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ePaper created 2015-12-29, 14:54:09 | version 1.38.0
41413_2015 laser laser_opis przypadku research I I 13laser2_2015 Fig. 6_Vicious cycle of dental fear according to Berggren. ietyrepresentsastatewherethepatientisevokedand prepared for something unpleasant, unknown and negativetohappen.Dentalphobiarepresentsasevere type of dental anxiety, which is characterised by per- sistentfearofclearlydiscernibleobjectsandsituations andresultsinavoidanceofnecessarydentaltreatment or enduring treatment only with dread.33 These psychological reactions interfere sig- nificantlywithdailylife.Theyareproblems suffered by many patients worldwide and remain a significant challenge in provid- ingadequatedentalcare.Theaetiologyof dental fear and anxiety is multifactorial. The idea of a “vicious cycle of dental fear and anxiety” has been promulgated by sev- eral studies to explain the mechanism of their appearanceanddevelopment.Someresearchersposit a role of psychological variables such as embarrass- mentandfeelingsofshameculminatinginavoidance of dental treatment and deterioration of oral health34–36 (Fig. 6), whereas Bauma et al. propose that anxietyplaysacrucialroleinthe“viciouscycleofden- tal fear”.37 Several studies among Australian dental patients present the role of dental fear as a component in the cycle of dental disadvantages with dentally anxious individuals avoiding dental care. It results in worsen- ingtheirdentalproblemsandincreasingthelikelihood that subsequent dental visits will be for emergency reasons.Sodentalfearfeedsbackitselfasaresultofa number of repercussions of the fear. These conceptu- alisations are described in another model of the so- called “vicious cycle of dental fear” (Fig. 7).38, 39 ArecentstudybyvanWijkandHoogstrateninves- tigated the interaction between anxiety and dental pain. They suggest that people who respond fearfully topainareatincreasedriskofendingupinthe“vicious cycleofdentalanxiety”(Fig.8).40 Ifthiscycleisnotbro- ken, a severe form of dental anxiety, dental phobia, might develop. So they propose a modification of the “viciouscycle”emphasizingtheleadingroleofthefear of pain in the mechanism of the development of den- tal anxiety. In view of the above mentioned, it is sug- gested that dental fear and anxiety result in a delayed and symptom-driven treatment culminating in an avoidance of necessary dental care and deterioration ofbothoralhealthandoverallhealth.Thislinkedchain feedsbackintotheexperiencesofdentalfearandanx- iety.Overall,thesestudieshighlighttheneedforalter- native methods in dentistry that will weaken the im- pact of the main components that nourish and em- power the “vicious cycle”. Consequently, the proven connection between dental anxiety and pain41, 42 , keepspatientsawayfromthedentalpracticeandthus mayfrequentlyresultinacutesymptomsandcompli- cations.The21st centurycallsforadifferenttreatment atmosphere and conditions that eliminate the ele- ments constructing the “vicious cycle” of dental fear. _Decreasing dental anxiety Several studies have shown that the most potent triggers for dental anxiety are the sight of the anaes- thetic needle and the sight, sound, smell and vibration ofdentalhandpiecesandrotarydentaldrills,whichare pain-associatedwithdentaltreatment.43-45 Ithasbeen suggestedthatreducingthesestress-triggersisanef- fective procedure for managing anxious patients.41, 42 For this reason, anxious patients who must undergo restorative procedures are often managed using the “4S”ruleorthesocalled“4S”principle.Itisbasedonre- moving four of the major primary sensory triggers for dental anxiety in the dental setting—sight (air turbine drill, needles), sounds (drilling), sensations (high fre- quency vibrations—the annoyance factor), smells— and it is used in conjunction with other measures and alternative methods to mitigate anxious behaviours and their consequences.41 A therapy with Er:YAG laser in paediatric dentistry has known advantages, espe- ciallyforthesafetyofitsuseandforitsgentleapproach with patients.46 Dental laser treatment reduces the need for injected local anaesthesia and obtains very lowtonulllikelihoodofodontoblasticpainandthean- noyance factor during carious removal. There is no smellordentineablationvapourincaseofinadequate suctionduringcavitypreparation.Thedominantphys- ical sensation is popping (shock waves) and ablation sound. This new technology offers new possibilities to the paediatric dentists’ to completely change restora- tive treatments and thereby help to decrease dental anxietyofpatients. Fear/anxiety Avoidance Deterioration of dental state Feelings of shame and inferiority