International Journal of Medical Dentistry 7 Synthesis ON PSYCHOLOGICAL DISTRESS AND FEAR OF DENTISTRY Magdalena IORGA 1 , Tudor CIUHODARU 2 1 Lecturer, Ph.D, psychologist, Dept. Behavioral Sciences, “Gr. T. Popa” University of Medicine and Pharmacy Iasi, Romania 2 Associated, Ph.D, professor, MD, “Apollonia” University Iasi, Romania Corresponding author: tudorciuhodaru@yahoo.co.uk Abstract Anxiety and fear are normal reactions in humans when situations are evaluating as being painful. In medical dentistry, anxiety and fear characterize in fact o problematic patient with special reactions during dental interventions and avoidance behavior, both behaviors having a great impact on patient’s dental health. The paper presents some DVSHFWV RQ WKH SV\FKRORJLFDO SURﾀOH RI RGRQWRSKRELFV causes and consequences of dental fear on patient’s dental health, and some considerations on psychological interventions meant at reducing anxiety and fear during dental treatment. Keywords: psychological distress, fear, dentistry, children, patient, adult. 1. INTRODUCTION The terms of dental anxiety (appreciated by self-report scales) and/or dental phobia (described by criteria present in psychiatric manuals) are often used as synonyms referring to the same problem. It is about a patient having a severe anxiety regarding dental care and a behavior pattern of avoiding dental interventions. Dental anxiety has been reported to be around 20% in population, and severe phobia (including avoidance behavior) has been related in 5% of general population. Regarding the population suffering from severe dental fear, studies are pointing some results important for identifying causes and suggesting treatments. A study of Moore et al., in which 208 patients with a high rate of dental fear were questioned, showed that 66% of them suffer from social embarrassment about their dental fear and their inability to solve this problem [1]. Anxiety and fear are probably WKH PRVW VLJQLﾀFDQW SUHGLFWRUV IRU GHQWDO EHKDYLRU PDQDJHPHQW GLIﾀFXOWLHV DQG DOVR WKH PRVW important factors in self-evaluation of pain. Dental fear leads to poor dental health and consequently reduces life quality. 2. PSYCHOLOGICAL PROFILE OF ODONTOPHOBICS Dental anxiety seems to be linked to self-pain reports. The studies focusing on the relation EHWZHHQ GLIIHUHQW NLQGV RI IHDU LGHQWLﾀHG VRPH possible components of the dental fear construct. Among them, fear about social contact, pain, mutilation and the lack of comfort determined by the closeness between doctor and patient. People who experienced pain during dentistry treatments are more likely to react as being into a painful situation again, even if there is no dental intervention. Painful situations are usually unpredictable as to their intensity, duration and consequences. Some studies focusing on pain prediction proved that underpredicted pain is followed by an increase in predicted pain, while overpredicted pain is followed by a decrease in predicted pain; accurate predictions do not lead to changes in predictions [2-4]. Such studies are important for clinical practice, where medical interventions are causing different levels of physical distress, their results proving that clinical pain is determined by the tendency to overpredict pain and is related to an avoidance behavior [5]. 6XEMHFWV ﾀJKWLQJ ZLWK VRPH VHYHUH OHYHO RI fear and continuously avoiding medical WUHDWPHQW DUH ﾀQDOO\ VXIIHULQJ IURP D EDG condition of their teeth. The worse is their teeth condition, the more intense and painful is the intervention. Anxious subjects are usually expecting more pain and fear than they experienced during dental treatments, whilst anxiety experienced during interventions seems to be the most important variable that feeds the reaction. Painful experiences will bring up memories to the surface