THE MANAGEMENT OF FEAR &

ANXIETY IN THE PEDIATRIC

DENTAL PATIENT
 Fear
It is a response to an object or situation,
real & imaginary that indicates harm
or,
an unpleasant emotion of effect consisting
of psychophysiological changes in response
to realistic threat or danger to one’s own
existence
The physiological response is that of flight
or fight
The development of fear
 primary emotion acquired soon
after birth, with no awareness of
the stimulus producing fear
 with age, there is an awareness of
fear-producing stimuli leading to
flight/fight response
 The value of fear
 Fear is a protective mechanism for self-
preservation
 Protects the individual from harm & self-
destruction
 Can be utilized to keep the child away from
dangerous situations of either a social or a
physical nature
 Should be channeled toward dangers that really
exist, & away from non-dangerous situations
Types of fear

1.Innate fear
2.Acquired fear

Objective fear
 Subjective fear
 Objective fears
 those that are produced by direct stimulation of
the sense organs
 generally not of parental origin
 responsive to stimuli that are felt, seen, heard,
smelled or tasted, & are of a
disagreeable/unpleasant nature
 may be associative in nature
 Subjective fears
 those that are based on feelings &
attitudes that have been suggested to the
child by others about him without the
child’s having had the experience
personally
 may be acquired by imitation of fear
displayed by parents or from friends,
playmates, reading materials, radio, TV etc
 more difficult to overcome & eradicate
 Fears of the preschooler

 fear of separation from parent or of

abandonment
 fear of not having satisfied the
parent
 fear of falling, of noise, of strangers
Fears of the early schooler

 fear of the dark/staying alone

 fear of supernatural powers like

ghosts & witches, of imaginary
objects & of situations such as war
Fears of the late schooler

 fear of bodily injury (by age 9)

 fear of failure
 fear of not being liked
 fear of competition
 fear of punishment
 fear of crowds, heights etc.
Fears of the adolescent

 Fear of rejection

 Fear of performance
 Anxiety
Anxiety is apprehension, tension
or uneasiness which stems from
the anticipation of danger, the
source of which is largely unknown
or unrecognized

Anxiety = ‘fear spread thin’

Types of anxiety
 A-Trait - free-floating
 A-State – specific; arises most
acutely at a particular moment in
association with a particular event or
environment

- Spielberger, 1966
Fear vs anxiety

Anxiety
Fear

Factors determining child’s
reaction to fear & anxiety

 the degree of fear

 the ability to cope with fear

 the motivation to cope with fear

Expressions of fear & anxiety
 flight
 aggressiveness
 crying
 evasiveness
 apathy & withdrawal
 regression
 vomiting or stomachaches
 trying to suppress & hide the fear
 Causes of fear of the
dental office
 separation from parents
 unknown situation
 presence of strangers
 possibility of bodily harm
 attitude of parents or other children to
avoid the dentist
 parental threat as punishment for bad
behaviour
 PHOBIA
It is a special kind of fear that is out of
proportion to the situation, which cannot
be explained or reasoned away, is beyond
voluntary control & which leads to an
avoidance of the feared situation e.g., the
dental surgery

Phobos – a Greek god who could strike

fear into one’s enemies
Types of phobia
 Blanophobia – fear of the injection
needle