physiological methods of pain management?

1. relaxation (deep or counted breathing)

2. audio/video distraction

3. environmental control (color, atmosphere)

what are examples of psychological methods of pain management?

1. desensitization

2. iatrosedation

3. euphemistic language

4. behavior modeling

5. cognitive behavior therapy

what is iatrosedation?

act of making calm through clinician’s behavior

what are examples of euphemistic language?

1. discomfort vs pain

2. remove vs extract/pull

3. syringe vs needle

what are principles of pain management prevention?

1. establish a relaxed atmosphere

2. attend to each patient as an individual

3. provide an accurate description of what will occur

4. give patients feeling of control (give breaks, hand signals)