RGUHS Nat. J. Pub. Heal. Sci Vol No: 16 Issue No: 3 pISSN:
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1Dr. R. Hemalatha, Professor& Head, Department Of Pedodontics, SRM Dental College, Chennai -89.
2Professor and Head, Department of Pedodontics and Preventive Dentistry, Senior Lecturer, Department of Oral Medicine and Radiology, Faculty of Dental Sciences, Sri Ramachandra University, Ramapuram, Chennai, Tamil Nadu, India
*Corresponding Author:
Dr. R. Hemalatha, Professor& Head, Department Of Pedodontics, SRM Dental College, Chennai -89., Email: hemas_pedo@rediffmail.com
Abstract
Dental fear and its corresponding anxiety have been posing various problems in management strategies especially in pediatric age groups. The adverse effects of which are carried over into adulthood ,which in turn can lead to total avoidance of dental treatment and a deterioration in oral health consequetively.
Formal assessment measures like projective techniques (Facial Image Scale-FIS) are essential to serve the purpose. Children project with a lot of subjective fears, though they may vary in intensity from simple nervousness to dental anxiety. It evaluates dental fear in children from the point of view of dentists, parents and children. Both dependant and independent variables were assessed using the same questionnaire. Therefore it is mandatory for a pediatric dentist to assess the levels of fear at an early stage, so that they can identify those patients who need assistance on fear grounds ,thereby they could be alleviated or warded off ,to develop good patients for the future.
The present study was one such attempt to record the fear status in children using the Facial Image Scale. The results revealed that children were more comfortable in the waiting area than in the dental operatory. Even within the confines of the operatory they were more comfortable with the less invasive procedures in comparison to the more invasive ones like extraction.We concluded the study with the notion that if we as dentists could dedicate some extra time towards conducting such surveys we could go a long way towards gaining a good rapport with our patients
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INTRODUCTION
Dental fear is a normal emotional reaction to one or more specific threatening stimuli, when mild it is consistent with normal development. It becomes a concern only when it is disproportionate to actual threat and daily functioning becomes impaired. It can neither be explained nor voluntarily controlled and if persistent can lead to total avoidance of dental treatment.
Development of fear is explained by Rachman's model1 of fear acquisitioning, which proposed that fear might develop through three pathways.
1 .Direct conditioning (Classical conditioning)
2. Vicarious conditioning (Modeling)
3. Information/Instruction.
Second and third are manifestations of indirect fear acquisitions. Auto-evaluation or FIS is a validated recommendation of dental fear and anxiety assessment.
The purpose of the study was to evaluate dental fear and cooperation during treatment using FIS, which consisted of a series of smiley faces ranging from neutral to happy; and to identify the fear determinants including the impact of age and gender.
METHODS
Healthy patients who visited the Department of Pediatric dentistry, SRM Dental College, were selected after getting approval from Ethical committee. The purpose of the study was explained and consent obtained from parents .Hundred and fifty patients reported with various oro-dental problems between the age group of 3-14 years .Parents and children were approached in the dental operatory after explaining the contents of the Questionnaire .Their willingness to participate was recorded by obtaining their signature. Each Questionnaire had two pages of FIS: .First page contained the patient's identification proforma.
Fear motives like pain, extraction or injections, discomfort to noise, smell, taste, touch and light and fear of unknown origin. The second page contained the parents' identification data, educational qualification, living environment, previous dental visits and FIS .Both the children and parents were asked to give their ratings independently in total privacy.
FIS consists of a row of five faces ranging from (unhappy-neutral-happy) Children were asked to give their ratings both in waiting room and in the operatory in order to improve the validity.
1,2, 3: acceptible
4: dental fear
5: extreme fear.
It is an easy tool even for young individuals .It measures state dental anxiety(what it intends to)
Inclusion Criteria
Healthy communicative children, who visited the operatory for the first time for various oro-dental problems.
Exclusion Criteria
Patients with disabilities and children who were less than three years of age.
RESULT ANALYSIS
Frequency Distribution Graphs and Histograms inferred the following.
1. Sex
In the waiting area the difference between male and female patients was found to be almost negligible .both were in the band between 2.8-2.9 which gave the inference that they were in the neutral to unhappy position and well within acceptable limits .interestingly females scored a shade better.
In the dental table the fear of the male patients comes down and reaches a score little above 3 thereby entering in the zone of happy to neutral and in acceptable level. The female patient score remained the same as in the waiting area.
2.Urban versus rural population
In the waiting area the results were almost equal for both the samples in the range of 2.8-2.85 which gave the inference that they are in neutral to happy and in acceptable position.
The urban population shows some improvement and remained in acceptable position itself. The rural patients almost remained in the same zone as the patients in the waiting area. It is to be noted that there is no increase or decrease. They are in neutral to happy and in acceptable zone.
3. Visits
The classification score of differentiating patients with their subsequent visits shows some clear -cut differences.
The patients with subsequent visits in the dental table show some improvement and moved from zone of neutral to happy and in acceptable level.
In the waiting area also there was an improved score for patients with subsequent visits.
4. Fear reasons
Children who were happy in the waiting area slowly transformed into fearful patients for less invasive procedures like prophylaxis and restorations and were most fearful for more invasive procedures like extractions.
DISCUSSION
Dental fear is of a multi-factorial origin2 It is a distressing problem for the triad of dentist ,parents and children3. It is constantly met among young individuals of 3 years of age and also registered in older ones to peak at 11years and declines in adolescence4. FIS is a suitable method for assessing children's state anxiety .In order to validate evidence for FIS ratings of both parents and children was recorded5. It is based on simple and suggestive images and is easy to understand even for young children thereby proving to be a useful tool. It measures state dental anxiety6 Smiley faces ranged from neutral-happy7. Children's mean FIS in the waiting area was significantly lesser than in the dental operatory .Frequency of fear in girls were more than boys. It also showed variations depending on cultural differences8. It declined in 9-11 year age groups.
Most of them were comfortable as long as invasive procedures were not started .They were very co-operative in the first appointment followed by comfort zones even till restorative phase(less invasive)They ventured into un -co-operative status only for extraction with maximum peak only for Local anesthesia.(needle phobia)Even after LA they could be counseled and motivated to co-operate .Establishing a strong rapport on child's first dental visit helps to create a comfortable atmosphere in which the child does not feel threatened .9 FIS (projective technique) was simple easy fast and efficient though children between 3-5 years had some difficulty. Parental reports of their child's anxiety on assessment measures are often used as estimates of anxiety. (Kleinberg and colleagues) have reported a good correlation with clinically noticeable dental fear in children .Questioning children directly about dental anxiety is straight forward and good to employ in clinical settings .Review showed that positive behavior improved between 3-6 years.
CONCLUSION
Assessment of dental fear through potential tools is recommended since it can customize behavioral treatment and management strategies for individuals' .A friendly relationship is important for effective and efficient treatment. to be performed .Fear is not an inclusive character of those with increased levels of anxiety .Timid patients with exaggerated concerns demonstrate increased fear. More attention should be focused towards psychological aspects of dental patients.
ACKNOWLEDGEMENT
I personally thank my DEAN, Dr. M.R Balasubramanium and the Instituitional authorities for giving me due permission to carry out the study
Supporting File
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