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ePaper created 2015-12-29, 14:54:09 | version 1.38.0
42 3_2015 laser 42 laser_opis przypadku I research 14 I laser2_2015 Fig. 7_Vicious cycle of anxiety, modified by van Wijk and Hoogstraten. Numerousstudieshavebeendesignedtodetermine the subjective acceptance and pain perception of an Er:YAG laser for soft and hard tissue therapy and to consider the influence of this new technology in case ofdentalanxiety.Asresultsofseveralstudiesonpatient acceptanceofdifferentmethodsforcavitypreparation have shown, Er:YAG lasers have an acceptable effi- ciency compared to the conventional mechanical preparationandpatientsagedtenyearsandolderpre- ferthealternativemethod.47-49 Theanalysisoftheobtainedresultsfromtheuseof pain assessment scales indicates that patients have been reported no or low pain perception during laser preparation in contrast to the high pain levels during theconventionalmechanicalpreparation.Thesignif- icant decrease of patient discomfort and dental anx- ietyhavebeenfoundtobecausedbythepainlessna- ture, elimination of the high frequency vibrations generated by the rotary conventional instruments and noncontact mode of lasers. Due to its versatility, Er:YAGisthemostfrequentlyusedlaserbypaediatric dentists to treat both hard and soft tissues in the oral cavity.Genoveseetal.havebeeninvestigatedthesub- jective tolerance and acceptance of laser therapy in children needing both dental and soft tissue treat- ments.46 Theresultsshowthatthehardtissuetherapy have been carried out without anaesthesia and with good collaboration of the patients in 90 per cent of thecases.Whileinthesofttissuetherapytheaccept- ance has been presented in 62 per cent of the treated patients because of the more invasive nature of the procedure.Thefindingsofthisstudyshowatotalac- ceptance of 75 per cent of the treated cases. Hence, the comfort registered during the treatment con- tributes to a decrease of dental anxiety and makes lasertechniquesaveryeffectivemethodinpaediatric dentistryandagoodtreatmentoptionforanxiouspa- tients.Fearofpainhasbeenstronglylinkedtothede- velopmentofdentalanxietyandavoidanceof dental treatment.50 The application of Er:YAG lasers leads to a decrease of dental anxiety by eliminating the main component of the “vicious cycle of den- talanxiety”whichispain,andthemajorstress trigger observing the “4S” rule which are high frequencyvibrations.Thus,thistechnologyof- fers new possibilities for an improved service of anxious patients in both children and their parents. Because nowadays many children may experience laser treatment as their first contact with dentistry, there is a possibility that a new generation of patients willgrowupwithadifferentattitudetowardsdentistry. Parents are also enthusiastic about being able to offer theirchildrentheadvantagesoflasercare.51 _Phobic Patients Dentalphobiarepresentsaseveretypeofdentalanx- iety, which is characterised by persistent fear of clearly discernible objects and situations and results in avoid- ance of necessary dental treatment or enduring treat- mentonlywithdread.33 Severalstudiesreportthat6-15 percentofpeopleavoidregulardentalcarebecauseof dentalanxietyandphobia.52 Theprevalenceofgeneralandspecificphobiasre- duceswithage.52 Theconceptofthe“viciouscycle”as mentioned previously is valid for adults and children and adolescents with dental phobia. Surprisingly, amongdifferentsubtypesofphobias,thedentalpho- bia is the most prevalent (3.7 per cent).52 These find- ings should alert both researchers and dental practi- tionerswiththeobjectivetoseekforwaysofimprov- ing this condition. The Diagnostic and Statistical Manual of Mental Disorders distinguishes phobia from fear on the basis of the feared stimulus being avoided or endured with intense distress. Precisely thosepeoplereporthighdentalfear,avoidanceofvis- itingthedentistandsignificantsocialandfunctional impacts who meet the criteria for a dental phobia.38 Er:YAG lasers can also be used in different paedi- atric soft tissue procedures, such as frenectomy, op- erculectomy, exposure of unerupted teeth, some oral pathologicalconditionsincludingmucocele,fibroma, haemangioma, herpes labialis and aphthous ul- cers.3, 14, 53 _Conclusion Anxiety Fear of pain Avoidance of dental treatment More fear