Summative Case Study 2018

Student name: Kimberly Kai Qin Ng

Student number: 1503288

Mr F. is a professional in his 30s who is married and has two children aged 7 and 5.
He lives in a detached house in Guildford close to where he grew up. Mr F has had
difficulties attending the dentist for the past 10 years as he suffers from dental
anxiety. Mr F. works for a well-known finance company and his physical appearance
is an important part of his professional presence. Mr F. often feels disadvantaged in
his job due to the poor state of his teeth and thinks that others have been promoted
before him because of it. The problems with his teeth have also had an impact on Commented [NK1]: Somani et al. (2010) and Karunakaran
his family life and he hardly ever takes his family out to restaurants as he's afraid to et al. (2010) showed that people who are deemed to be
more attractive with less visible dental decay are rated as
'dribble' during dinner, he seldom smiles or holds his hand in front of his mouth more able. This may explain why Mr F experiences a
when he does, which makes him appear shy. He rarely eats foods that are difficult to disadvantage at work due to his perceived dental health.
chew, such as bread rolls or apples. His wife is getting fed up with the restrictions
on their social life.

Mr F. finds it difficult to talk about his dental anxiety: In the past, whenever he
mentioned an upcoming dental appointment and the fact that he worries about it,
his colleagues laughed at him and he feels that they think a man in his position
should not be afraid of anything, let alone going to the dentist. Mr F’s working
environment is such that only people who are ‘driven’, are competitive and are
totally determined, succeed, so to admit that he is essentially defeated by a dental
appointment is wholly incompatible with the expectations of him at work, but also at
a personal level; his feelings about the dentist are totally incompatible with the view
that he likes to have of himself. It is very important to him that none of his
colleagues suspect that he suffers from dental anxiety or that he is in anyway
different to them. For this reason, he never talks about the subject to his colleagues
even though he can't sleep the day before a dental appointment.

He's been able to have basic check-ups but hasn't seen a hygienist in years as he
finds he can't stand the high-pitch noise of the ultra-sonic scaler. On one occasion,
he was so scared during dental treatment that he was unable to unclench his jaw
and open his mouth. Now, when he does attend a dental appointment, he tries to
find a spot in the waiting room that allows him to sit as far away from the treatment
rooms as possible so as not to hear the noise of the dental equipment, which
reduces the anxiety somewhat. Whenever he hears the high-pitched sound his heart
starts beating very fast and his hands get sweaty, and on one occasion he had to
leave the dental surgery.

Commented [NK2]: This phenomenon can be explained

Mr F’s children have noticed that he does not like going to the dentist and they are
also scared of going for dental checkups. The situation has deteriorated so much
that any kind of high-pitch noise makes him feel extremely anxious. One of his
by the vicarious conditioning theory, which posits that
patients acquire fear about something after seeing others’
fearful experience of it (Carter et al., 2014). In line with that,
Mr F’s children are influenced by his fear of the dentist, and
have acquired the same fear.
children has a toy that emits a somewhat high-pitch sound and he has to leave the
room whenever the child is playing with it.
The last time Mr F. has had his teeth cleaned the experience felt extremely painful to
him. Mr F. had to wait in the dentist chair for quite some time while the hygienist
was filling in some medical forms. Mr F. got very flustered while he was waiting and
kept thinking about how painful the treatment was going to be. Before the treatment
commenced the hygienist told Mr F. that she would be using a numbing gel. Even
though the numbing agent was applied, as soon as the hygienist used the ultra-sonic
scaler, Mr F. gestured for the treatment to be stopped. He claimed that he could still
feel pain. The hygienist pointed out that she had checked carefully that the affected
areas had been anaesthetised before proceeding; however, Mr F. insisted that the
treatment was painful. The hygienist explained that the numbing gel won’t stop Mr
F. from experiencing pressure and vibration on his teeth and gums and wondered if
this was what he had experienced. Mr F. admitted that he had not known this and
that he felt very relieved – he wondered if all this time he had been unnecessarily
worried about experiencing pain when going to the dentist!
This information - the explanation of the difference between pain and pressure
perception – makes future visits to the particular hygienist much easier for Mr F. He
is less worried about the possibility of feeling pain. He is able to relax a lot more and
doesn’t even mind the ultra-sonic scaler that much anymore. In fact, he now
believes that his hygienist is someone really skilled at her job, who must know all
the secret techniques of not hurting patients, so he will only see her and no one
else.
Commented [NK3]: Mr F associates high-pitched sounds
with the ultrasonic scaler and his fear of going to the
dentist/hygienist. This can be explained by the classical
conditioning theory, demonstrated by Pavlov’s dog or Little
Albert’s rat. This is one of three pathways of fear-acquisition.
It theorises that neutral stimuli which are associated with
fearful events go on to become inherently feared (Rachman,
1997). This may be why Mr F is afraid of high-pitched sounds,
from dental or other sources, even though the sounds
themselves are not objectively dangerous or fearful.
Commented [NK4]: Preparatory information has been
found by Newton et al. (2012) to help individuals with
moderate dental anxiety. This involves providing the patient
with procedural information, sensory information and coping
information. In this case scenario, the hygienist gives sensory
information to the patient on what he would feel despite the
anaesthetic, i.e. a description of the “pressure and vibration
on his teeth and gums”. This helped Mr F with his anxiety
and this is consistent with research findings.
Commented [NK5]: Reference List:
Carter, A.E., Carter, G., Boschen, M., AlShwaimi, E. and
George, R., 2014. Pathways of fear and anxiety in dentistry: A
review. World Journal of Clinical Cases: WJCC, 2(11), p.642.
Karunakaran, T., Gilbert, D., Asimakopoulou, K. and Newton,
T., 2011. The influence of visible dental caries on social
judgements and overall facial attractiveness amongst
undergraduates. Journal of dentistry, 39(3), pp.212-217.
Newton, T., Asimakopoulou, K., Daly, B., Scambler, S. and
Scott, S., 2012. The management of dental anxiety: time for
a sense of proportion?. British dental journal, 213(6), p.271.
Rachman, S., 1977. The conditioning theory of
fearacquisition: A critical examination. Behaviour research
and therapy, 15(5), pp.375-387.
Somani, A., Newton, J.T., Dunne, S. and Gilbert, D.B., 2010.
The impact of visible dental decay on social judgements:
comparison of the effects of location and extent of lesion.
International dental journal, 60(3), pp.169-174.