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Behavior change is a very important concept in the overall management of patients who do not listen to the advice given by healthcare professionals, they are described as being non-adherent, but also anxious patients such as Mr. F. The hygienist used behavior change techniques (BCT) shaping knowledge from the BCT cluster described by Michie et al., (2012), by informing Mr. F that ‘the numbing gel won’t stop Mr. F from experiencing pressure and vibration’. This small adjustment of engaging with Mr. F and explaining to him what he should expect, instead of carrying on with the treatment already had a positive influence on his outcome, as he is now less worried about the possibility of feeling pain. This improvement in Mr F’s behavior can further be implemented by setting SMART goals, in order to help him to look after his oral health. Doing will mean that in the future Mr. F may not be required to visit the hygienist as regularly, therefore he might eventually have a positive outlook on the dental setting. SMART goals must be specific (e.g. interdental cleaning at least once a day), measureable, accurate, realistic and time-specific. Any barriers that would prevent him from achieving this behavior must be addressed and a plan must be put in place so that if these barriers do occur then he would know how to get back on track.
Dental anxiety is a very common phenomenon which approximately 25% of the population experience. Anxiety is described as ‘a vague, unpleasant feeling accompanied by the thought that something undesirable is about to happen’.
The manifestation of anxiety can have cognitive components which are observed in Mr. F’s behavior, as he cannot sleep the day before a dental appointment. Classical conditioning which was described by Pavlov’s experiment on the salivation of dogs in association with ringing a bell, is useful in explaining why Mr. F is afraid to see the hygienist and has not seen them in years. Mr. F has formed an associative relationship between the high pitched sound of the ultrasonic and pain. Therefore, it has been conditioned into him that every time he goes to see the hygienist he will experience pain. This is exhibited by his heart starting to beat ‘very fast’ at the sound of the ultrasonic. Mr. F’s anxiety has even been relayed over into his personal life as he has to leave the room whenever his child is playing with a toy the makes the similar high pithed noise.
Being judged by others, especially people we are surrounded by on a daily basis can have an impact on our psychological state of mind. Mr. F believes that his physical appearance plays a huge role in his job and that his colleagues have been promoted ahead of him due to the appearance of his teeth.
Studies have shown that the general public associate poor dental condition to poor social performance and intellectual ability. Mr. F’s colleagues laughed at him for worrying about his upcoming appointments. The fundamental attribution error explains that ‘people tend to attribute others’ behaviors to their own dispositional qualities rather than situational factors’, therefore, not being about to understand the underlying reasons as to why people such as Mr. F exhibit these behaviors. Instead of being supportive they are being critical of Mr. F’s behavior, making Mr. F not want to express his feelings with them in fear of being judged ‘he never talks about the subject to his colleagues’. Keeping these negative feelings to himself and not being able to console in someone may make his dental anxiety worse.
Conformity is the tendency for groups of people to give into the pressures of social norm. In Mr. F’s household the children are very young (5 and 7 years old), so in their eyes their father’s anxiety about going to the dentist may appear to be normal. Hence why they are also afraid of going to the dentist.
Vicarious conditioning could have contributed to the reason for the children being afraid of the dentist. Hearing about the traumatic experiences that their father has experienced has conditioned the children to have a similar behavior. Research has shown that anxious children are more likely to have parents or relatives who are also anxious about going to the dentist.
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