|Year : 2014 | Volume
| Issue : 4 | Page : 159-163
Management of dental anxiety: A survey of Nigerian dentists
Akeredolu Patricia1, Akinboboye Bolanle Oyeyemi1, Gbotolorun Olalekan Micah2, CI Emeka2, AA Adesida3
1 Restorative Dentistry, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
2 Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
3 Depatment of Anaesthesia, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
|Date of Web Publication||11-Dec-2014|
Akinboboye Bolanle Oyeyemi
Restorative Dentistry, Lagos University Teaching Hospital, Idi Araba, Lagos
Source of Support: None, Conflict of Interest: None
Background: Dental anxiety is a major issue with respect to provisions of and access to dental care. We evaluated the knowledge and management of anxiety among Nigerian dentists. Materials and Methods: The study population included 192 Nigerian dentists recruited during an annual national dental conference in Abuja. The conference was a meeting point for dentists with post graduation experience ranging between 1 and 32 years and from different part of the country. They completed a structured questionnaire on dental anxiolysis. Data analysis was performed using SPSS version 16. Results: Of the interviewed dentists, 122 (55.1%) practiced in teaching hospitals and 24% had their specialization in child dental health. A total of 34 (19.8%) dentists had been exposed to formal trainings on the practice of dental anxiolysis. Of this number, 66% had basic life support training and only 11.8% had refresher training programs. The most preferred route of administration of anxiolytic drugs was oral (57.3%). Most of the respondents were of the view that dental anxiolysis should not be instituted for all dental patients. Conclusion: The interviewed Nigerian dentists were knowledgeable and managed dental anxiety. Although some of them had no formal training on dental anxiolysis, the major consensus is that dental anxiolysis should not be instituted for all dental patients.
Keywords: Dental anxiety, anxiolysis, Nigerian dentists
|How to cite this article:|
Patricia A, Oyeyemi AB, Micah GO, Emeka C I, Adesida A A. Management of dental anxiety: A survey of Nigerian dentists. Sahel Med J 2014;17:159-63
| Introduction|| |
Management of dental anxiety involves dental anxiolysis, which is a drug-induced state in which patients respond appropriately to verbal commands with no effect on cardiovascular or ventilator functions although cognitive function and coordination may be impaired. ,
Dental anxiety may be exogenous or endogenous  and can be measured reliably and differentiated by the symptoms.  Exogenous anxiety responds to an anticipated unpleasant external situation and the features include moist palms, fluttery stomach, fine hand tremors, hot flashes or a combination of these reactions. This form of anxiety affects both sexes equally, not discriminating among age groups, and can be treated with behavioral management.  Endogenous anxiety attacks occur spontaneously without provocation. Symptoms include lightheadedness or dizziness, difficulty in breathing, hyperventilation, tightness of the throat, chest pains and fear of losing control, sleeplessness and varying or continuous levels of nervousness. 
Patients with dental anxiety suffer considerably from impaired oral health-related quality of life, and the degree of this impairment is related to the extent of dental anxiety/fear.  It is a major issue with respect to provisions of and access to dental care.  It has been stated that 31% of adults suffer from dental anxiety.  A study carried out among Ghanaians revealed that 47.3% of dental patients were fearful of various dental treatments.  The field of dentistry offers many options that ease fear and pain, although they are underutilized. These resources include patient management skills, use of oral sedatives/nitrous oxide for conscious sedation and general anesthesia services provided by dental anesthesiologists. In dentistry, the objective of sedative management is often to achieve mild to moderate levels of sedation. Pain relief is not a major goal; rather, sedation is used as an adjunctive means of controlling the psychological component of discomfort and resistance to treatment.  However, it is important for the dentist to be aware of these considerations before employing any form of sedation, as the agents and techniques. Nathan and Bamgboye , reported that sedation will only short circuit the occurrence of non-coping behavior. Thus, sedation is advised only when behavioral strategies alone have failed or are contraindicated. It is only optimally effective when there is a rapport between the dentist and the patient. 
Avoidance of dental treatment which is related to dental fear which can be reduced by professional commitments to its alleviation . Te objective of this study is to evaluate the management of dental anxiety among Nigerian dental practitioners.
| Materials and methods|| |
This was a descriptive study carried out in 2011 among Nigerian dentists at a national conference of dentists in Abuja. The conference was a meeting point for 310 dentists from different parts of the country. A structured questionnaire was administered to Nigerian dentists who were selected randomly using a table of random numbers in an annual national dental conference. The questionnaire was anonymous. Information obtained included field of specialization, duration and place of practice, knowledge of and educational exposure to management of dental anxiety, knowledge of dental anesthesia, preferred drugs and route of administration, types of sedation and complications arising were requested.
The respondents were also asked to rate the frequency of application of the outlined dental anxiety management techniques on a 5-point Likert scale that was scored as follows: a = 1, b = 2, c = 3, d = 4 and e = 5. A total score of 2-6 indicated knowledgeable and 8-10 indicated not knowledgeable.
Data were analyzed using SPSS version 16.0 Inc., Chicago, IL, USA. The statistical significance of outcomes was evaluated at the 95% confidence level. P < 0.05 was considered significant.
| Results|| |
A total of 192 dentists were administered the questionnaires. Response rates for the different questions vary among the respondents. [Table 1] shows that 33 (17.2%) child dental health specialists managed dental anxiety more than their counterparts in the other fields. More than half (67.7%) of the dentists in our study claimed to be knowledgeable in the practice of dental anxiolysis. [Table 2] shows the proportion of respondents with formal training program on dental anxiolysis. Only 17.7% of the study population had formal training on sedation. The preferred route of administration of drug was oral (57.3%) [Table 3]. The preferred inhalational and intravascular drugs were nitrous oxide (67.7%) and midazolam (40.6%), respectively [Table 4]. The highest proportion (29.6%) of dentist seen were child dental health practitioners [Table 5].
Only 25 (13.4%) respondents reported complications including deep sedation 8 (32%), deleted reversal 2 (8%), dizziness 5 (20%), reversal failure 2 (8%), syncope 3 (12% vertigo 2 (8%) and vomiting 3 (12%). Most of the respondents, 183 (96.5%), did not practice elective intubation. Three (1.25%) of the respondents had less than 25% of intubation cases. Four (2.3%) of the respondents intubated more than 25% of their cases. Of the respondents, 125 (84.4%) believed that dental anxiolysis should not be instituted for all patients. Consent was obtained by 124 (65.5%) of the respondents before instituting dental anxiolysis on their patient.
| Discussion|| |
Majority of the Nigerian dentists who participated in the study were specialist in the child dental health. This is in contrast to the report from Illinois, USA, where majority of dental practitioners were oral and maxillofacial surgeons.  Majority of the studied Nigerian dentist reported being knowledgeable about dental anxiety questionnaire. A study carried out earlier in Nigeria among dentists observed that only 26.7% of respondents were aware of dental anxiety questionnaires and 15.1% have seen the instrument applied.  The reason for our finding might be related to improved awareness in dental anxiety. Furthermore the study populations are different being exclusively made of specialists or consultants in the current report compared to compared predominantly trainees made of residents and house officers win the previous report. 
Majority of the Nigerian dentists with formal training had no retraining program. This is in contrast to the Illinois study,  where 90% of the respondents were exposed to formal training and 80% reported recent training within the last 2 years preceding the study. This suggests that majority of the study population might have been adequately trained or retrained on dental anxiolysis.
In contrast to the Illinois study, majority of those administering conscious sedation with formal training had only basic life support training, and only few had both basic and advanced cardiovascular training. In Illinois report,  dentists practicing dental anxiolysis either had Type A or Type B permits, which regulated all practitioners who administered conscious sedation regardless of the route of drug administration. In Illinois, no permit was required for dental anxiolysis, type A permit was required for conscious sedation and type B permit was required for deep sedation and general anesthesia. The rules also mandated that annual continuing education credits should be earned in sedation/anesthesia for all practitioners with a sedation/anesthesia permit.
The most preferred route of administration of sedation drugs was oral. This is a contrast to a previous study conducted among Nigerian resident and house officers where intramuscular route was the most preferred route.  it is uncertain if this is a reflection of changes in anxiolysis practice pattern of Nigerian dentists. Oral route is non-invasive and potentially less associated with risk of viral and bacterial infection and side effects ,,
Our study shows that the interviewed dentists preferred nitrous oxide (67.7%) as their inhalation drug. This is probably because nitrous oxide inhalation is relatively inexpensive, easy to administer and amenable to control through careful titration or incremental dosing. This inhalational sedative that offers anti-anxiolytic effects with virtually no side-effects are few.  Midazolam (40.6%) was the preferred drug among the respondent.
It seems most of our respondents did not have to intubate and put patient under general anaesthesia. This is similar to the report from the Illinois study,  which reported that 94% of their respondents did not intubate.
| Conclusion|| |
In conclusion only a few of the study population had formal training on dental anxiolysis and this procedure was practiced predominantly by oral surgical and child health dentists. Oral route of administration was the preferred route and administration of anxiolytics while the predominantly used inhalational and intravenous agents were nitrous oxide and midazolam. Majority of the dentists do not believe in instituting anxiolysis for all dental patients.
| References|| |
Newman WA, Anderson DM. Dorland's Illustrated Medical Dictionary, 29 th
ed. Philadelphia, Pa: WB Saunders; 2000. p. 109.
Maggirias J, Locker D. Psychological factors and perceptions of pain associated with dental treatment. Community Dent Oral Epidemiol 2002;30:151-9.
Arthur W. Differentiating endogenous panic/anxiety disorders from dental anxiolysis. Anesth Prog 1989;36:127-39.
Weiner A, Sheehan D, Jones K. Dental anxiety the development of a measurement model. Acta Psychiatr. Scand 1986;73:559-65.
Mehrstedt M, John M, Tonnies S, Micheelis W. Oral health-related quality of life in patients with dental anxiety. Community Dent Oral Epidemiol 2007;35:357-63.
ADA guidelines for the use of conscious sedation, deep sedation, and general anesthesia for dentists. Available from: http://www.ada.org/prof/ed/guidelines/cs-guide.html. [Last accessed on 2002 Nov1].
McGoldrick P, Dejongh A, Durham R, Bannister J, Levitt J.Psychotherapy for dental anxiety (Protocol for a Conchrane Review) 2003;1:51-3.
Ofori M, Adu-Ababio F, Nyako E, Ndanu T. Prevalence of dental fear and anxiety amongst patients in selected dental clinics in Ghana. Health Educ J 2009;68:130-9.
Nuttall NM, Bradneck G, White O, Morris J, Numm J. Dental attendance in 1998 and implication for the future. Br Dent J 2001;1905:177-82.
Bailenson G. Sedative management. In: NowakAJ, editor. Dentistry for the Handicapped Patient. St Louis: CV Mosby Co; 1976. p. 253-75.
Nathan J. Managing behaviour of precooperative children. Dent Clin North Am 1995;39:789-816.
Bamgboye P. Management of the anxious paediatric dental patient. Nigerian Dent J 1985;6:56-60.
Folayan MO, Faponle A, Lamikanra A. Review of pharmacological approach to Dental anxiety. Int J Paediatr Dent 2002;12:347-54.
Parven SP. Recognizing and managing dental fears: Anxiolysis from the perspective of a dental student. J Dent Educ 2010;74:397-401.
Arigbede AO, Ajayi DM, Adeyemi BF. Dental anxiety: Investigative and management techniques often employed in a cross section of Nigerian Specialist Dental Clinics. Port Harcourt Med J 2009;3:27-30.
Hunt N, Griffiths P, Southwell M, Stillwell G, Strang J. Preventing and curtailing injecting drug use: A review of opportunities for developing and delivering 'route transition interventions'. Drug Alcohol Rev 1999;18:441-51.
Flick W, Katsnelson A, Alstrom H. Illinois dental anaesthesia and sedation survey for 2006. Anaesth Prog 2007;54:52-8.
Donaldson M, Gizzarelli G, Chanpong B. Oral sedation: A primer on anxiolysis for the adult patient. Anesth Prog 2007;54:118-28.
Foley J. A prospective study of the use of nitrous oxide inhalation sedation for dental treatment in anxious children. Eur J Paediatr Dent 2005;6:121-8.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]