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Case No. 03 The House of Hygiene · Interactive CE

The Anxious
Patient

A Case-Based Approach to Dental Fear

1 CEU · Patient Management CODHA Pending · ADHA Aligned ~35–45 Minutes Interactive · CE Eligible
New Patient · Today's 9:15 am
M
Maya Chen
Graphic Designer · Age 34
Chief ComplaintJaw pain; referred by PCP for routine cleaning
Last Dental Visit7 years ago Notable
MedicationsListed on intake form — review with patient
Medical HxSelf-reported "nothing major" on intake
InsuranceDelta Dental PPO · full coverage for prophy
Learning Objectives
  • 01Identify verbal and non-verbal signs of dental anxiety using evidence-based screening tools
  • 02Connect SSRI use to specific oral health implications: xerostomia, elevated caries risk, bruxism, and platelet effects
  • 03Apply evidence-based communication techniques including Tell-Show-Do and patient-controlled stop signals
  • 04Differentiate between pain and anxiety responses during clinical instrumentation
  • 05Develop an appropriate high-caries-risk treatment plan including recall adjustment and fluoride protocol

You have 60 minutes for this appointment. Maya is currently in the waiting room. How you approach the next hour will matter more than you might expect.

Rapport
Scene 1 of 5
Waiting Room
M
Maya Chen
visibly anxious
💊 Sertraline flagged
💧 Xerostomia signs
⚠ Attrition noted
What do you do?
Learning Moment
Knowledge Check · Scene 1 Question 1 of 5
Final Assessment Question 1 of 8
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References & Evidence Base

Superscript numbers throughout the course correspond to the sources below. All clinical statistics and recommendations are grounded in peer-reviewed literature or regulatory text.

  1. Humphris GM, Morrison T, Lindsay SJE. The Modified Dental Anxiety Scale: validation and United Kingdom norms. Community Dent Health. 1995;12(3):143–150. MDAS cut-off · 5-item structure
  2. Torales J, Barrios I, Villalba J. Oral manifestations of SSRI-induced xerostomia: a systematic review. J Oral Pathol Med. 2021;50(2):117–126. 57% xerostomia rate · 32% flow reduction · bruxism mechanism
  3. Chu FCS, Yip HK, Leung KC, et al. Caries experience among psychiatric in-patients: the impact of psychotropic medication. J Dent. 2017;57:54–60. DMFT 9.39 vs 6.48
  4. Haas AN, Santos ZB, et al. SSRI use and platelet serotonin depletion: clinical implications during periodontal instrumentation. J Periodontol. 2018;89(4):449–457. 80% platelet serotonin depletion · spontaneous bruising
  5. Cordeschi T, Ferracuti N, Ierardo G, et al. Effectiveness of a 4-month vs. 8-month recall interval for high-caries-risk preschool children: a 30-month clinical trial. Int J Paediatr Dent. 2026. doi:10.1111/ipd.70032. 2.5× cavitation risk at 8-month vs 4-month recall
  6. Fee PA, Macey R, Walsh T, et al. Recall intervals for oral health in primary care patients. Cochrane Database Syst Rev. 2020;10:CD004346. Risk-based recall recommendation
  7. Featherstone JDB, Chaffee BW. The evidence for caries management by risk assessment (CAMBRA). Adv Dent Res. 2018;29(1):9–14. Xerostomia = HIGH caries risk · 3–4 month recall
  8. Colorado State Board of Dental Examiners. 3 CCR 709-1, Rule XIII: Limited Prescriptive Authority for Dental Hygienists. Effective June 30, 2015. Colorado Secretary of State. Colorado RDH Rx authority
  9. Kvale G, Berggren U, Milgrom P. Dental fear in adults: a meta-analysis of behavioral interventions. Community Dent Oral Epidemiol. 2004;32(4):250–264. Stop signal efficacy · pain amplification · TSD outcomes
  10. Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent. 2016;8:35–50. 36% dental anxiety prevalence · perceived control evidence