Psychological Aspect Of Patients Undergoing Dental Extraction

Keywords

Extraction; Psycological; Patients; Surgery.

Introduction

The anxiety disorders and major depressions are common during visits to any doctor. Visit to a dentist is mostly an anxiety inducing memory for people [13]. Dental anxiety can be defined as an abnormal fear of visiting the dentist for preventive care or therapy and unwarranted anxiety over dental procedures and may have psychological, cognitive and behavioural consequences [11]. Furthermore, it is a barrier to the dental care utilisation. People avoid going to a dentist because of the fear and anxiety they have towards the dentist [4].

Tooth extraction is one of such procedures which brings about dental anxiety in people to the maximum extent [7]. Many of the studies done under this topic to check the physiological status of people undergoing extraction have been found to have people with the maximum anxiety level compared to other dental procedures [6]. It is important for the dentist to understand the anxiety and its consequences in dental care and thus identify behaviours of anxiety in order to maintain a relationship of trust with the patient [19].

The best way to assess dental anxiety is by using questionnaires or scales. The types of dental anxiety scales are Modified Dental Anxiety Scale, Corah'sDAS,Trait Anxiety Scale and State Anxiety Scale [17]. Modified Dental Anxiety Scale(MDAS) is a method used to assess the level of anxiety in people visiting dental clinics and also on the dental anxiety people face when they are undergoing extraction [23]. Advantage of the MDAS is that it is a more time efficient, simple, and cost-effective instrument for population-based research [20].

Age, education level, gender, occupation,past dental experience, dentist's communicative skill and financial stability have various levels of variations in dental anxiety. Recently there has been a growing interest in the body’s ability as a self-organizing and self-repairing system [3]. The placebo effect is an example of the body’s self-healing abilities through psychological means. This effect has been observed in relation to many diseases and treatments [15]. The present view is that it results from doctor/patient interaction, which seems to be a very potent therapeutic ‘tool’ [14].

The mechanisms triggered by psychological factors are not well understood. However, there is evidence that placebo analgesia is mediated, at least partly, via the opioid peptide system. Recent research in neurophysiology and endocrinology indicates a closer relationship between higher cortical functions and autonomic processes than previously believed [21]. The general practitioner often meets the patient early in the disease, when one might expect the chance of helping the patient by strengthening his selfherding might be best [9]. Although GPs acknowledge the doctor patient relationship as an important part of their armamentarium, we wanted to study this issue further.

Materials and Method

In this study a population of 100 dental patients listed for extraction regardless of their gender were presented with a questionnaire. This took place in Saveetha Dental Hospital. A structured questionnaire was designed consisting of a mixture of modified dental anxiety scale questions and perception questions. The patients awaiting dental extraction procedure found outside the clinic were individually interviewed. In this questionnaire, the first 5 sets of questions will be able to explain why the patient's anxiety level and the other 5 sets of questions will determine the patient's anxiety level. The data collected from the survey was thoroughly analysed and the psychological status of patients undergoing dental extractions was evaluated.

Results

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Discussion

In this study 3 factors affecting dental anxiety were studied; past dental experience, past dental extraction and doctor-patient communication. To begin with, patients with pleasant past extraction experience have proven to feel a lower anxiety level. This is the case where the pleasant past experience has left a good impact on the image of dentistry and removed the common phobia towards dental clinics [10].

Furthermore, in this study it is seen that majority of them had disagreed with feeling anxiousness and that the majority population being men, it is evident that most of the men denied expressing their emotions [1]. The plausible explanations could be that the women admit to their fears more readily than men or that they have lower tolerance levels compared to men [1].

It was also seen that the majority of patients felt anxious the most when they were waiting outside the clinic for their turn and when they were seated in the dental chair while their doctors brought the forceps and injection [22]. People generally have phobia towards sharp objects such as injections and forceps and it is commonly known and expected to face when visiting a dentist thus the waiting time before they have it in their mouth the anxiety begins building up in them [8].

In addition to this, the doctor-patient relationship has shown to be significant [18]. It is seen that doctors who had talked over with their patients regarding their dental procedure had been able to reduce their anxiety level for the extraction.

In this study a bonus question was asked to inquire about the patient’s psychological status. The patients were asked what their image of a dentist was [16]. Surprisingly, the majority of the patients with past dental experiences had described the dentists as a rather friendly and helpful person. However, when asked a newbie they had given an image of a scary person in white coats and with sharp instruments [5].

Conclusion

Thus, from the current study it can be concluded that dental anxiety is significantly affected by past dental experiences, past extraction experiences and by doctor-patient communication.

According to George et al, it is said that Chennai has 45.5% prevalence of permanent tooth loss [5]. Furthermore, Oosterink and colleagues proved that surgical procedures are the most anxiety provoking stimuli [6]. Therefore, it is important to know the patients’ psychological aspect in order to carry out an efficient and pleasant dental extraction experience.