1. Introduction
Anxiety and fear reactions in the dental setting are common and vary in intensity. Phobic forms occur in about 5% of subjects in most of the investigated populations, who risk the avoidance of dental treatment in spite of oral health problems [1,2]. Less-intense feelings of anxiety are more frequent and reported as causing strain by nearly 50% of all patients when visiting the dentist. Anxiety and fear in patients are a challenge for dentists and a risk to trouble-free treatment [3]. To understand the origin and development of dental anxiety, several factors have proven to be relevant. Melamed, a pioneer in investigating this phenomenon, wrote in 1979, summarizing: “Many researchers … have uncovered combinations of family experience, attitudes, traumatic facial experience, low pain tolerance, and high anxiety which underlie dental fear” ([4], p. 172]). Today, a cognitive–behavioral model of dental anxiety is widely accepted where negative expectations, cognitive appraisal processes, and a lack of adequate coping behavior support feelings of worry and anxiety [5,6].
Because experiences with dental treatment as well as the learning of coping behavior start early in childhood, adult patients often report traumatic events with the dentist in childhood as a cause of their fear [7]. Actually, patients with the onset of dental anxiety in (young) adulthood are much less frequent, and personality factors (vulnerability, general anxiety) seem to be more important than conditioning processes in those cases [8,9]. Therefore, parents, dentists, teachers, and staff persons should provide realistic information about dental procedures, demonstrate dental instruments, and help relax and distract the children when they experience unpleasant sensations [10].
When dealing with children who are already anxious, the dentist (or other professionals) should be capable of evaluating the child’s condition and assessing the intensity and source of his/her anxiety to decide upon an effective management strategy, which enables the necessary dental treatment. The first steps in this regard are careful observation of the child’s behavior and physical state, accompanied by sensitive questions about his/her feelings and past experiences and interviewing parents as an additional source of information. This approach corresponds to established diagnostic principles in that it uses several methods to enhance the quality of information and avoid misjudgments. Moreover, correlations between self-reported anxiety, behavioral and physiological signs of fear,...
; Pieper, Klaus 2