Sedation 6th Edition Malamed Test Bank

Sedation 6th Edition Malamed Test Bank

Chapter 01: Pain and Anxiety in Dentistry

Malamed: Sedation, 6th Edition

MULTIPLE CHOICE

• It is estimated that somewhere between % of the population of the United States

voluntarily avoids seeking dental care because of their fear of dentistry.

• 1 and 4
• 6 and 14
• 20 and 25
• 50 and 60

ANS: B

It is estimated that somewhere between 6% and 14% of the population of the United States voluntarily avoids seeking dental care because of their fear of dentistry. These individuals delay treatment until they are in such pain that home remedies are no longer effective. The physician/dentist will have to treat both the patients’ acute dental problem and their psychological emergency.

REF: p. 2

• According to a survey of dentists by Kahn, Cooper, and Mallenger, 57% of those responding

stated that the most stressful factor in their dental practices was

• staff management.
• financial aspects, particularly in the beginning.
• the “difficult” patient.
• mastering the technical aspects of cosmetic dentistry.

ANS: C

According to a survey of dentists by Kahn, Cooper, and Mallenger, 57% of those responding stated that the most stressful factor in their dental practices was the “difficult” patient. For many patients, fear of pain keeps the patient from seeking needed dental care until the pain, which is exacerbated by this fear, ultimately forces the patient to the dental office. Attempts to treat these patients without addressing their fear usually leads to great frustration and increased stress for the physician/dentist, and as well as an increased level of fear for the patient.

REF: p. 3

• A patient with low to moderate anxiety
• will be seen in the dental office far less frequently than the person with severe

anxiety.

• does not experience a degree of heightened anxiety as the scheduled dental

appointment nears.

• will not appear on a regular basis for scheduled care.
• would admittedly much rather be somewhere else rather than the dental office.

ANS: D 1 / 4

A patient with low to moderate anxiety would admittedly much rather be somewhere else than the dental office. These patients are much more typically seen than the person with severe anxiety. This patient, however, does experience a degree of heightened anxiety as the scheduled dental appointment nears. This apprehension over the forthcoming dental treatment does not prevent the patient from appearing in the office. They will appear on a regular basis for scheduled care because they know that avoidance of needed dental treatment will only lead to more significant problems later on.

REF: p. 3

• Which of the following choices is associated with fear rather than anxiety?
• A specific unpleasurable state of tension, which indicates the presence of some

danger to the organism.

• A short-lived phenomenon, disappearing when the external danger or threat passes.
• Arises from anticipation of an event, the outcome of which is unknown.
• A learned response.

ANS: B

Fear tends to be a short-lived phenomenon, disappearing when the external danger or threat passes. It includes a feeling that something terrible is going to happen; physiologic changes, including tachycardia, profuse perspiration, and hyperventilation; and overt behavioral movements, such as becoming jittery or shaking. Anxiety is defined by Weiss and English as “a specific unpleasurable state of tension which indicates the presence of some danger to the organism.” Anxiety tends to be a learned response and arises from anticipation of an event, the outcome of which is unknown.

REF: p. 3

• Which of the following choices correctly lists the five universal fears mentioned in the text?
• Pain, drowning or suffocation, helplessness and dependency, bodily change and

mutilation, and falling.

• Pain, the unknown, helplessness and dependency, bodily change and mutilation,

and death.

• Falling, the unknown, height, snakes and spiders, drowning or suffocation, and

death.

• Pain, heights, helplessness and dependency, bodily change and mutilation,

drowning or suffocation.

ANS: B

Most persons harbor five universal fears: fear of pain, the unknown, helplessness and dependency, bodily change and mutilation, and death. When the stress of the dental situation is superimposed onto these fears, many patients find themselves unable to successfully cope and they exhibit “dental phobia”—an irrational fear of dentistry and all that it represents.

REF: p. 4

• Of the five universal fears mentioned, the fear of _ is easily the most significant

fear harbored by the typical dental patient.

• unknown
• pain
• dependency 2 / 4

• mutilation

ANS: B

Of the five universal fears mentioned, the fear of pain is easily the most significant fear harbored by the typical dental patient. Milgrom found that patients who were not experiencing dental pain when they appeared for routine treatment fully expected that at some time during their treatment they would experience pain, and that the person most likely to inflict the pain on them was their dentist.

REF: p. 4

• The personality type will prove very difficult to manage with the use of

pharmacosedation.

• passive
• aggressive
• authoritarian
• stoic

ANS: C

The authoritarian personality type will prove very difficult to manage with the use of pharmacosedation. This individual, the “executive type,” is a “take-charge” person who likes to be in complete control of their situation at all times. Where anxiety exists and pharmacosedation is indicated, this patient will prove somewhat more difficult to sedate successfully. Authoritarian patients often prove unwilling or unable to release control of their mind to the drug(s) being used.

REF: p. 5

• According to Table 1-1 in the text, which of the following dental situations was ranked as

most fear provoking by the total group of patients?

• Dentist laughs as he looks into your mouth
• Getting in the dentist’s chair
• Dentist is giving you a shot
• Dentist holds syringe and needle in front of you

ANS: D

The statement “dentist holds syringe and needle in front of you” (4) was considered to be more fear provoking than “dentist is giving you a shot” (5) by the total group of patients.However, the high-fear patients put “dentist is giving you a shot” (4) ahead of both “having a probe placed into a cavity” (5), and “dentist holds syringe and needle in front of you” (6). So, for most patients anticipation of the injection produces more fear than the actual injection.

REF: p. 5

• Which of the following statements is true regarding management of a patient’s fear of

dentistry?

• Of the many variables that influence the pain reaction threshold of a patient,

anticipation and anxiety appear to be the most important.

• Apprehensive patients have a raised pain reaction threshold.
• The apprehensive patient will respond not adversely to stimulation that the more

relaxed patient would interpret as painful. 3 / 4

• Pain and anxiety are related linearly.

ANS: A

Of the many variables that influence the pain reaction threshold of a patient, anticipation and anxiety appear to be the most important. Apprehensive patients have a lowered pain reaction threshold. The apprehensive patient will respond adversely to stimulation that in the more relaxed patient would not be interpreted as painful. Pain and anxiety are related circularly.Ignoring fears and anxieties increases the frustration and stress of the physician/dentist and staff and increases the likelihood of stress-related emergency situations developing in the patient.

REF: p. 5

• According to Dionne, % of responders would visit a dentist more often if given a drug to

make them less nervous.

• 5.2
• 18.1
• 33.3
• 50.0

ANS: B

According to Dionne in the Unites States, 18.1% of responders would visit a dentist more often if given a drug to make them less nervous. In Canada, Chanpong found that 7.6% of surveyed responders stated they had “missed, canceled or avoided a dental appointment because of fear or anxiety.” 31.1% of the high fear group, 31.1% were “definitely interested” in sedation or general anesthesia, which would allow you to undergo dental treatment while partially or completely asleep, in a safe, controlled environment.

REF: p. 7

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