The Tribune

Dental clinician Dr Sparkman Ferguson and clinical psychologist Dr Stephanie Hutcheson are introducing a new research project to explore dental fear and its treatment.

In our first article we discussed the nature of normal anxiety then defined dental anxiety and dental phobia so we will not review that here. In this instalment we examine how dental anxiety and dental phobia develop. While a comprehensive examination of the multiple factors that explain these phenomena is beyond the scope of this article, we can destil the wealth of research into this triad: priming, learning and association.

Priming refers to our readiness as humans to be sensitised to perceived danger or threats in our environment and to be prepared to respond in ways to minimise injury and escape potentially threatening circumstances; what is dangerous and how to respond.

For the patient with dental anxiety and phobia, the dental environment is perceived as threatening due to a number of factors, among them lack of control, lack of understanding and or knowledge of the procedures, the supine position in the dental chair with the dental professional leaning over the patient, examination of the mouth under bright lights as well as the variety of noisy, shiny, sharp, and unfamiliar instruments.

Coupled with these variables is the dental procedure itself which may seem invasive and involve the administering of anaesthesia through needle injections to which there is some degree of discomfort or even pain. Further, for some patients with a heightened level of anxiety the use of anaesthesia is less effective because of the anxiety so their experience is most unpleasant.

Consequently, the learning is the package of the dental procedure and experience embedded with the previously mentioned factors. When the experience is direct it is more potent and salient but patients can also experience anxiety vicariously or second hand through the verbal reports and modelling of others recounting their dental mishaps and fears. Though this explanation is overly simplistic these encounters are potent and readily remembered as scary and to be avoided, which provides the platform for negative associations with dental treatment.

The patient, now exposed to what is catalogued mentally as a angst-ridden, must avoid further encounters and now employs behavioural strategies to minimise or eliminate the possibility of such experiences again. They have learned to associate a plethora of negative and threatening consequences to dental treatment. Their behavioural expression of this will be to continue to make appointments and keep them, tolerating them with great anxiety. They “white knuckle” it through dental care. Others, delay dental care for as long as possible until dental emergencies drive treatment. Then there are others who avoid care altogether to the detriment of overall dental health.

But individuals can overcome these challenges.

Dr Stephanie Hutcheson, a clinical psychologist and the Assistant Professor of Psychology at the University of the Bahamas, and Dr Sparkman Ferguson, a dental clinician, have devised the Adult Dental Anxiety Programme (ADAP).

What is ADAP? It is a pilot intervention and research project designed to provide psychoeducation, and interactive participation for persons with dental anxiety and dental phobia. The pilot programme is free to all participants who seek to overcome their dental fears.

Persons interested may call 323-2755 to sign up for the ADAP pilot research and intervention programme, which is scheduled for April 2018.