(By Dr. Joseph D. Lim and Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI)
THERE is a simple way to avoid anxiety in the dental clinic, a study shows.
Unpleasant emotional reaction to dental procedures is common. In fact, high levels of anxiety and/or fear are felt among one out of every seven patients treated in Western countries, according to a study on the management of fear and anxiety in the dental clinic. The study is published in PubMed One.
“An anxious patient either skip the appointment or delay the treatment,” says the lead author, Ramesh Kunusoth of the Department of Oral and Maxillofacial Surgery, MNR Medical College & Hospital, Hyderabad, India.
For example, local anesthetic injection is associated with high levels of anxiety in some patients. It can make simple dental procedures like extraction time-consuming.
When a patient avoids regular dental visits out of fear, their oral health condition worsens, Dr. Kunusoth says. This means that the patient is revisiting the dental office when the dental issue is already at an advanced stage, requiring more complex, perhaps more traumatic (to the patient), treatment.
“More complex treatment reinforces or exacerbates the fear, which leads to continued avoidance,” says Dr. Kunusoth.
Dental anxiety can be managed by pharmacological and non-pharmacological ways. Non-pharmacological management includes communication skills, rapport and trust building, systemic desensitization, acupressure, laser acupuncture, hypnosis, music, audio-visuals, imagery, meditation (remember, this is India), relaxation, breathing, and virtual reality headset.
Dr. Kunusoth and his co-researchers describe a simple straightforward technique to manage the fear of the anesthetic needle during extraction. They use a virtual reality headset.
“The virtual reality headset diminished the fear and anxiety, allowing the extraction to be carried out smoothly,” Dr. Kunusoth says.
The headset was used, for example, on a 20-year-old female patient who complained of pain from an impacted tooth. It was necessary to extract her third molar but even just the word extraction made the patient anxious, and she totally declined the procedure.
It was revealed that she has a phobia of local anesthesia injection and had a traumatic experience of extraction during childhood. The patient was counseled that the procedure will be pain-free. The patient’s blood pressure and heart rate were monitored before extraction.
The patient was asked to do meditation and deep breathing. Once she was relaxed, distraction technique using music and audio-visual media was used to take her attention off the process of injecting local anesthesia. But the distraction technique failed. Again, the patient was relaxed by peaceful conversation and meditation.
Since the mere site of syringe created anxiety in the patient, it was decided to alter the patient’s vision by using a virtual reality headset. Soothing video of the patient’s choice was played.
The virtual reality headset temporarily blocked the patient from the outside world. Under local anesthesia, tooth extraction was successful. The patient was surprised that the procedure was completed very fast and without pain.
Among all the distraction technique, using music and audio-visual media did not help much, says Dr. Kunusoth. Hence virtual reality headset was tried.
“The virtual reality headset is a powerful distraction tool for pain as well as anxiety. Virtual reality provides a 3D environment, including both computer graphics and 360-degree video, that surrounds a user and responds to an individual’s actions in a natural way.”
Virtual reality headsets help a user enjoy an immersive 3D environment by eliminating their connection with the real world. The headsets can be used with a myriad of apps on smartphones to provide a virtual reality experience like sitting on a beach.
“It works by engaging different senses like hearing and vision together and diverting attention from painful stimuli to a new tranquil 3D environment,” Dr. Kunusoth says.
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Joseph D. Lim, Ed. D., is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; Honorary Life Member of the Thai Association of Dental Implantology; and Founding Chairman of the Philippine College of Oral Implantologists. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.
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Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines, College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De la Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He is an Associate Professor; Fellow, International Congress of Oral Implantologists; Member, American Academy of Implant Dentistry and Fellow, Philippine College of Oral Implantologists. For questions on dental health, e-mail limdentalcenter@gmail.com./PN
