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                                                        DR. DAN PETERSON

                                                                      1415 SAGE STREET ~ GERING, NEBRASKA 69341 
                                                             
      Call: 308-436-3491       www.dentalgentlecare.com           

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DENTAL ANXIETY

& Pain Management

Our caring staff has been trained on  how to help you with dental anxiety

How to have a more relaxed visit:

     We begin the process of helping you to deal with your anxiety at your phone call, while making your appointments.  Our staff has been especially trained in caring patient services and will inform you of what to expect and answer your questions to ensure your confidence and comfort during your visit.

Quick Fact File Alleviating Dental Discomfort or phobia:

Nitrous oxide-also know as laughing gas, nitrous oxide is inhaled to decrease the anxiety of patients.

Oral conscious sedation-pills are given to take the edge off.

Topical anesthetics-These medicines are applied with swab to numb the gums, before injectable anesthetic is administered.

Analgesics such as aspirin or ibuprofen

General anesthesia-renders a patient fully unconscious, general anesthetic is reserved for people with severe anxiety or those requiring extensive dental surgery, often used with children.  We perform this procedure at our local hospital.

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    These  are some things we offer which can help you through this difficulty: 

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Tell our staff about your reservations so we can bring them into the open to help us tailor your treatment to your needs.

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Prearrange a signal ahead of time, like raising your hand, to indicate your are needing a break.

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Our staff will explain each procedure.

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We have patient education on CD Rom in the treatment rooms to help you understand the procedures.

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Wear loose, comfortable clothing.

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Don't cross your legs while receiving treatment.

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We will show you what the handpiece sounds like before the procedure begins.

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If the cavity is small enough we can use air abrasion to treat the cavity instead of the handpiece.

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Distraction strategies, we offer headphones during the procedure.

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Eat a light meal the day of your appointment.  

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Eating high protein foods produces a calming effect, unlike sugary foods.

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Avoid caffeine before a dental appointment to help make your less anxious.

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Try to schedule your visit for a time when you won't be rushed

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We offer ear plugs during the procedure.

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Air abrasion- uses powerful particles of aluminum oxide to remove debris and decay. The most exciting thing for patients is that air abrasion is painless and, in some cases, doesn't require an anesthetic. Although air abrasion is not suitable for all dental procedures, it is often used for bonding procedures, and on tooth restorations involving  tooth-colored fillings.

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Pain management techniques:

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Topical anesthetic before the injection-topical anesthetics, applied 
with a swab, are routinely used to numb the area in the mouth or
 gums where the dental work will be done. The topical anesthetic is given prior to injection with a local anesthetic.

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Nitrous oxide -"laughing gas" to helps you relax

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Slow smooth injection technique

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Room temperature anesthesia

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Electronically delivered anesthesia (also called transcutaneous electrical nerve stimulation [TENS]). This is an alternative to the shot of anesthesia. Adhesive pads are placed on the face and a battery-powered device sends electrical impulses to the treatment area to numb it. The patient controls the level of stimulation through a hand-held unit. Another form of electronically delivered  anesthesia is called cranial electrotherapy stimulation. Under this technique, electricity is passed into the brain, which causes 
relaxation. Again, the patient controls the intensity of the current, increasing or decreasing it to control the pain as needed. Advantages of these approaches are that as soon as the device is switched off, the effect is instantly reversed. The patient is able todrive and resume normal activities immediately following the dental
visit.

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Oral sedation.  An oral medication, such as Halcion, works on the central  nervous system to help you relax. Oral sedatives are often not prescribed  because they take about 30 min before their effects 
are felt and can cause downiness that may last for hours.

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Relaxation techniques help to reduce pain and anxiety:
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Guided Imagery-imaging a pleasant experience or a particularly soothing environment.  By concentrating on creating as much detail as possible, your mind becomes absorbed in this task rather than focusing on what we are doing.

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Deep breathing-involves breathing deeply and slowly, which floods the body with oxygen and other chemicals that workon the central nervous system to improve your comfort.

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Progressive relaxation-you consciously concentrate on relaxing every muscle in your body beginning  all the way up to your head to reduce muscle tension whichreduces pain.

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Hypnosis, self-induced as a way to produce a relaxed state.

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Mental health therapy to work with a professional with severe anxiety and phobias and may include:
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Systematic desensitization where you are gradually exposed to the things you are afraid of.

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Cognitive behavior therapy teaches you to calm your mind and body and to change negative/harmful thinking patterns so you
feel better and think more clearly.

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Psychotherapy where you increase your personal awareness and come to understand and make peace with difficult events or fears from the past.

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Let us help you overcome your dental fears with trust and care.

Conquering Fear With Trust!
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We recommend taking Advil or Tylenol at home before having dental work done at the office.

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Music therapy. 

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Get a good night's sleep the night before your appointment.

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Talking you through procedures.

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Friends or family are invited to be with you during this time.

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Medications that your family doctor might recommend.

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Negative thoughts can increase pain.  If you arrive at our office angry, fearful or sad, take a moment to get in a neutral state of mind through relaxing, music or prayer,  that way the dental treatment will be more comfortable.*

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Click here to learn all we have done and continue to do to ensure that every aspect of your visit is designed to create optimal comfort.   

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If the sound of the dental handpiece or drill causes you psychological fear please tell us about it BEFORE a procedure

Try one new positive step to help you relax during your next visit.

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How do you feel about going to the dentist?   * 23947 responses
I don't mind it at all.
21%
It's a little nerve-wracking, but not so bad.
31%
It's panic-inducing. I dread it.
27%
I'm so terrified, I haven't gone in years.
22%

*http://www.msnbc.msn.com/id/5446421/100604

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Updates in Anxiety In Dental Patients

Is the Chair Position Important?

Dental anxiety in the general population is more prevalent in females than in males.  The presence of dental anxiety was studied in a group of 189 females and 176 males using the following scales: the Dental
Anxiety Scale, the Self- Rating Depression Scale  and the Quality of Life Index .  The results obtained showed significant differences only in relation to dental anxiety regarding the use of instruments (such as needles and handpieces) and the tilted-back position of the chair No significant gender differences emerged between the two groups in relation to dental anxiety regarding dentist-patient relations , depression , and the quality of life .  The results may explain why women avoid dental care and indicate new designs to make the chair position more comfortable would be useful.


Read complete article at http://www.thejcdp.com/issue021/index.htm Citation:  Settineri S, Tatě F, Fanara G.  Gender Differences in
Dental Anxiety: Is the Chair Position Important?  J Contemp Dent Pract 2005 February;(6)1:115-122.

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Seizures and Dental Procedures

Patients with seizure disorders, even those well controlled with antiepileptic drugs can and do have seizures when subjected to stress. If fear is the cause then any type of sedation will be beneficial. Specifically, IV sedation with midazolam or diazepam would be MOSTpreferred as these are the agents administered IV to terminated seizures. Oral sedation with benzodiazepines  such as triazolam will also be beneficial, as would inhalation sedation with nitrous oxide and oxygen.
Sedation is used to PREVENT medical emergencies, and properly administered does not cause them.

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The prevalence of dental anxiety in the general population seems to be fairly stable, and the incidence is not reduced in spite of more modern treatment methods. Intensive fear often leads to avoidance of care and consequences like poor oral health, psychosocial problems and reduced quality of life. The etiology of dental anxiety is complex, but is often associated with direct traumatic dental experiences during childhood. These negative experiences are reported as painful/unpleasant and are influenced by the patient's perception of lack of coping and control. However, several positive dental appointments before any invasive or painful treatment sessions may act as a barrier to these perceptions of lack of coping.

[ Skaret E,Soevdsnes EK  Behavioural science in dentistry. The role of the dental hygienist in prevention and treatment of the fearful
dental patient ,  International Journal of Dental Hygiene 2005; 3(1):2.]

 

Dental fear in sexually abused women

Sexual abuse linked to dental fear  

 80% of the adult population that has some level of anxiety of dental treatment, females report much higher levels of anxiety than males. Studies reveal that sexual abuse is quite prevalent, with 1 in 4 females reporting a history of sexual abuse and 1 in 7 males reporting a history." There are long-term consequences that may affect the way these people cope with anxiety-provoking situations, and how they may approach or avoid various types of medical treatment. Many of these patients possibly do not know why they are afraid or have these anxieties. There are several signs of childhood sexual abuse that dental patients exhibit, some of the common signs of past sexual abuse include resistance to being placed in a horizontal position, fear of having objects placed over the face, sudden outbursts of crying without apparent reason, severe gagging and an involuntary turning of the head away from the dentist as he approaches the mouth. It is important to note that :acting like a parent or adult authoritative figure will actually worsen the flashback and frustrate the dentist even more.  [Bynes J Dentistry Today, Dr. Jack Bynes 2004; 22(12) www.dentalfear.com]

Please also see: Dental phobia center

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Dental fear in sexually abused women

    The aim of the present study was to investigate dental fear in women who have been exposed to different kinds of sexual abuse. In a cross-sectional questionnaire study, 99 sexually abused women were divided into three groups: one group who reported having been exposed to sexual touching (ST); one group who reported intercourse (IC); and one group who reported sexual abuse involving oral penetration (OP).

The mean score on dental fear assessments was significantly higher for all groups. Women in the OP group scored significantly higher than women in other groups on dental fear. The  majority of the women reported that they had experienced problems in relation to dental treatment situations. 

About half of the women in the OP group and one-third in the other groups reported that they had never considered that there was a relationship between the abuse and their problems with dental treatment situations.
Significantly more women in the OP group reported that they had not been aware of the relationship, possibly because the abuse had been repressed. The majority of the women with extreme dental fear had never informed a dentist that they had been sexually abused.
At our office we are sensitive to these issues and do all we can to help you through this difficult issue.

Tiril Willumsen, Dental fear in sexually abused women, European Journal Of Oral Sciences 109 (5), 291-296

http://www.msnbc.msn.com/id/5446421/ 10/06/04

Resources: Dental Anxiety Fact Sheet by AGD December 2001 Dental Impact, page 20.
* Negative Thought Increase Pain Perception. a Canadian research project. March 2002.

Dental Phobia and Anxiety

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February 06, 2008

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          If you have any questions please e-mail me at: drdpeterson@scottsbluff.net
                                                                                 308-436-3491 Office number

PLEASE NOTE: The information contained herein is intended for educational purposes only.  It is not intended and should not be construed as the delivery of dental/medical care and is not a substitute for personal hands on dental/medical attention, diagnosis or treatment.  Persons requiring diagnosis, treatment, or with specific questions are urged to contact your family dental/health care provider for appropriate care.
This site is privately and personally sponsored, funded and supported by Dr. Peterson.  We have no outside funding.
Confidentiality of data including your identity, is respected  by this Web site. We undertake to honor or exceed the legal requirements of medical/health information privacy that apply in Nebraska.

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