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Paediatric Dentistry$
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Richard Welbury, Monty S. Duggal, and Marie Thérèse Hosey

Print publication date: 2018

Print ISBN-13: 9780198789277

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780198789277.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2022. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use.date: 01 July 2022

Management of pain and anxiety

Management of pain and anxiety

5 (p.67) Management of pain and anxiety
Paediatric Dentistry

M.T. Hosey

G.J. Roberts

Oxford University Press

Pain and anxiety are natural physiological and psychological responses. Pain is a direct response to an adverse stimulus that has occurred; anxiety is the unpleasant feeling, the worry that something unpleasant might occur. Pain and anxiety are often intertwined, especially in the dental setting. The best way to manage child dental anxiety is to avoid its occurrence in the first place through prevention of dental disease, good behaviour management, pain-free operative care, and treatment planning that is tailored to the needs and developmental stage of each individual child. These issues are detailed in the previous chapters. This Chapter specifically focuses on pharmacological pain and anxiety control and explores the roles of conscious sedation and general anaesthesia (GA) as adjuncts to behaviour management. A child’s perception of pain is subjective and varies widely, particularly with age. Infants up to about 2 years of age are believed to be unable to distinguish between pressure and pain. Older children begin to have some understanding of ‘hurt’ and begin to distinguish it from pressure or ‘a heavy push’. It is not always possible to identify which children are amenable to explanation and will respond by being cooperative when challenged with local anaesthesia (LA) and dental treatment in the form of drilling or extractions. Children over 10 years of age are much more likely to be able to think abstractly and participate more actively in the decision to use LA, sedation, or GA. As children enter their teenage years they are rapidly becoming more and more like adults and are able to determine more directly, sometimes emphatically, whether or not a particular method of pain control will be used. The response is further determined by the child’s coping ability influenced by family values, level of general anxiety and intelligence. There is a strong relationship between the perception of pain experienced and the degree of anxiety perceived by the patient. Painful procedures cause fear and anxiety; fear and anxiety intensify pain. This circle of cause and effect is central to the management of all patients. Good behaviour management reduces anxiety, which in turn reduces the perceived intensity of pain, which further reduces the experience of anxiety.

Keywords:   anxiety, chloral hydrate, day surgery, endotracheal intubation, flumenazil, general anaesthesia, hypnotic suggestion, ibuprofen, ketamine, laryngeal masks, midazolam

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